Finding out that my father's death was plausibly preventable.
Statins are a class of drug that lower low-density lipoprotein (LDL) cholesterol (the bad kind) by reducing the amount of cholesterol that the liver makes and increasing the rate at which the liver removes LDL from the bloodstream. (LDL content is primarily a function of genetics and dietary saturated fat content, which is unfortunate because we evolved to greatly enjoy foods high in saturated fat, such as butter, full-fat dairy, and red meat.)
Statins are readily available and longstanding with research starting around the 1970s and lovastatin being the first to receive FDA approval in 1987. It was quickly followed by a host of other statins after other pharmaceutical companies realized the benefits. There are currently several statins that vary by how aggressively they lower LDL, allowing doctors to choose the best one to match the patient's medical history, risk factors, and desires. An option for everyone!
Statins are incredibly effective at lowering LDL levels. Low-, moderate-, and high-intensity statins are defined as able to reduce LDL by 20-30%, 30-40%, and >40%, respectively. In turn, they reduce relative risk across a variety of events by a substantial amount. Go look at the r/Cholesterol subreddit for plenty of anecdotal success stories.
Statins are incredibly cheap. GoodRx tells me that lovastatin is as low as $15, pravastatin $24, and fluvastatin $42. A friend got a 90-day supply of rosuvastatin for $14 with health insurance. The patents have expired and the pills are being manufactured generically for cheap. Consider this situation for a moment. LDL is in your bloodstream, passive but malign. It floats along and, if there's enough of it, forms plaque on the artery walls. Enough buildup and a plaque can rupture, a clot forms on it, and the artery becomes blocked. But wait! Scientists have developed a drug that, with a little dietary change and cardiovascular exercise, can greatly reduce this risk if it hasn't progressed too far. No surgery, no voodoo, no prayers. Just a tasteless oral tablet at some convenient frequency for mere cents a day. And some people believe that big pharma shouldn't get paid handsomely for the risk they incur and the good they bring!
Statin side effects are uncommon and minor. They include muscle aches and increased chance of developing diabetes, especially for those who are obese or have prediabetes. I'd much rather risk having achey muscles than a heart attack that kills me and leaves my loved ones alone.
I recently learned that my father, who died of a heart attack at the age of 56, was well aware of his high LDL levels, the corresponding risk of heart disease and death, and had multiple friends, including his wife—my mother—urge him to start medication to remedy it. As his death implies, he didn't take their advice and got handed an early grave, leaving a family mourning and a rich social life with a hole in it.
And for what? Fear of side effects and lack of a primary care physician were the stated reasons according to my mother. I know the doctor shortage is real, but c'mon! Appointments are still available for the motivated and patient. Or could it also have been a bruise to the ego, an old-school mindset that real men don't take medicine because that's for wimps and they'll just power right through it? Yeah, let's power through a clogged artery! If I push hard enough, my super strong heart muscles will just push the plaque through, if not unclog it altogether! Or was it just a misunderstanding of the risk? A miscalibration about what high LDL means and ultimately could mean? Or was it a "nothing shows up on these other tests that could indicate heart issues so I'm fine"? Or was it cognitive dissonance? Fear of confronting mortality and the thought of a widow and half-orphans and not eating cheesesteaks or nightly ice cream?
Whatever the reason may have been, it was likely a bad one when looking at the costs and benefits of the treatment options. I'll stop short of accusing my father of revealing his preferences to us by way of abstaining from taking a statin (I wasn't that bad of a son, or so I tell myself!) because I'm confident that he loved us and wanted to live a long life, but fuck! What a stupid, selfish, short-sighted decision.
It's rarely the case that person A can say to person B "You're being an idiot. Really think about what you're doing and if that is for the best." and have person B really think about it. Like sit down for an hour and write down the costs and benefits and talk to others and do some research and play out the scenarios and make an informed decision. There really should be a sacred word or phrase that people can use to invoke this level of seriousness, like "Dad, cowabungamungajunga, you should work hard to fix your LDL."
I don't know if something like that would've worked on my father. My mother apparently tried—how hard, I don't know and don't want to ask lest I bring up horrific feelings of guilt for not pushing harder or memories of those dark days—and it didn't work, so would a child doing it be much more effective?
I look at this now and realize I've acted in a similar way since his death: I exercise a bunch with the expectation that it cancels out any genetic component or poor dietary choices; I have a poor diet because I'm exercising so much and it cancels out; I don't get any sort of testing done because I exercise so much and it cancels out despite knowing both of my parents have high cholesterol. Who's the selfish one now?
And so I got a blood panel and found I had high LDL. And so I got a second, more specialized blood panel and found I had high lipoprotein(a). And so I got an angiogram and found I had minor plaque buildup in some arteries. And so I got immediately prescribed a statin and ordered to limit consumption of my delicious cookies and cakes and cheeseburgers.
The days of out-riding and out-lifting my genetics and diet are over and it's for the best.
Again, there's no telling what would've happened had my family pushed my father harder or from a different angle to be put on a statin. He may have become convinced, begrudgingly relented, or stood his ground, but if something is important enough, we should've been willing to incur the costs of achieving it, whether that be through "nagging" or trying to explain the importance in different ways until it hit home.
And so I have learned another valuable lesson in all of this: for actions where the reward greatly outweighs the risk but is incredibly inconvenient and/or expensive, I should be willing to incur costs to increase the chance the correct decision is made. This means following up with friends and family on getting stuff done; offering to pay for things if they are unwilling to pay themselves; and politely helping them uncover the root cause of why they don't want to get it done. (Of course, what's "important" and "correct" is subjective, but there are some general things that I think most people can agree upon.)