Climbing 50 stairs a day may stave off heart disease — while living near a park or lake can keep you mentally well. How to improve your health, according to new studies

Yahoo! Life

Climbing 50 stairs a day may stave off heart disease — while living near a park or lake can keep you mentally well. How to improve your health, according to new studies

Kaitlin Reilly – October 14, 2023

(Getty Images)
Climbing stairs may reduce your risk of cardiovascular disease. (Getty Images)

There’s so much health and wellness news out there. Here are some of this week’s health headlines and what you can take away from them to better impact your health.

Cycling may improve mental health

A survey of 1,200 middle school students who participated in a cycling program found improvements in their mental health and physiological well-being. The improvements appeared especially significant in students who were ethnic minorities from low-income families.

Why it matters: Cycling combines transportation, leisure and exercise — three things that can benefit young people greatly once they learn how to ride safely. For older individuals, the same reasoning can be applied to dusting off your own bike: A 2017 study found that people who commuted by bike to work had lower risk for certain cancers and cardiovascular disease.

Climbing stairs may impact heart health

A U.K.-based study published in the journal Atherosclerosis found that people who climbed 50 stairs over the course of a day reduced their risk of atherosclerotic cardiovascular disease and of cardiovascular disease in general by 20% when compared to people who did not climb any stairs daily.

Study author Dr. Lu Qi, director of Tulane University’s Obesity Research Center, told Medical News Today that stair climbing is a “vigorous exercise” which is associated with “lowering body weight, improving metabolic status and inflammation, and reducing other diseases which may increase the risk of heart disease, such as diabetes.”

Why it matters: We know that getting your heart pumping is important for your overall health, yet many people say they struggle to fit exercise into their lives. Choosing to take the stairs wherever you can, as evidenced by this study, is one potentially easy way to reap the benefits of exercise without overhauling your lifestyle.

Living near ‘green’ or ‘blue’ spaces may benefit mental health

A 10-year study out of the U.K. published in the journal Planetary Health found that greater exposure to green and blue spaces — such as living near a park or a lake, respectively — reduced your likelihood of developing a mental health condition.

Why it matters: There’s mounting evidence that suggests natural spaces may benefit mental health. A recent study suggested that fishing benefited mental health in men — but that the correlation had less to do with angling itself, and more to do with access to blue spaces. Whether you live somewhere with access to more natural environments or not, seeking them out whenever possible can allow you to reap some of these benefits.

Your Apple Watch can now tell you how much sunlight you’re getting

new feature in the Apple Watch series 6 or later tracks how much time in the sun you’re getting, which is made possible by the wearable’s ambient light sensor, as well as its GPS and motion sensors.

Why it matters: If you already track the amount of steps you take each day, you may benefit from also tracking your time in the sun. Morning sunlight, for example, can help improve your sleep later on, and exposure to sunlight in general can help raise vitamin D levels, which are important for boosting immunity and energy. Of course, it’s also important to be aware of the risk of sun exposure, which can lead to skin cancer — so if you’re tracking your sunlight with your watch, you might want to also use it as a reminder to keep the time limited and to reapply sunscreen.

Children may benefit greatly from practicing mindfulness

Researchers at the Massachusetts Institute of Technology found that children who used a mindfulness app at home for 40 days reduced their stress levels, as well as reporting lower negative emotions like fear and loneliness overall. The study, which was conducted in 2020 and 2021 during the height of the COVID-19 pandemic, allowed researchers to see how children with higher levels of mindfulness appeared less emotionally affected by the global crisis.

Why it matters: Mindfulness has long been studied for its mental health benefits — a 2023 study showed that mindfulness techniques, when practiced over time, may be as effective as taking medication.

Many parents are now teaching their children how to be mindful as well. Sarah Ezrin, author of The Yoga of Parenting, previously told Yahoo Life, “I wasn’t taught any self-regulation techniques as a kid. I had to learn them all as an adult and, while they’ve been inordinately helpful, I can only imagine what learning these right out the gate can do for our development, mood regulation and emotional regulation skills.”

Want to live to a healthy 100? Longevity doctor Peter Attia has advice.

The Washington Post

Want to live to a healthy 100? Longevity doctor Peter Attia has advice.

Andrea Atkins – October 13, 2023

“If you improve your health span, so that when you’re 80, you actually function like a 65-year-old, it’s almost impossible to not also get five to 10 years of life-span extension,” says Peter Attia, author of “Outlive: The Science & Art of Longevity.” (Dia Dipasupil via Getty Images)

Do you want to live to 100? Thanks to modern medicine, you have a decent chance of doing so.

But if you want to live well to 100, physician and best-selling author Peter Attia says you may have some work to do so that your last decade of life – your “marginal decade,” as he calls it – is healthful and rewarding, not limited by disease.

If we adopt new ways of looking at our health, we can do a better job of matching our life span (how long we live) to our “health span” (how long we live free from chronic disease or other health problems), says Attia, the author of “Outlive: The Science & Art of Longevity.”

In a phone interview, Attia talked about “the Four Horsemen of Chronic Disease” – cardiovascular disease, cancer, cognitive diseases (such as Alzheimer’s) and metabolic diseases (such as Type 2 diabetes) – and new ways to plan for longevity. The following was edited for length and clarity.

Q: Many people fear living to be 100, imagining loneliness, poor health and solitude. Should living so long be our aim?

A: I don’t think it should, actually. A lot of those fears are really valid. I think a better goal is to maximize health span. When you do that, you will automatically get a longer life span. If you improve your health span, so that when you’re 80, you actually function like a 65-year-old, it’s almost impossible to not also get five to 10 years of life-span extension.

Q: One of the ways to improve health span is through something you call “the Centenarian Decathlon.” What is it, and how do we train for it?

A: It’s a mental model which says that the greater the specificity with which you train for your physical goals, the more likely you are to achieve them.

I think back to the very first goal I ever had, which was to run five five-minute miles. That’s a lot more specific than saying I want to be able to run five miles. If you want to achieve that, you have to train with far greater specificity than if you just want to able to run five miles. And this is true across the board. And it’s what’s necessary to achieve remarkable feats.

I ask patients to think specifically about what they want to be able to do when they are in their 80s or older, and to start training for that when they are in their 40s or 50s or 60s.

Q: You mean, for example, if you want to hike for two miles when you’re 80.

A: Yes.

Q: Why won’t just hiking every day in the years leading up to that prepare you to continue walking outdoors?

A: Because as you age, the degradation of strength, stamina, balance, lower leg variability is so profound that it is insufficient to just hike two miles when you’re in your 40s and 50s, and assume that’s going to get you doing the same thing when you’re 80. When you’re 80, you have to aim much higher. . . . The Centenarian Decathlon is asking, “What do you want to do in your marginal decade?” And the more specific you can make it, the better, because you’ll be able to train for it, and increase the odds that you will be ready for it.

Q: And if you want to lift your great-grandchild when you’re 80, you need to do what, exactly, when you’re 50, 60 and 70?

A: To safely pick up a 30-pound child from the floor, you need hip flexibility and abdominal and spinal stability to get into a low squat position, then you need to be able to pick up a 30-pound weight. It’s harder to do a squat with weight in front of you because it requires more core stabilization and more scapular stability [shoulder strength]. This essentially means you need to be able to do a 30-pound goblet squat at the age of 85. . . . By the time they’re 85, most can’t even do the goblet squat, without any additional weight. So just on that one metric of strength, we have something that we need to train for.

Q: You say exercise is the most important tactic for longevity, but more than 60 percent of Americans do not get enough exercise. Can sedentary people undertake the vigorous training that you recommend?

A: If you’re starting from zero, just getting to 90 minutes a week of exercise will result in a 15 percent reduction in all-cause mortality [including the Four Horsemen]. That’s dramatic. I mean, we don’t have drugs that can reduce 15 percent all-cause mortality across the board. And the good news is it’s not just like this abstract thing of “we’re adding a couple of years to your life.” No, no. You’re going to feel better in three months.

Every person who saves for retirement, in my view, is doing something slightly more difficult. Because in the short term, you get nothing out of saving for retirement. . . . And I would say with these other changes that we ask people to make, at least they’re getting a benefit today.

How is anybody supposed to find time for this? I would just say, if you’re not going to make time for this, what are you making time for?

Q: Most of us succumb to one of those Four Horsemen. What do these diseases have in common?

A: Cancer, cardiovascular disease and neurogenerative diseases, Alzheimer’s being the most common, are all exacerbated dramatically by metabolic disease. So, if you have Type 2 diabetes, your risk of those other diseases goes up dramatically.

Q: You suggest getting ahead of these diseases by screening, gene testing or digging deeply into bloodwork to uncover markers that, frankly, most insurance companies won’t pay for. What do you say to patients, and your critics, about why these things are worth doing?

A: I guess the question is, what’s the alternative? The alternative is continuing to do what we’re doing. How is that working out? Not so well. So, if herculean preventive measurements are too expensive, treating them is costlier.

Is it expensive to get a $1,000 CT angiogram when you’re 40? Yes, it is. Do you know what it costs to get a stent placed? Or to get a bypass when you’re 65? Unfortunately, if you really want to take prevention seriously, you’re on the hook for the cost.

Q: Does this mean that only rich people can live healthfully to 100?

A: Screening is simply one small part of this. Far more relevant to increasing your health span is not whether or not you’re getting a CT angiogram, it’s whether you’re doing all of the other things that we talked about vis-à-vis sleep, nutrition and exercise. You don’t have to be wealthy to do those things.

Q: Isn’t it true that even if you do all of this, the Horsemen could still come for you?

A: Isn’t there a chance that if you save for retirement, your investments will sour before you need to draw the money out? Yeah, of course, there is. But if you don’t do these things, you dramatically increase the odds of things not going well.

Study reveals why residents of this major city are losing an average 12 years off their life expectancies — and it’s likely not what you think

The Cool Down

Study reveals why residents of this major city are losing an average 12 years off their life expectancies — and it’s likely not what you think

Laurelle Stelle – October 14, 2023

Air pollution can have a dramatic effect on human health. Living somewhere with heavily polluted air leads to long-term health problems.

A recent study examining the toll taken by pollution concluded that residents of Delhi, India, were losing almost 12 years from their life expectancy due to tiny particulates in the air, The Weather Channel reported.

What’s happening?

The study used satellite data from 2021 to determine the amount of PM2.5 pollution in different areas. PM2.5 refers to particulates under 2.5 micrometers in size. Particulates this small can be inhaled deep into the lungs, causing breathing and cardiovascular issues, according to one report in the Journal of Thoracic Disease.

The recent study found that Dehli had the highest levels of PM2.5 pollution worldwide, The Weather Channel reported. Residents there were exposed to 126.5 micrograms per cubic meter of air — more than 25 times the World Health Organization’s recommended maximum of five micrograms per cubic meter.

Across India as a whole, the average was 58.7 micrograms per cubic meter, or almost 12 times the recommended level, The Weather Channel reported.

This might sound like a faraway problem, but some cities in the United States also suffer from particulate pollution. Statista reported that as of 2022, Oak Ridge, Tennessee, had a PM2.5 level of 33.5 micrograms per cubic meter, over six times WHO’s recommended level.

Why are these numbers concerning?

According to The Weather Channel, pollution numbers this high have a measurable and dramatic impact on human lifespans. The study found that Delhi residents have their life expectancies shortened by 11.9 years compared to someone living with the clean air that the WHO recommends. The average Indian loses 5.3 years of life expectancy.

To put this in perspective, the researchers compared these numbers to the reduction in life expectancy caused by cardiovascular diseases, the number one cause of death worldwide. According to the study, cardiovascular disease reduced the average lifespan of India’s residents by 4.5 years — making air quality a more severe threat to health.

What can be done about PM2.5 pollution?

According to the New York Department of Health, one of the most common sources of PM2.5 pollution is gas-powered vehicles — and Delhi is famous for its traffic.

Switching to electric vehicles, like this solar-powered seven-seat bike from Indian entrepreneur Asad Abdullah, could make a world of difference. This change becomes more possible every year as EVs become more and more cost-effective.

Unretiring: More retirees are going back to work because they want to — or need to

Yahoo! Finance

Unretiring: More retirees are going back to work because they want to — or need to

Kerry Hannon, Senior Columnist – October 14, 2023

Richard Eisenberg retired in 2022.

At 65, he stepped away from his job as managing editor for “Next Avenue,” the PBS website for people over 50, where he had worked for a decade.

“I had a rough idea of what my retirement would be,” Eisenberg told Yahoo Finance. “I knew I would be ‘unretiring’ since I still wanted to be doing some writing, some editing, and some teaching, but not all the time.”

So far, he has. Eisenberg, who lives in Westfield, N.J., explores “unretirement” in his expert columns, podcast and teaching posts, including an online NYU master class.

“I’m seeing a lot of curiosity about the idea,” he said. “I’m still a little surprised that it seems like such a foreign concept to people.”

A growing number of retirees like Eisenberg have stepped off the sidelines and headed back to work, especially after many were forced to retire in the pandemic, according to a new report from T. Rowe Price. Around 7% of retirees are looking for work in retirement, while 20% say they’re already working part time or full time.

“In 2021, during the pandemic, that percentage was 10%,” Judith Ward, a certified financial planner and thought leadership director at T. Rowe Price, told Yahoo Finance. “They might have been forced to retire, and now we’re seeing that they are reentering the workforce.”

"Unretiree" Richard Eisenberg teaching students at the NYU Summer Publishing Institute 2023 (Photo courtesy of Eisenberg)
“Unretiree” Richard Eisenberg teaching students at the NYU Summer Publishing Institute 2023 (Photo courtesy of Eisenberg) (Richard Eisenberg)

The two main reasons for coming back into the workforce are a tale of opposites. While 45% chose to work for social and emotional benefits like Eisenberg, a slightly larger percentage — 48% — felt they needed to work for financial reasons.

Older adults, those age 65 and older, represent the fastest growing group of homeless, while poverty among older Americans has escalated. Policymakers and researchers have also been fretting that the share of older Americans with debt has risen from 38% to 63% since 1990, according to a recent report by the Center for Retirement Research at Boston College.

“Many people retired during the pandemic for a variety of reasons and the financial reality of that is now hitting home,” Chris Farrell, author of “Unretirement” and “Purpose and a Paycheck,” told Yahoo Finance. “Working even a few hours a week can help shore up household finances.”

“They’re taking advantage of the tight labor market to unretire, often by picking up part-time work, flexible gigs, starting their own business, and even encore careers,” Farrell said.

Damascus, Md.-based resident Gary Socha, 69, who retired after being laid off during the pandemic from his publishing job, stepped back in two years ago and is now working part time, four hours a day, as an advertising and event representative.

“It was too early, and my wife is five years younger and still working,” Socha told Yahoo Finance. “And financially… it just seems to make sense to make some more money and make yourself a little bit more secure and more comfortable for when you do retire. I could see doing this for quite a while.”

For other retirees, the lack of retirement planning or saving is coming back to haunt them.

“It’s not uncommon for people to retire without having actually made a retirement plan, and then find some financial surprises along the way,” Mark Miller, a retirement expert and author of “Retirement Reboot,” told Yahoo Finance. “That can prompt some people to go back to work. And the faster pace of inflation we’ve been experiencing also is motivating some people to go back to work, just to help cover their living expenses.”

T. Rowe Price
Source: T. Rowe Price (T. Rowe Price)

How much wealth you have to tap, of course, is the lynchpin. There’s a huge difference by household assets when it comes to retirees who say they “don’t need to work,” according to the T. Rowe Price report, which surveyed 2,895 401(k) retirement plan participants and 1,136 retirees with a Rollover IRA or a left-in-plan balance.

The report found 37% of retirees with household assets under $50,000 said they don’t need to work versus 55% of those in the $50,000-to-$250,000 category and 72% with assets of $750,000 and above.

Women are particularly vulnerable. In the report, 49% of retired women who were working or looking for work said they need the money compared to 41% of men.

One reason is that many women have less savings to depend on in retirement and lower Social Security benefits because of time out of the workplace for caregiving.

“Typically, lower incomes, higher debt loads — especially student loans — and shorter job tenures are some of the factors contributing to the gender savings gap,” Sudipto Banerjee, T. Rowe Price’s vice president, retirement, and author of the report, told Yahoo Finance at the WISER Annual Women’s Retirement Symposium.

The biggest financial payoffs of additional years of paid work are pushing back retirement account withdrawals, continuing to save, and delaying claiming Social Security benefits.

“Additional income can give you more time to contribute to your savings and it can also help you pay down debt and increase your cash reserves ahead of full retirement,” Ward said. And for those unretirees who haven’t started taking their Social Security benefit, delaying to claim means more money down the road.

“You’ll get a higher benefit, and it’s inflation-adjusted, so that’s a good deal for many people,” Ward said.

Grey haired female entrepreneur multitasking at home, video conference, speaking and listening on mobile phone, wireless technology
Many retirees are looking to continue working in some form, a T. Rowe Price report finds. (Getty Creative) (10’000 Hours via Getty Images)
The feel good part of staying on the job

There’s also the emotional draw of working, which is the second most-cited reason retirees choose to return to work.

Many retirees see part-time work as a good transition strategy with 57% of retirees wanting to continue working in some form, the T. Rowe Price report found. Men, in particular, were more likely to cite social connections as motivation to work.

“A lot of us want to work part-time in retirement,” Eisenberg said. “We want to stay active, have social connections, bring in some income and to stay mentally engaged, but we also want to have time to do other things.”

Plus, there’s the freedom to do what you want to do this time around, Eisenberg said. That means choosing a working route that isn’t stuffed with meetings, administrative duties — all “the parts of our former job that we didn’t like so much.”

And then there are the psychological benefits that work can offer, Robert Laura, a retirement coach, told Yahoo Finance. Several studies have indicated the positive mental effects of working. In fact, among older adults, retirees are more likely to experience depression compared to those who are still working, according to one recent paper.

“Work provides routine, structure, connection, mental stimulus, purpose, and relevance,” Laura said. “These are all things that many people don’t realize they are losing when they leave work and that aren’t easily replaced with golf, grandkids, and crossword puzzles.”

Kerry Hannon is a Senior Reporter and Columnist at Yahoo Finance. She is a workplace futurist, a career and retirement strategist, and the author of 14 books, including “In Control at 50+: How to Succeed in The New World of Work” and “Never Too Old To Get Rich.” 

Trump is slamming Israel and babbling about Barack Obama. Who would vote for that mess?

USA Today – Opinion

Trump is slamming Israel and babbling about Barack Obama. Who would vote for that mess?

Rex Huppke, USA TODAY – October 13, 2023

Former president and current criminal defendant Donald Trump, the front-runner in the GOP presidential primary, is getting worse.

I realize that’s a mighty high bar for him to clear, but he’s doing it, each day showing independent voters and Republicans who still value sane leadership why he should never be allowed within 10 square miles of the White House.

In the wake of the hideous Hamas attack on Israel, with American lawmakers and both sides of the aisle pledging full support for our ally, Trump’s political instincts told him to slam Israeli Prime Minister Benjamin Netanyahu and say: “Israel was not prepared.”

Former President Donald Trump greets supporters at the Palm Beach County Convention Center in West Palm Beach, Florida on October 11, 2023.
Trump criticizes Israel then praises Hezbollah. Whose side is he on?

Trump then praised the terrorist organization Hezbollah, which on Wednesday was attacking Israel along its northern border.

“You know, Hezbollah is very smart,” Trump said. “They’re all very smart.”

MAGA loyalists’ minds won’t be changed by anything, but those voters also won’t be enough, should Trump win the GOP nomination, to get him back into office. He’ll need to win over independents and even some moderate Republicans who put country over party while making headway with the ever-growing number of Generation Z voters who, based on recent elections, broadly reject Trump’s MAGA movement.

How is he going to do all that when he’s running around the country insulting an ally reeling from an unspeakable terror attack and generally sounding like his brain has turned to oatmeal?

After horrific Hamas attack on Israel, Biden acts presidential while Republicans act like fools.

Trump’s insensitive Israel comments are just the start of his recent madness

Consider an assortment of baffling/disturbing comments Trump has made in speeches and on social media just in recent weeks.

He has repeatedly misidentified President Joe Biden as former President Barack Obama, recently saying at a rally “you take a look at Obama and look at some of the things he’s done” and then, in an interview this week about Biden’s response to the attack on Israel, saying, “It’s all coming through Iran, and Obama, he doesn’t want to talk about it. … He doesn’t even mention them in a statement.”

The Fox News interviewer had to correct him afterward.

Trump can’t keep Jeb Bush and George W. Bush straight …

In another recent interview, Trump said: “We have the worst education almost in the large world, the world that people know about.” As opposed to the large world people don’t know about?

He said at a rally that the U.S. Capitol “looks like sh-t.”

Referring to Jeb Bush, Trump said: “He got us into the Middle East. How did that work out?” It was President George W. Bush who “got us into the Middle East.”

… much less Joe Biden and Barack Obama

In a Sept. 15 speech in Washington, D.C., Trump suggested Biden will lead America into World War II, which ended in 1945: “We have a man who is totally corrupt and the worst president in the history of our country, who is cognitively impaired, in no condition to lead and is now in charge of dealing with Russia and possible nuclear war. Just think of it, we would be in World War II very quickly if we’re going to be relying on this man.”

When questioning someone’s lucidity, it’s generally best to sound lucid yourself.

Donald Trump, if you're reading this, the photo is of Joe Biden, not Barack Obama.
Do independent voters want a president echoing the words of Hitler?

Late last month at a rally, Trump mocked Rep. Nancy Pelosi, D-Calif., and her husband, who was brutally attacked and beaten in their home last year.

“We’ll stand up to crazy Nancy Pelosi, who ruined San Francisco – how’s her husband doing, anybody know?” Trump said as the crowd laughed. “And she’s against building a wall at our border, even though she has a wall around her house – which obviously didn’t do a very good job.”

Biden is too old. And so is Trump. As a Gen Z voter, I want younger candidates.

Speaking of immigrants, Trump said in an interview earlier this month: “It is a very sad thing for our country. It’s poisoning the blood of our country.”

That language mirrors lines in Adolf Hitler’s “Mein Kampf” and is in line with the way white supremacists discuss immigrants.

Face it, the drunk at the end of the bar is making more sense than Trump

Trump has said recently that forest fires could be prevented “if you dampen your forests.”

He said anyone who robs a store should be shot – “If you rob a store you can fully expect to be shot as you are leaving that store. Shot!”

Former President Donald Trump arrives to speak at the Palm Beach County Convention Center in West Palm Beach, Florida on October 11, 2023.

And in a Florida speech this week, he went on this rant (I’ve used all-caps and phonetic spelling to illustrate the pronunciation of words he loudly emphasized): “Instead of keeping terrorists and terrorist sympathizers out of America, the Biden administration is inviting them in. You know why, because he’s got a boss. Who’s his boss? Barack HOO-SANE Obama. Barack Hoo-sane Obama. You remember the great Rush Limbaugh, Barack Hoo-SANE Obama. He’d go, Barack Hoo-SANE Obama.”

While Republicans question Biden’s age, Trump appears to be losing it

Petty criticism of Israel (Trump remains mad at Netanyahu because the prime minister accepted that Biden won the 2020 election), violent rhetoric, mixing up the names of political rivals, mocking an attack on a lawmaker’s spouse and generally sounding like the town drunk slouched at the end of the bar airing conspiratorial grievances. And that’s only a small sample of Trump’s madness over the past few weeks.

Setting aside his two impeachments, his incitement of an attack on the U.S. Capitol, his election denialism and the 91 state and federal felony charges he faces, I have to ask independents and on-the-fence Republicans alike: Would you actually vote for that mess? Is that really the best the Republican Party can offer America and the world?

People will keep taking swipes at Biden’s age, though Trump is only three years younger. But if you listen and pay attention to the former president, you’ll see a profoundly unhinged man teetering on a full separation from reality.

The ham has slipped off his sandwich. It’s time to stop pretending otherwise.

Russia is bringing back its bloody ‘human wave’ tactics, throwing poorly trained troops into a massive new assault in eastern Ukraine

Business insider

Russia is bringing back its bloody ‘human wave’ tactics, throwing poorly trained troops into a massive new assault in eastern Ukraine, White House says

Sonam Sheth and Jake Epstein – October 13, 2023

  • The White House said Russia has resumed using bloody tactics in its war against Ukraine.
  • It involves throwing “masses of poorly trained soldiers right into the battlefield without proper equipment” John Kirby said.
  • Kirby also said that North Korea sent Russia 1,000 containers of military equipment and munitions.

The White House said Friday that Russia has resumed employing the so-called “human wave” tactic in its war against Ukraine.

“As was the case during Russia’s failed winter offensive last year, the Russian military appears to be using human wave tactics, where they throw masses of poorly trained soldiers right into the battlefield without proper equipment, and … without proper training and preparation,” John Kirby, the spokesperson for the National Security Council, said.

He added that Russia “continues to show no regard for the lives of its own soldiers, willingly sacrificing them in pursuit of Putin’s goals, while Ukraine continues to fight bravely, effectively, and smartly.”

Kirby said that where Russia is making progress, it is “very scant and short.” But he said Russia’s decision to resume human wave tactics is “a sobering reminder that Russia is not prepared to give up on this fight. And as long as Russia continues its brutal assault on Ukraine, the United States must support the Ukrainian peoples’ ability to defend themselves.”

The Pentagon on Wednesday announced a new security assistance package to help Ukraine fend off Russian aggression. It’s the Biden administration’s 48th “tranche of equipment” provided to Ukraine since August 2021, the Pentagon said, and it includes additional anti-tank weapons, air defense capabilities, and other equipment.

Kirby said Friday that Russia launched its renewed offensive in the Donbas region of eastern Ukraine.

He added that this wasn’t a surprise, given Russian President Vladimir Putin’s goal of bringing Ukraine back into the Soviet sphere of influence.

“And I would add that we have seen the Ukrainians work very hard to repel these offensive maneuvers, and they appear to have done just that,” Kirby said.

The White House also said North Korea recently sent Russia 1,000 containers of military equipment and munitions and that it believes North Korea wants Russian military assistance in return, including fighter aircraft, armored vehicles, ballistic missile production equipment, and surface-to-air missiles.

russia north korea weapons routes
White House

Kirby said the US is closely monitoring whether Moscow delivers on Pyongyang’s expectations, adding that “we have already observed Russian ships offloading containers in the DPRK, which may constitute … the initial deliveries of material from Russia.”

Kirby said that a military alliance between Russia and North Korea could undermine “regional stability and the global nonproliferation regime” and that the US is taking several steps in response to sanction the two countries.

Related:

The Hill

White House: North Korea has provided Russia with 1K containers of military equipment, munitions

Alex Gangitano – October 13, 2023

The White House on Friday announced North Korea has delivered military equipment to Russia amid the country’s invasion of Ukraine.

“Due in part to our sanctions and export controls, Russia has been forced to desperately search around the world for military equipment,” National Security Council spokesperson John Kirby told reporters. “We now have information that North Korea has delivered arms to Russia for use in Ukraine. Our information indicates that in recent weeks, North Korea has provided Russia with more than 1000 containers of military equipment and munitions.”

The White House released imagery Friday showing the movement of these containers from the Democratic People’s Republic of Korea (DPRK) into Russia by ship.

“We condemn the DPRK for providing Russia with this military equipment,” Kirby said, adding that the White House will monitor the situation and continue to expose such arms deals.

The update follows weeks of concerns over North Korean attempts to negotiate an arms deal with Russia. North Korean leader Kim Jong Un met with Russian President Vladimir Putin last month.

Graphic provided by the White House National Security Council.

Kirby said U.S. officials are now monitoring closely whether Moscow will provide Pyongyang with materials.

“This expanding military partnership between the DPRK and Russia, including any technology transfers from Russia to the DPRK, undermines regional stability and the global non-proliferation regime,” he said.

On Thursday, an American aircraft carrier arrived in South Korea as a demonstration of strength as tensions rise with North Korea. The carrier group will stay in Busan until Monday, following military drills with South Korea and Japan earlier this week.

The White House has warned North Korea against supplying Russia with arms amid its war against Ukraine. National security adviser Jake Sullivan last month said Pyongyang will “pay a price” if it follows through on a potential deal.

Empire building has always come at an economic cost for Russia – from the days of the czars to Putin’s Ukraine invasion

The Conservation

Empire building has always come at an economic cost for Russia – from the days of the czars to Putin’s Ukraine invasion

Christopher A. Hartwell, Professor of International Business Policy, ZHAW School of Management and Law and Paul Vaaler, Professor of Law and Business, University of Minnesota – October 13, 2023

The Russian economy: A Potemkin village? <a href=
The Russian economy: A Potemkin village? Getty Images

President Vladimir Putin’s invasion of Ukraine has come at huge economic costs. By conservative estimates, the Russian economy has taken a US$67 billion annual hit as a result of war expenses and the effects of economic sanctions. In the early stages of the invasion, some analysts put the costs even higher, at $900 million per day.

These war costs show no sign of abating. The newly released Russian government budget for 2024 calls for a 70% defense expenditure increase, an astonishing reallocation of precious resources for a war that some observers expected to last a week at most.

Despite the toll of war and sanctions, the Russian economy has not collapsed and seems to have proven somewhat resilient against being shut out of global value chains.

Indeed, if you were to tune in to broadcasts of state-run RT television’s “CrossTalk” with American host Peter Lavelle, you’d be reassured that hardly anyone notices “irrelevant” Western sanctions, with even some reputable Western economists claiming that sanctions are harming Europe more than Russia.

Certainly, Muscovite oligarchs can still stroll across Red Square to Agent Provocateur and the GUM luxury shopping mall to buy lingerie for their wives and perhaps mistresses, too. And almost 8 in 10 Russians report to pollsters that sanctions have not affected their daily lives.

But from our standpoint as experts on Russian economic history, it looks very much like a Potemkin village – a false facade that belies harsh economic realities, including unsustainable defense spending, a plummeting currency and rising bond yields. Meat and poultry prices in Moscow continue to riseretail sales across Russia have dropped by nearly 8% since February 2022, and Russia’s aviation industry has plummeted for lack of spare parts and maintenance.

Such an economic hit was to be expected. As we show in a preprint study, imperial overreach from Russia in territories that are not its own has resulted in long-term damage to the Russian economy for over a century. More importantly, even during czarist times, rebellion in the modern-day lands of Ukraine against Russian rule led to the highest costs for the Russian economy.

Huge boost in military spending

Russia’s ability to seemingly absorb massive shocks since February 2022 is due in part to producers becoming accustomed to the milder sanctions that began in 2014 with the initial invasion of Ukraine and annexation of Crimea.

However, a larger driver of performance has been the Russian government taking it upon itself to try to keep the economy afloat by increasing its involvement in all sectors of the economynationalizing formerly Western-owned businesses and pumping money from the state budget into the military industrial complex.

This approach has continued with the Russian government’s 2024 budget, which is currently on its way to be rubber-stamped in the Russian parliament, the Duma. While mobilization of troops for Russia’s growing quagmire is moving in fits and starts, the Kremlin has proceeded with a full-scale economic mobilization. Expenditures on defense are forecast to be 6% of the country’s GDP, making up a full 29% of all Russian government spending, according to an analysis by the Bank of Finland, and with an additional 9% spent on “national security.” In contrast, social programs are a mere 21% of the budget. Compare this with the United States, where defense spending is 3% of GDP and 12% of all government expenditures.

Financial markets have reacted poorly to Russia’s most recent imperial adventure. The ruble’s turbulence is well known, once again breaking 100 rubles to the dollar on Oct. 3, 2023, but Russia’s inability to service its debt has been more under the radar.

For the first time since the Bolsheviks refused to honor the country’s foreign debt in 1918, Russia defaulted on its foreign currency payments in June 2022, and major ratings agencies stopped rating Russian government bonds.

At the same time, bond yields on existing Russian government debt – an excellent measure of fiscal risk – have been climbing almost continuously since the first invasion of Ukraine in 2014, rising to nearly 14% in 2014 and recently climbing to over 13%, an 18-month high.

Ponzi-like scheme

The combination of military aggression, stretched finances and battlefield stagnation are nothing new for Russia, especially in Ukraine. As our study shows, czarist fiscal management from 1820 to 1914 was based on a Ponzi-like scheme that funded land grabs and military expansion with government borrowing through bond issues, taxation of newly acquired territories and bond repayment by a government now overseeing a more geographically extensive state.

By 1914, Czar Nicholas II had bonds worth more than $155 billion in 2022 dollars trading abroad – by comparison, the value of British debt in 1914 equates to approximately $123 billion today.

Vladimir Putin’s handling of the economy since the early 2000s has been based on a similar pyramid scheme, we would argue. A combination of aggressive foreign borrowing and natural resource exports have financed foreign wars and domestic repression in territories of Russia’s near abroad: These have included conflicts in Chechnya and Georgia in the 2000s; Crimea and the Donbas in the 2010s; and the rest of Ukraine in the 2020s. Until this current round of aggression toward Ukraine, the outcome of these conflicts appeared to favor Russia, with its seemingly strong central government, military and economy.

However, Russia may now be at an inflection point. Historically, when Russia’s military was successful, it was able to finance both its war machine and industrialization.

Yet even past military success put the regime on very shaky ground that allowed small setbacks to threaten its foundation. Military reversals such as the stunning loss to Japan in 1905 or even the costs associated with pacifying troublesome territories such as in the Caucasus created more difficulties and risk for Russian bond markets and its economy. Indeed, unrest, armed rebellion and serf revolts in the far reaches of the empire raised Russian bond yields by approximately 1%. This risk was much higher than if such unrest occurred even in St. Petersburg or Moscow.

And perhaps most importantly, in Ukraine the cost of empire during czarist times was the largest, with each rebellion or bout of unrest in Ukraine raising Russian yields by between 3% and 3.5%.

With its newest defense budget going “all in” on its already faltering invasion of Ukraine, Russia appears to have learned none of the lessons of its past. Then as now, Ukraine and Ukrainian defiance constituted a grave threat to Russian territorial ambitions.

In 2024, that defiance just might prove too determined and too costly for an increasingly fragile Russian economy. And as in 1917, the consequences could be far beyond the control of the modern-day czar in the Kremlin.

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The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.

Toxic PFAS from US military bases polluting drinking water, report finds

The Guardian

Toxic PFAS from US military bases polluting drinking water, report finds

Tom Perkins – October 13, 2023

<span>Photograph: Frederic J Brown/AFP/Getty Images</span>
Photograph: Frederic J Brown/AFP/Getty Images

Plumes of toxic PFAS “forever chemicals” flowing from at least 245 US military bases are contaminating or threatening to pollute drinking water for nearby communities, and hundreds more are likely at risk across America, a new Department of Defense report finds.

The number of communities threatened by the military’s pollution is likely to increase as further more investigations are carried out. The defense department has only looked at about one-third of more than 700 facilities suspected of having contaminated the ground with PFAS.

Related: Drinking water of millions of Americans contaminated with ‘forever chemicals’

While the report acknowledges the pollution, it does not clarify which drinking water sources are polluted, how high PFAS levels are in the polluted water systems, or provide information about the plumes’ locations.

The sheer number of bases and the lack of clarity is “shocking”, said Scott Faber, the vice-president of government affairs at the Environmental Working Group non-profit, which tracks military PFAS pollution.

“A good neighbor would let you know that their use of PFAS was the reason your water was contaminated, and a bad neighbor would only tell you: ‘Hey, a plume is heading in your direction,’” Faber said.

The defense department did not immediately respond to a request for comment.

PFAS, or per- and polyfluoroalkyl substances, are a class of about 15,000 compounds most frequently used to make products water-, stain- and grease-resistant. They have been linked to cancer, birth defects, decreased immunity, high cholesterol, kidney disease and a range of other serious health problems.

They are dubbed “forever chemicals” because most do not degrade in the environment.

The military is considered one of the largest PFAS polluters in the world, largely due to its use of firefighting foam laced with the chemicals discharged during emergencies or training exercises. Some of the highest levels of PFAS in groundwater ever detected have been found around bases. The Environmental Protection Agency’s advisory health guidelines state that less than one part per trillion (ppt) in drinking water is safe, while levels found around military bases have exceeded 2.25m ppt.

Congress in recent years has included in Defense Authorization Acts requirements for the military to begin investigating PFAS pollution in and around its facilities. The defense department has so far confirmed PFAS contamination at 455 bases, it wrote in the new report, and of that group it has confirmed that 275 out of 295 checked, or about 90%, have plumes “in the proximity” of drinking water supplies.

The report does not clarify what “in the proximity” means and does not specify which types of drinking water supplies are threatened. Though it provides a list of bases, public drinking water systems can draw from surface water or community wells, and it is unclear how the plumes may be impacting those pulling water from private wells.

“That is what we know so far because that’s all the DoD told us, and it took an act of Congress to get that much information,” Faber said.

Though the report does not provide clarity on which communities are drinking contaminated water, the defense department in August issued a separate report revealing that it is now providing clean drinking water to 53 communities.

The military currently only provides clean drinking water for communities with levels of PFOA and PFOS, two kinds of PFAS compounds, above 70 ppt. The EPA is proposing lowering the legal limit to 4 ppt. If it does, as expected, the defense department will likely be forced to provide drinking water to most, if not all, communities around facilities where there is PFAS contamination.

Even as the military uncovers more PFAS pollution in and around its sites, the amount of spending on remediation of all pollution at its bases is dropping.

“Communities around the facilities must be really frustrated because they in all likelihood are drinking from wells that are contaminated by the military, but the DoD is coming up short,” Faber said. “Inevitably we will get answers for these questions as we move through the process.”

New study reveals alarming factor linked to 400,000 deaths annually: ‘A severe public health crisis’

The Cool Down

New study reveals alarming factor linked to 400,000 deaths annually: ‘A severe public health crisis’

Rick Kazmer – October 13, 2023

Europe is proving a miserable World Health Organization statistic to be accurate.

The Guardian reported that about 98% of the continent’s populace is breathing polluted air. That aligns with WHO experts who estimate that 99% of people globally inhale crummy breaths.

What’s worse for Europeans, monitoring shows about two-thirds of residents are sucking in air that’s more than double the pollution of WHO quality standards, and the pollution is linked to 400,000 deaths annually, per the Guardian.

“This is a severe public health crisis,” Utrecht University environmental Professor Roel Vermeulen, who led the research, told the newspaper.

What was studied? 

Experts used satellites and 1,400 ground monitors to learn about Europe’s air quality. The findings are troubling because the air pollution includes particulates, tiny particles of solids or liquids in the air that are inhaled, according to a Centers for Disease Control and Prevention (CDC) description.

Forest fires and wood stoves can cause particulate pollution. But, burning dirty energy for industry and transportation also releases dirty air, which the Guardian reported is churning out most of Europe’s poor atmosphere.

What’s the impact?

The particulate pollution can end up in our bloodstreams, according to the Guardian, and the CDC reports that eye irritation, trouble breathing, and cancer are possible repercussions. Air pollution, as part of planet-wide overheating, has even been linked to poor classroom performance.

Experts said the reality in Europe is even worse, with hundreds of thousands of deaths each year. In Germany, France, and Spain, no less than 37% of the population live with air at double WHO standards — in Germany, it’s 75%, the Guardian reported.

Eastern Europe, however, is the worst region, appearing to be darkened with coal dust on a map shared by the newspaper that blotches the areas with the most smog.

“What we see quite clearly is that nearly everyone in Europe is breathing unhealthy air,” Vermeulen said.

What can help? 

Air filters provide an immediate way to take control of your indoor atmosphere. Surprisingly, outdoor versions are in operation in India to clean city air.

For lasting change, education and smart, planet-friendly lifestyle choices can help to prevent more pollution from dirtying our air. Recycling, using renewable energy, and simply planting a tree are some of the suggestions from Just Energy. Even cutting back on beef in the weekly menu can promote a more sustainable food chain.

These are just some ways to help reverse the smoggy disaster hovering in Europe.

“These deaths are preventable,” Dr. Hanna Boogaard of the U.S. Health Effects Institute, told the Guardian.

The truth about the safety of statins

The Telegraph

The truth about the safety of statins

David Cox – October 13, 2023

The pros and cons of statins

If you were offered a potentially life-saving drug, free on the NHS, is there any doubt you would refuse it? With experts increasingly realising that statins are the magic bullets to help halt the alarming rise in heart deaths, new draft guidance issued earlier this year said people as young as 25 should be taking the cholesterol-busting drugs to ward off heart attacks and strokes.

In January 2023, the National Institute for Health and Care Excellence (Nice) watchdog which provides guidelines for the NHS, released a set of new recommendations suggesting that statins should be rolled out on a far wider scale for those at risk of cardiovascular disease.

Around 10 million people in England are currently eligible for the cholesterol-lowering drugs but Nice has recommended widening the window of eligibility to encompass those between 25 and 84 who are deemed to have a 10 per cent or higher risk of a cardiovascular event in the next decade. It would mean that up to 25 million people could receive statins, with the aim of preventing the onset of cardiovascular disease, a set of chronic illnesses that are responsible for one in four deaths.

Sir Nilesh Samani, medical director of the British Heart Foundation and a cardiology professor, says it is without question that statins are life-saving drugs for patients with existing heart disease.

“If you had a heart attack or a stroke, or you suffer with coronary heart disease or angina, then the evidence basis is not controversial at all,” he says. “Everyone would recommend those patients to take them. In terms of people who haven’t got an established disease, the statin recommendation is based on an assessment of their risk over the next ten years.”

One group of patients who could particularly stand to benefit from preventative statins is the estimated 250,000 people in the UK who have a condition known as familial hypercholesterolemia, which means they have high cholesterol from birth. A 2019 study that followed 214 patients with the condition for 20 years, after they began receiving statin therapy as children, found that it reduced their cholesterol by an average of 32 per cent and reduced their risk of cardiovascular disease in adulthood.

However, not everyone is able to tolerate the drugs and scientists are still learning more about some rare statin-induced side effects. The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) recently revealed that between 1995 and 2023, there have been 10 cases of a neuromuscular disorder known as myasthenia gravis, which may have been triggered by statins.

But Samani points out that given the many millions of people who take statins – 9.5 million people were prescribed them in 2022 – it is hard to draw conclusive links between the drugs and such rare isolated events.

“With very rare things, it’s very difficult to attribute them to the drug because so many people are on statins,” he says.

So what are statins, and how exactly do they work?

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How do statins really work?

Statins are a class of drugs that include atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin. In general, they act to lower the levels of a type of cholesterol known as low-density lipoprotein or LDL cholesterol.

Dr Unnati Desai, national lead for GP services at Nuffield Health, says: “LDL is often referred to as bad cholesterol because elevated levels of LDL are associated with an increased risk of cardiovascular disease.”

Statins reduce LDL cholesterol through two main mechanisms of action. The first is to block the activity of an enzyme called HMG-CoA reductase, which plays an essential role in how cholesterol is produced in the liver. They also increase the number of LDL receptors on the surface of liver cells, enabling the liver to remove LDL cholesterol from the bloodstream more efficiently.

But while they might work in similar ways, no two statins are the same. They each have distinct chemical structures and vary in potency, dosage and how they are metabolised in the body. High potency statins tend to be offered to patients who have already experienced a serious event such as a stroke or heart attack. “Some are more effective at lowering cholesterol levels than others,” says Dr Desai. “For example, rosuvastatin and atorvastatin are considered high-potency statins and can lower cholesterol more effectively at lower doses compared with moderate-potency statins like simvastatin and lovastatin.”

Statins can be classified as being either fat-soluble or water-soluble which affects how well they are absorbed within the body and their side effect profile. “Fat-soluble statins like atorvastatin and simvastatin, are better absorbed and may have a more substantial effect on cholesterol,” says Dr Desai. “Water-soluble statins, like pravastatin, are less likely to penetrate cells but may be associated with fewer muscle-related side effects.”

But we are still learning more about the other benefits statins can bring to cardiovascular health. For example, earlier this year, a study from Stanford Medicine discovered that simvastatin can improve blood vessel health, which could be why heart failure patients who take statins are less likely to suffer a second heart attack.

The pros and cons of statins

  • Pros
  • Cons
  • Proven to reduce risk of heart attack and stroke, especially if you’ve had one before
  • May not be suitable for those with liver disease
  • Anti-inflammatory properties can benefit heart and blood vessels
  • Can worsen muscle inflammation in people who have muscle conditions
  • Cheap and easy to access from your GP or over the counter at low doses
  • Interact with other medications so may worsen side effects
Should I be taking statins for my cholesterol?

Based on the new Nice recommendations, NHS doctors will compute a cardiovascular disease risk score for all patients, before offering them the choice of going on statin therapy.

The latest tools used to compute these risk scores are based on AI analysis of the patient’s electronic health records and consider a whole variety of factors, not just cholesterol levels.

“Factors considered also include age, family history of heart disease, smoking status, blood pressure level, and whether they have diabetes or not,” says Dr Gosia Wamil, a cardiologist at Mayo Clinic Healthcare in London. “These newer calculators can improve prediction of who needs to be treated or not.”

How long do statins take to work?

Statins will start to reduce LDL cholesterol within weeks, but it can take several months before their full benefits are apparent. According to Dr Wamil, long-term data indicate that the efficacy of statins remains largely stable over time. “There have been no indications of waning effectiveness observed even after prolonged use over many years, provided that they are consistently and appropriately administered,” she says. “LDL should be monitored, and the statin dose may need to be adjusted occasionally to achieve a good effect.”

Are statins causing my aches and pains?

The most widely cited complaint from taking statins is muscle aches, and having prescribed the drugs for more than 30 years, Sir Nilesh says there is no question that statins are linked to a slightly increased risk of aches and pains.

However, he believes that the degree of media coverage surrounding statin-induced muscle aches has contributed to a medical phenomenon known as the nocebo effect (the opposite of the placebo effect), where the belief that a drug will cause harm ends up triggering negative symptoms.

In one British Heart Foundation study, participants were given a dummy pill or a placebo, which they believed was a statin, and yet they still complained of muscle aches. Last year, a large analysis published in The Lancet estimated that 90 per cent of the time, muscle aches were not related to statins.

“There’s evidence that people have now been conditioned in some way to expect muscle aches with statins,” says Samani. “So anytime they get aches, they think it’s the medicine.”

Are there any other side effects?

In some very rare cases, statins can cause a condition called rhabdomyolysis in which muscle cells break down, releasing a protein called myoglobin into the bloodstream which can clog up the kidneys, resulting in acute kidney failure and other complications.

The early signs of rhabdomyolysis tend to be muscle inflammation, and so people experiencing particularly severe muscle pain after starting on a course of statins should consult their doctor. However, rhabdomyolysis affects only 1.5 in every 100,000 people who take statins.

“Long-term statin use is considered safe and associated with significant benefits in reducing cardiovascular events,” says Dr Wamil. “Regular monitoring and reporting of any unusual symptoms to a healthcare provider are essential but the benefits of long-term statin use in preventing heart attacks, strokes, and mortality often outweighs potential risks, especially for individuals at high risk of cardiovascular disease.”

In January 2023, the National Institute for Health and Care Excellence watchdog released recommendations suggesting that statins should be rolled out on a far wider scale.
How much alcohol can I drink with statins?

There are no guidelines against drinking alcohol while taking statins, but Dr Desai suggests discussing your typical weekly alcohol consumption with a health professional before starting on the drugs.

“There’s no absolute contraindication to drinking alcohol when taking a statin, however it is important to drink within the recommended limit of 14 units per week, ensuring alcohol-free days by spreading the drinks over three or more days during the week,” she says.

However, you do have to be slightly careful about grapefruit juice or eating these fruits. This may seem unusual but grapefruit can actually react with certain statins, inducing severe muscle or joint pain. You should avoid them completely if taking simvastatin, while consumption should be minimised when on atorvastatin. Other statins are not known to react with grapefruit.

Is there an alternative to statins?

For those concerned about whether they will be able to tolerate statins, there is a far wider range of cholesterol-lowering alternatives than ever before.

The most widely used are PCSK9 inhibitors, a class of drugs which includes medications like inclisiran, alirocumab and evolocumab, and have been shown to be capable of reducing LDL cholesterol by around 50 to 60 per cent or more.

PCSK9 inhibitors reduce the activity of a protein called PCSK9 that normally blocks the liver’s cholesterol receptors. By inhibiting this protein, the receptors are able to keep extracting cholesterol from the blood.

“These drugs are usually used as an additive treatment for people whose cholesterol doesn’t come down sufficiently with statins or are statin-intolerant,” says Sir Nilesh.

Dr Wamil says that while they tend to be well-tolerated by patients, the disadvantages are that not everyone likes having to receive regular injections and they come at a higher cost for healthcare providers. “Whether they are better than statins depends on an individual’s specific health circumstances,” she says.

Should I take statins?

Ultimately the question of whether someone should begin taking statins, depends very much on their individual health circumstances.

“For anyone, their risk is a third lower with a statin,” says Dr Iqbal Malik, a consultant cardiologist and medical director of One Welbeck Heart Health in London. “If your risk is near zero, it is not worth it, but if your risk is very high, it is definitely worth it.”

Sir Nilesh Samani says that statin therapy should always be the result of a shared decision-making process between the cardiologist and the patient, and a two-way conversation about their risk of disease and the relative benefits which the drug might be able to offer them.

“There’s always the balance between trying to reduce the total number of heart attacks and strokes, and the issue of medicalising more of the population,” he says. “So it is very much an individual, shared decision-making process. If the patient is a frail 85 year old with multiple other health problems, then a statin might not be the right thing. But if they have a family history of disease, and a 10 per cent risk of having a stroke in the next decade, most doctors would feel that the benefits are probably there.”