Interesting. I don’t think we should underestimate that the effect on people and their families was on average extremely different though:

In the UK and France losing your job is tough, but your family still has health care, your kids can still go to good colleges (and good earlier education), there is still elder care for your parents and you’ll still be somewhat ok when you retire and so on.

In the US losing your job without being able to find a new one could often mean that your life is at least partially f*cked with respect to being able to keep your kids in good schools, help them go to college, have good health care for your family, support your aging parents and remain on a path to a decent retirement. Higher percent of Americans likely lost their homes, etc.

Also, in France and the UK peoples’ identities and lives are less equal to and centered around their careers compared to how it is in the US.

So the psychological stress, etc was almost certainly fundamentally worse and more intense for the average person and family in the US from the financial crisis, Great Recession and their wake.

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I’m skeptical. I’d like to see data. One proxy I could find is the suicide rate increase and it was actually higher in the EU vs the US (identical to Canada):

In the EU, there was a rise in the suicide rate of 6.5 % above past trends in 2009. In Canada, suicides rose by 4.5 % between 2007 and 2009. In the USA, suicides rose by 4.8 % between 2007 and 2010.
Source: Mental health outcomes in times of economic recession: a systematic literature review 2016

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Suicide is very tricky. Actually can go up when people “have more time/ability to “be depressed”” vs “fighting for their families survival”.

The data during that specific period is also difficult to understand since before the Great Recession suicides were going up in the US but down in Europe so the background noise was complex for that “natural experiment.

Still, having said that - countries with best/largest social security nets like Sweden and Austria did NOT have an increase in suicides during the Great Recession

Looking to recent history, two countries have previously broken this link: Sweden, between 1991 and 1992, and Finland, between 1990 and 1993, both experienced substantial rises in unemployment concurrent with reductions in suicide.
Reference Stuckler, Basu, Suhrcke, Coutts and McKee
1 In the present recession, Sweden again exhibited no marked increase in total suicide rates.

Economic suicides in the Great Recession in Europe and North America | The British Journal of Psychiatry | Cambridge Core?

Some other quick things from papers on the general topic

We comprehensively review empirical literature examining the relationship between the Recession and mental and physical health outcomes in developed nations.

Overall, studies reported detrimental impacts of the Recession on health

Macro- and individual-level employment- and housing-related sequelae of the Recession were associated with declining fertility and self-rated health, and increasing morbidity, psychological distress, and suicide

Health impacts were stronger among men and racial/ethnic minorities.

***Importantly, strong social safety nets in some European countries appear to have buffered those populations from negative health effects. ***

In the United State (U.S.), the Recession disproportionately impacted already marginalized populations. Non-Hispanic blacks (NHB), Hispanics, and those with less than a college education suffered disproportionately high unemployment compared to other groups, due in part to their greater representation in the hard-hit construction and manufacturing industries [7, 8]. Availability of subprime credit and discriminatory lending also led to higher foreclosure rates for NHBs and Hispanics and in poor and minority communities [9].

Exposure to labor and housing market recessionary factors may have differed substantially across nations due to social, political, or cultural differences [4].

The effect on health is thus likely to vary across countries based on demographic trends, social safety nets, and healthcare systems.

The housing crisis appears to have had a detrimental impact on mental health—above and beyond impacts related to unemployment or financial strain—particularly in the U.S.

Importantly, stronger safety nets in some European countries may have buffered their populations against negative health impacts of the economic downturn or limited the widening of inequalities, a finding with strong policy implications for the U.S. [44, 91].

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Let’s say the cause of the increased crude CVD mortality rate in the US is the 2008 crisis:

  • Why would the age-standardized rate still be declining in the US?
  • Why would the crude one still be increasing despite the crisis being over?
  • Why nothing happened during the previous recessions (2001, 1990, 1981)?

Per ChatGPT:

This graph clarifies that within age groups in the US (especially the 70+ years group), the cardiovascular death rate continues to decline steadily, even after 2010. Therefore, the increase in the crude cardiovascular death rate since 2010 cannot be explained by worsening health within specific age groups.
Instead, the rising crude death rate is primarily due to demographic shifts—specifically, a larger proportion of the population entering older age categories (70+). This demographic change leads to an overall increase in cardiovascular deaths in the general population, even though each age group’s individual risk is decreasing.

QED

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You are trying to create a straw man and say that is said something I didn’t

I just said that heart attacks and strokes while in the medium and long run are due to a whole range of important things - in the short run can be pulled forward in time by severe stress (as the Great Recession and Covid are pandemic created).

Macro version of

Heart attacks increase by ~24% on the Monday after spring daylight savings time shift compared to other Mondays.

https://www.bmj.com/content/348/bmj.g3640

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Breathe in, breathe out, and chill out. We’re just discussing the cause of the increase of the CVD mortality crude rate and it seems that’s it’s not the economics but then… What can it be? :man_shrugging:

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I think if the entire population started taking Bempedoic Acid + Ezetimibe (BA+EZ) after the age of 30, or if their LDL was above 70 (which is probably the same cohort), we’d have a dramatic drop in cardiovascular disease the likes of which no one has ever seen before.

For some reason though, most medical systems seem to be OK with letting their populations develop CVD in their 70s, having stents and heart operations, or suffer from heart attacks and strokes. This is their ‘Normal’ outcome and why cardiovascular disease is the number 1 global killer of man.

To me, it seems that an easy daily pill of BA+EZ could be provided for everyone at a cheap cost (bulk production of 8 billion a day). Companies could make a larger profit due to volume and governments could save on costly medical treatments. Even if doctors just prescribed it to everyone over the age of 30, or for anyone with an LDL over 70, the effects would be massive. I guess it’s up to us to spread the word and take matters into our own hands. I only wish I had found out about this when I was 30. Except BA+EZ didn’t exist back then.

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I’m not the guy you asked, but the answer is like HFpEF. From hypertension and terrible metabolic health.

THANK YOU. Well said. This drives me crazy too. For example, in the UK, you can’t get a PCKS9i until you’ve had a heart attack. It boggles my mind. I have familial hypercholestrolemia and UK doctors just sorta shrug their shoulders and say “yeah but you’re young”. And I say “yeah but I’m building plaque right now”. They basically see it like “something had to kill you, so it might as well be this” ignoring the fact that if I have a heart attack, then the NHS would be paying for all sorts of expensive interventions to keep me alive. Total failure of preventative medicine.

We have to abandon this idea that LDL-C of anything higher than 70mg/dl is “normal”. As you said, the “normal” outcome of the status quo is a heart attack at 70-75, heart failure for your last few years and death before 80. That’s nowhere near good enough.

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Paywalled paper:

https://www.mayoclinicproceedings.org/article/S0025-6196(25)00075-8/abstract

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Edit: the graph in the preview doesn’t really show the conclusion. The conclusion is that combination therapy is better than statin monotherapy.

Glad I’ve smashed my own LDL-C to lower than 40 mg/dl. If only I can do the same for Lp(a) soon!

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It looks to me like most of the effect is driven by Lee et al, which looks like a cohort study.

The largest analysis to examine the best way to lower levels of “bad” cholesterol in patients with blocked arteries shows that they should immediately be given a combination of a statin and another drug called ezetimibe, rather than statins alone. This could prevent thousands of deaths a year from heart attacks, strokes and other cardiovascular diseases.

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If it was done early it would be millions of deaths every year.

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The age-standardized change is flat, doesn’t that suggest that there has been no increase?

Prof. Banach said, "Cardiovascular disease kills around 20 million people a year worldwide. Based on our previous analysis, we estimate that if combination therapy to reduce LDL-C was included in all treatment guidelines and implemented by doctors everywhere for patients with high cholesterol levels, it would prevent over 330,000 deaths a year among patients who have already suffered a heart attack, and almost 50,000 deaths alone in the U.S.

This is cause enough to advocate for Ezetemibe + statin.

Start everyone on EZ+statin early before they have developed plaque and save 20 million people a year worldwide. This should be a no-brainer, but for some reason it isn’t.

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No increase in CVD deaths in any age group, so why would it be HFpEF? It’s most likely just aging population (more people >70yo => higher share of CVD deaths vs other causes of deaths)

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The effect on all-cause mortality (OR, 0.81; 95% CI, 0.67 to 0.97; P=.02) is insane! Ezetimibe :muscle:

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You said it. Specifically, “Now, we’ve basically used up the benefits of the improved treatment and the deaths are catching up again.” Though I know you’re going to try and weasel your way out of this.

So a better question is, "what happened in who were turning 40 in 2010 (i.e. those born in 1970).

I don’t find this convincing as an explanation for the sharp reversal in the mortality rate in 2010.

I wouldn’t be looking at what happened in 2010 that suddenly caused a bunch of deaths.

When you see a large change in the mortality rate, you should absolutely look first at the surrounding social or economic or disease factors - unemployment, war, covid, etc.

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I don’t need to weasel because what I wrote is still true. If you interpret that as “we are getting worse at treating CVD” then that’s entirely a problem with reading comprehension.

I am reporting what the authors of that statistical analysis study (where the graph came from) and the president of the AHA said when he presented those data. He talked about better AMI therapy (reperfusion), better cholesterol management, smoking cessation as contributing to the decreases, and HFpEF, diabetes contributing to the increase. The sex difference narrowing is because in the 1990s and early 2000s massive efforts were put into educating doctors that women have hearts and get heart disease too.

IMO, it seems that people are trying to imagine that one dramatic thing has happened which can explain everything. If you zoom out the Y axis, the changes are much more modest and noisy. That sudden, skyrocketing spike of 2010 is… nothing more than a return to the 2005 numbers. In fact, women are still better off in 2020 than 2005, according to the graph.

Of course you are entitled to your own beliefs, and if you don’t “buy” this version maybe you can submit your alternative hypotheses and data for peer review somewhere.

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