# RE: [IP] Heart Attacks and Diabetes (LONG response)

```Kathy Bruckmeyer [mailto:email @ redacted] wrote:

> Hey people!
> Why do you look at statistics???

Kathy, it's what I *DO*.

Maybe I can give a little perspective to the statistical aspects of health.

The statement that I made yesterday about diabetics being at the same risk
for a heart attack as non-diabetics who have already had one is a
statistical statement.  It's based on thousands of records of data.  These
data are known as retrospective data since they study events that have
happened in the past.

Risk is a statistical term and refers to a ratio - it's the rate of heart
attacks in diabetics who have not had a previous heart attack divided by the
rate of heart attacks in non-diabetics who have had a heart attack.  That
ratio is near one.  Further, when this value is calculated, because a rate
involves many measurements, we can also calculate a confidence interval -
typically a 95% interval.  This means that any value that falls within the
interval is not statistically different from the central value.  This is how
we accommodate the randomness involved.  You hear this phrased differently
in popular surveys - usually something like "plus or minus three percentage
points".

The heart attack risk is a simple one - in a statistical sense.  By that, it
means the risk when controlling for all other factors, such as body mass
index, smoking, sex, age, and probably a few more.

Now we can take that and apply it to us.  Because these data are
retrospective, we can only make inferences about others who match the
profiles, and that's how risk is applied.  It does *NOT* mean that you or I
will have a heart attack.  Some of us will, and some won't.  Because of all
the other factors, we *can* move ourselves to other categories and reduce
the risk - again realizing that this is a statistical number.

For an extreme example, you may remember Jim Fixx, author of "The Complete
Book of Running" (later he wrote "The Second Complete Book of Running" - if
the first was complete, why was a second one necessary?).  Fixx's major
hypothesis was that if you run, you will live a long healthy life without
cardiovascular problems.  Fixx collapsed after a run one day and died of a
massive heart attack.  He was 56 years old.

Nathan Pritikin promoted his diet as healthy for the whole body,
particularly protecting a person from heart disease.  He committed suicide
when, at the age of 63 (IIRC) he was found to have advanced coronary artery
disease.

There have been others who have smoked since they were children and died of
causes unrelated to smoking at over 90 years old.

Statistics is the very essence of YMMV.  The bottom line is that none of us
knows in advance what complications we might suffer, or even *IF* we will
suffer them.  Some of us with HbA1c's of under 6% will get retinopathy, and
others who can barely manage to get their HbA1c down to 8% will have
excellent vision all their life.  We can only talk about the risk, and do
what we can to lower that value.

James Handsfield, PhD, MPH
Statistician
Centers for Disease Control and Prevention
770-488-8106
email @ redacted
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```