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by brandonb·12y ago·view on hn ↗
Hey HN!

This project was inspired by a personal experience I had--I put my numbers into a spreadsheet provided by the American Heart Association and found I had a 50% lifetime risk of a heart attack. Yikes!

I've gone to regular check-ups all my life and always been a little outside of the cholesterol guidelines, but I never knew how seriously to take that. I didn't know you could translate those numbers into percentage chance of getting a heart attack, whether I was "high" or "low," or how much I could improve by making lifestyle changes.

I figured there must be other people out there who are similarly ignorant about their own health, so I built this. (Please don't take this as a substitute for going to the doctor; there are all sorts of things your doctor can tell you that a web page can't. This is just for education!)

Please let me know if you have questions!

6 comments
I've never really understood what life time risk means...

Does 50% mean I'll get a heart attack in my 40s, or mean I'll get one in my 80s instead of getting cancer, etc.

What I'm getting at is that if nothing else kills you, eventually your heart will fail. Shouldn't it be possible to decrease my heart attack risk by increasing my cancer risk?

These models often compensate for competing risks of death—if you're curious, look up "Cox proportional hazard" to understand some of the math behind this.

Your meta point is a good one—I would like to see a model that predicts either your total lifespan, or probability of living to (say) 80 years of age heart attack-free. Perhaps I'll try to get access to the raw Framingham data and build a model to do that.

(For this particular page, I just bootstrapped from the existing medical research, which, while it has its limitations, has at least been thoroughly studied.)

For those purposes, do you know how smoking marijuana maps to smoking cigarette? E.g. is 1 "dose" of pot = 1 cigarette? 10 cigarettes? Or does it not map at all?

What about electronic cigarettes?

Real life doctor here. Your question sounds simple, but the answer is complex. The heart disease risk from smoking probably stems from damage to blood vessels caused by toxins generated in the tobacco burning. "Toxins" is really the best word here, even though it's so general. I use it to encompass thousands of different chemicals like free radicals, known carcinogens, etc.

Current thinking is the body repairs that damage with clots and cholesterol. But, these repairs accumulate over time to occlude a blood vessel (atherosclerosis). If red blood cells can't get through, oxygen can't either, and heart cells downstream to the occlusion will die in minutes to hours.

Marijuana most likely generates a significant amount of toxins as well. However, marijuana smokers generally smoke less than cigarette smokers. Given that heart disease and cancer risk increases with the amount smoked, it would be reasonable to assume marijuana smokers are much less at risk (though the risk is nonzero). But, we don't have a clear conversion between marijuana and cigarette smoke yet. You may also consider that marijuana may be contaminated with other plants or chemicals.

Electronic cigarettes are possibly more safe than non-e cigarettes in terms of cancer risk (this is theoretical as no significant study has been done yet). However, some in vitro (cellular) research suggests nicotine may play a role in atherosclerosis discussed above. Also, nicotine can precipitate a heart attack if a heart is already diseased.

Just want to point out that a cursory search says marijuana deposits about 4x the amount of tar in the lungs as tobacco.

Unless it contributes to increased addiction, the manufacturers generally try and reduce the unhealthy components of the cigarettes - making them more palatable and keeping the addicts alive for longer so they can make more money off of them. There's really no such effort with marijuana as it stands today.

I'm totally unqualified to make this statement, but I'd venture a guess that most of the 'toxins' that are natural byproducts of combustion - not just the tar - are present in significantly higher amounts in marijuana.

Sticking to the 4:1 ratio, someone who smokes 5 joints a day is basically a pack a day smoker.

> Current thinking is the body repairs that damage with clots and cholesterol

does this imply that if there's very little damage (due to inflammation or substance abuse) elevated cholesterol doesn't really matter?

Damage accumulates with normal wear and tear, giving more chances for atherosclerosis to form. Cholesterol matters in otherwise healthy patients particularly as they age.
> free radicals

Are these are thing again? I was under the impression that it was 80's nonsense that's been debunked.

Free radicals are parts of a chemical structure that are unpaired and therefore super reactive. The reason they are linked to cancer is they can easily form bonds with molecules that they shouldn't be bonding with and cause crazy things to happen.

See http://en.wikipedia.org/wiki/Radical_(chemistry) for more detail

Also: "Marijuana may cause low blood pressure". [Source: http://www.mayoclinic.org/drugs-supplements/marijuana/safety...]

And, of course, blood pressure is one of the four numbers.

I think that the main cause of heart attacks is high blood pressure. Therefore smoking weed might be beneficial for people with heart attack risks.

(However if someone already have low blood pressure it might be dangerous for them)

Pot itself has no known health detriments. Smoking marihuana, however, does impart some of the risks of smoking, but not nearly the same. I don't know if it's possible to reach the same level of damage to your lungs with pot as you would with cigarettes.
> Pot itself has no known health detriments

You can't say this. There's a possibility that cannabis causes mental health problems in some people who don't have underlying disease. There's a stronger possibility that cannabis triggers mental illness in people who do have underlying disease but who would not otherwise have had an episode.

It is irresponsible to suggest that cannabis is harm free.

People like you do great harm to campaigns that aim to legalise drugs. Please stop.

Your response has the same logic that living gives you cancer. In all my years of medicine I have not seen this clear link you establish between mental illness and marijuana. I'd be very interested in learning more about it, if you have some resources for me to look at it.

I did not suggest that cannabis is harm free. I stated we cannot explicitly identified marijuana as the cause of illness.

How am I doing "great harm" to campaigns aiming to legalize drugs? (That's an honest question, I'm not quite processing your viewpoint on my argument, and am actually interested in your response.)

> I did not suggest that cannabis is harm free. I stated we cannot explicitly identified marijuana as the cause of illness.

Yes you did - using phrases like "there are no known health risks" you dismiss all the evidence we have that cannabis can cause harm.

Here's just one link, but there are many other reputable sources. This one discusses lung health.

http://www.nhs.uk/news/2012/06june/Pages/cannabis-lung-healt...

> The report says that the constituents of cannabis smoke are similar to those of tobacco smoke apart from the presence of THC (which is only in cannabis) or nicotine (which is only in tobacco). This means that cannabis smoke has the same carcinogens (substances that cause cancer) as tobacco smoke, although concentrations of these may be up to 50% higher. Like tobacco, cannabis also contains toxic carbon monoxide

Saying that this is equivalent to "no known health risks" is intellectually dishonest.

Unless he edited, he didn't use the phrase "there are no known health risks"

The phrase used was "no known health detriments", by which I believe he meant a direct causal link, such as with cigarettes and lung cancer.

I did not edit, and that is precisely what I meant. Thank you.
He did say "no known" detriments and from all I've read and heard, that remains true. There's correlations and linkage suggestions flung all around in the medical industry, but until proven, I think it's perfectly alright to say "no known" whatever.

Besides the patronizing of the parent post, I do think your argument is valid. Mostly since you use the phrases "stronger possibility." But again, without clinical proof, your argument is only as good as parent's.

In fact smoking marijuana causes extremely harmful effects in the brain:

http://www.northwestern.edu/newscenter/stories/2013/12/marij...

"Teens who were heavy marijuana users -- smoking it daily for about three years -- had abnormal changes in their brain structures related to working memory and performed poorly on memory tasks, reports a new Northwestern Medicine® study."

"The brain abnormalities and memory problems were observed during the individuals’ early twenties, two years after they stopped smoking marijuana, which could indicate the long-term effects of chronic use. Memory-related structures in their brains appeared to shrink and collapse inward, possibly reflecting a decrease in neurons."

> Smoking marihuana, however, does impart some of the risks of smoking, but not nearly the same. I don't know if it's possible to reach the same level of damage to your lungs with pot as you would with cigarettes.

Why not? Also, aren't marijuana cigarettes unfiltered, unlike tobacco?

The filters wouldn't make a difference here, since it's the toxins rather than the temperature doing the damage.
> The filters wouldn't make a difference here, since it's the toxins rather than the temperature doing the damage.

I'm confused by the answer: Cigarette filters don't filter toxins? And they do reduce temperature?

The toxins in cigarettes are the danger. Filters do little to stop the damage caused by toxins in cigarettes that simply don't exist in marijuana.
Cool tool, I like the simplicity. Just a bug, if I scroll back up and update the numbers/recalculate, the text changes but the graph does not.
Just wondering how you protect the data? I don't super care, and I almost care more about my email than I do about the numbers.
This app runs on Heroku, so it inherits all of the security controls described here: https://www.heroku.com/policy/security
Is there anything like this that uses ABSI or some other BMI alternative?
This. I am constantly being tagged as overweight and high risk because of my BMI (5'10" and 175-180lbs but I am very active and the weight is from muscle rather than fat).
There are three flaws with BMI:

• BMI over-estimates obesity in athletes

• BMI under-estimates obesity in fat people

• BMI over-estimates obesity in tall people.

You claim to be "very active" so you might want to try other more accurate measures of body fat.

(Although 5'10 at 175 is higher end of normal and probably isn't worth worrying about if it's stable (lol archaic units))

I haven't seen one yet, but I highly recommend knowing your cholesterol numbers since those will give a much more accurate result--both BMI and ABSI are very coarse-grained measures of what's likely to be happening inside your arteries.
So now I'm curious; I'd always thought obesity was itself a risk factor, but your calculator does not consider it.

Is the "problem" with obesity only its impact on blood pressure and cholesterol? Or does obesity also increase risk in other ways in addition to worsening those factors?

Obese by what metric?

BMI is archaic and a "one shoe fits all" metric. That doesn't mean that BMI is wrong - just that you should do more detailed diagnoses with your doctor to determine your health.

If BMI is saying you're obese, then get a comprehensive metabolic panel and lipid panel with your PCP, and go from there.

Obese by what metric?

The back-and-forth of this discussion about BMI is entirely predictable, but doesn't it sort of miss the point? Isn't it possible -- and I mean this sincerely, even though it's wildly simplistic -- to just look at a human and determine if they're carrying around excess fat?

A lot of times when I hear people saying that BMI doesn't account for how much they exercise, I'm looking at the person saying it and they appear unfit. On the other hand, do we need BMI to tell us that a fit person is fit? What am I missing here?

If they are morbidly obese, sure. For those who are questioning if they are obese and have health issues, a visual inspection isn't competent.
BMI is itself fine for my line of questioning, because I'm curious as to whether excess quantities of fat impact cardiovascular risk in the general case. Determining things like this is exactly the use case of BMI, since across large sample sizes it is a reasonable proxy for what we are really interested in (i.e. how much excess fat the participants have).

Mainly: I'm curious mostly about whether excess body fat on its own impacts cardiovascular health, or whether it does so only indirectly by increasing the risk factors this calculator uses.

Obesity seems to impact long-term cardiovascular health only through the other numbers--i.e., raising your blood pressure and lipids. In the Framingham 30-year risk study (http://www.ncbi.nlm.nih.gov/pubmed/19506114), they tried adding BMI to the risk model, but it didn't add any predictive value. But they used it to create a very approximate risk model for people who don't know their biomarkers.

Also note that you can appear perfectly thin, but have high blood pressure and cholesterol, and thus be at risk! So know your numbers. A lot of health is only revealed by what's going on within your body.

Doesn't matter, you still fit into many of the same statistical categories as other people listed as overweight by BMI. It is unlikely your muscle mass is solely responsible for you being listed as overweight
is this really case even if you're like 10-15% body fat? in that case, wouldn't your muscle mass be solely responsible for being listed as overweight?

Darren Sproles is 5'6" 190lb. Does he really fit into the same statistical categories as other people listed as overweight by BMI?

This is really just a spreadsheet still with a graph at the end. Would be more valuable if you actually show the ways to raise your HDL, and how to lower blood pressure, etc. Perhaps grab some data from some reputable health websites.
Did you try the "Lifestyle debugger"? It's on the results page, below the graph and its explanation.
Is there any way to get to that without entering the 4 numbers? I don't have my last cholesterol stats in front of me, but I'm still curious to see what suggestions it makes.

It doesn't seem productive to hide away the advice part of it; and in particular it would be sensible to at least hint that there's more than just a risk percentage to come after you enter the 4 numbers (which, let's face it, most people won't know off the top of their heads!).

...

Okay, I got through with faked numbers; I just put 150, 60, and 120. Note: the results aren't all updated correctly if you change the numbers at the top and recalculate. E.g., this line in particular has different numbers than the rest: "You're doing pretty well! Your risk of heart disease is 18%. With ideal risk factors, your risk would be 18%."

My main complaints about the results:

There's no obvious reason it should to demand my email address before it'll share advice on how to improve my health (on whatever figure happens to be too low/high).

From the page: "First, enter your email. We'll use it to send you a copy of your report and follow up on the actions identified. No spam."

Eh... This sounds too much like I'm about to hit the part in the funnel where they start trying to sell me something. Right? "Enter your email for the free whitepaper" means "sign up for our sales email stream".

I wouldn't have any use for a copy of the report buried in my email history; if they actually want me to keep a copy for reference, that's what a PDF download is for.

Followup on the actions suggested sounds like a potentially useful feature which would legitimately need my email -- but right now, I don't yet know what kind of advice it's going to give (what if the next page reveals that it's hawking AcmeCorp Super-HDL-Booster Supplements?), I don't know if I want followup before they explain what that would entail, and so this is where I stop.

The visible front of the website is also actively anonymous -- the page is copyright "Heart" (?), all contact info even in the privacy policy is anonymous (just this domain name and a PO box). The PP itself is clearly boilerplate edited to match the site (including some odd errors; e.g., I caught this near the top: "We implement a variety of security measures enters, submits, or accesses their information to maintain the safety of your personal information.") -- so it talks about purchases, but I'm not sure that reveals anything at all.

But I really do think it's important to connect online efforts with real people. If this is a spare time project intending to help other people, great; take credit for it! -- to be straightforward that it's not provided by a doctor (okay), but also that it's not provided by a shady snake oil company that's redirecting you into its sales funnel.

I notice the creator is hiding, and I immediately want to know why.

Try the next step about Debugging your life. Had solid recs.