Therefore the rules are too tight

Only one in 1,000 people is truly ‘heart healthy’, according to doctors examining lifestyle guidelines.

Given that it is very much less than 999 out of 1,000 who keel over from heart disease we might therefore conclude that the rules being used to define \”heart healthy\” are a little too tight.

16 thoughts on “Therefore the rules are too tight”

  1. He’s talking about risk, not certainty. Perhaps one in a thousand Englishmen will die of a heart attack before the age of 65 – not really much of a risk, unless the one turns out to be you. But the risk (he says) is zero if you’re in the “heart healthy” category.

  2. SBML is right: what matters is all-cause mortality.

    Anyway, why suppose that lessons that apply to fewer than 1 in a thousand must generalise to the masses? Maybe the 1 in a thousand are odd fish.

  3. The risks of congestive heart failure, stroke, and cancer will be lower for “heart healthy” people too. But the risk of being run over by a bus while out running will be higher.

    Tim’s demand that the proportion of people deemed “heart healthy” should be equal to the proportion of people who don’t die of heart disease is illogical. We know about risk factors, not the fate of individuals.

  4. I’ve buried seven family/friends in the past 20 years. None lived “unhealthy” lives. Three died from cancer (bowel and pancreas). Three died from or suffering with various types of dementia. All suffered a lingering death, some for a decade or more.

    The exception was my father. Aged 88 and fit, he complained of feeling unwell, took himself to bed and died of heart failure.

    When the medics come up with a sure-fire method for a long and healthy life, followed by a quick and painless exit, I’ll pay attention. Until then, how are you planning for your own death?

  5. I would translate that as pay us more(for monitoring and probably intervention) and recognise our infinite wisdom.

  6. @ PaulB
    The risk of being run over by a bus while out running is utterly negligible (unless you are a slow London office worker doing it in the lunch hour and there the biggest risk is a bicycle courier): I assume you mean a Volvo or 4×4*.
    What you should be moaning about is the fact that the risk of dying from a heart attack when “heart-healthy” is non-zero. Many years ago I did an analysis of the London Marathon after its first death and found that the mortality rate was a very small percentage of that one would predict for three** hours in the lifetime of that many individuals using the age distribution of the runners. More recently there was an academic study of marathons and half-marathons in the USA showing that the highest risk of death was not for those stupid middle-aged guys who tried to run a marathon or half-marathon overweight and without enough training who were almost invariably revived by medics but the few healthy fit guys who had an unrecognised heart defect.
    Either Professor Jean-Pierre Després is being misquoted or he over-simplified, leaving himself open to misinterpretation. The chances of a lethal heart-attack for those meeting all the seven conditions are NOT zero.
    * One of my friends, while carrying a lantern so that drivers could see and avoid him on unlit roads, was hit by a woman driving her husband’s 4×4, breaking his right arm: she said she was sorry, she had misjudged the width of the car!
    ** most people take more than three hours, so that was being conservative.

  7. Sorry, but that lots complete & utter bollocks. Just because few people die running actually marathons doesn’t mean that the training for & competing in marathons doesn’t cause damage. Humans aren’t evolved to run 26 odd miles. Or play tennis or ride bicycles.
    The whole thing’s a balance between the minimum of exercise that keeps the body healthy & preferred lifestyle. Straying either side has consequences.
    “Until then, how are you planning for your own death?”
    Gunshot wounds in someone else’s wife’s bed sounds good.

  8. BiS: this is where you run into the Monkey’s Paw problem. More specification required. At the moment, David Mills’s wife’s bed is an option, and one of the many that a vengeful deity might consider…

  9. John77: I hope I wasn’t moaning about anything, just trying to present a balanced view of the risks. The bus was synecdochic for motorized vehicles in general.

    I suppose the Professor was using “heart attack” rather narrowly to mean “myocardial infarct caused by coronary thrombosis”, not including cardiac failure related to hypertrophic cardiomyopathy. I agree that what he said is open to misinterpretation.

    You might want to check your calculation on the London Marathon mortality rate, which is badly wrong.

  10. @BIS… “Great minds..” etc.

    I’m planning on being shot in the back by an outraged husband at the age of 87.

  11. @ bis#10
    There are serious anthropologists who argue that humans evolved to run down game (which are significantly faster over short distances) until they are worn down by exhaustion. [The bow and arrow is a quite recent invention.]

  12. @ PaulB
    I said that I did the calculation several years ago – I cannot remember exactly how many but not long after the first death so presumably in the early or mid-90s well before the recent jump in mortality (3 in 6 years, the latest one of which was due to a drug unintentionally taken). The reference below shows that there was only one death in the first ten years and only five before the millennium. The higher death rate up to and including 2003 (after which there seems to have been a four-year gap, so this was a peak rate) was at a normal level. It follows that any calculation done in the early 90s would show a sub-normal death rate, half or less of the norm *before* you adjust for the large number of veteran runners who gain admission – after adjusting for the age profile the difference is even greater. My calculation was NOT wrong but is now out-of-date. If there have only been 3 deaths in 9 years since 2003 the the overall death rate before adjustment must now be a little rather than a lot ( and the adjusted rate significantly but not vastly) below average.
    http://www.pponline.co.uk/encyc/london-marathon-what-we-know-about-the-incidence-of-injury-illness-and-death-in-the-london-marathon-881

  13. There were just under 200,000 finishers in the 11 years up to 1991, when the first death occurred. Scaling that up from 3 hours to a year gives an annual mortality rate of about 1.5%. I don’t know the age and sex distribution of marathon runners, but for comparison the (all-cause) mortality rate for 50-year-old men in the uk in 1991 was about 0.17%.

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