CorCal, the randomized trial of whether a coronary calcium score beats the standard risk calculator for deciding who starts a statin, presented this afternoon at the European Society of Cardiology meeting. This is off the press release and the presentation. No paper yet, so numbers can move.

5,772 adults, none with known heart disease, diabetes, or a statin already. A coin decided whether the recommendation came from the pooled cohort equations, the traditional risk calculator, or from a calcium score. Mean age 64, 51 percent women. They counted heart attacks, strokes, stents and deaths.

After 4.2 years both arms landed on 2.7 percent. Hazard ratio 0.99, noninferiority not met.

That reads worse than it is. The interval runs from a 29 percent reduction to a 38 percent increase, wide enough to contain almost anyone's opinion about calcium scoring. Muhlestein, who ran the trial, told the room the events came in rarer than he had built it for and asked for a bigger trial. I would take him at his word rather than call this debunked.

The number I keep going back to is a different one. The calculator told people to start a statin more than three times as often. But of the people the calcium score flagged, 62 percent were still taking the pill, against 23 percent of those the calculator flagged. Fewer people told to take a statin, far more of them actually taking it. The trial cannot tell you why.

I wrote up where this leaves a score of zero, which is my situation:

Has a calcium score ever changed what you actually do, as opposed to what you know?

Maybe patients had calculators as much as u/cardiostrong_md and trust the “test” that directly measures something scary more?

The FDA approved Mounjaro today to lower the risk of heart attack, stroke, and cardiovascular death. That is the first time tirzepatide has carried a cardiac claim, and for people who qualify it is genuinely good news: one weekly shot that handles blood sugar, weight, and now cardiac risk.

Two things about it are worth knowing before the headlines flatten them.

Who it covers. The indication is for adults with type 2 diabetes at high cardiovascular risk. Not obesity, not general heart health. The trial population was narrower still, people with type 2 diabetes and established atherosclerotic disease. If you take tirzepatide for weight and do not have type 2 diabetes, nothing about your prescription changed today.

What the trial did. SURPASS-CVOT was not a placebo trial. Lilly ran Mounjaro against Trulicity, an older, cheaper GLP-1 that already has its own cardiovascular indication. That is a harder comparison than beating a sugar pill, and Lilly picked it deliberately.

The result, published in NEJM last December: hazard ratio 0.92, 95.3% CI 0.83 to 1.01. The thresholds were set in advance. Under 1.05 counted as non-inferior. Under 1.00 would have counted as superior. It landed on 1.01, clearing the first bar and missing the second by a hundredth.

So you will see "8% lower risk" everywhere this week. That 8% is the point estimate, and the interval around it still includes no difference at all. Lilly's own release says "non-inferiority" plainly and prints the interval. The overstatement is coming from the summaries, not the company.

I would not swing the other way and call it nothing, though. Matching a drug that already works is not the same as matching placebo, and the trial was big enough and long enough to have caught tirzepatide doing meaningfully worse.

What has not changed: nobody has shown tirzepatide cuts heart attacks and strokes in people with obesity but not diabetes, which is what SELECT did for semaglutide. SURMOUNT-MMO is built for that and has not reported. The nearest evidence is SUMMIT, 731 people with obesity and HFpEF, 9.9% against 15.3% for cardiovascular death or worsening heart failure. Different endpoint, narrower group, and the benefit came from the heart failure half.

I put the label language and the full numbers here

For anyone who follows trial design more closely than I do: how much weight should a non-inferiority win against an active comparator carry against a superiority win over placebo? I keep going back and forth on whether that is a higher bar or just a different one.

Peptides are all the rage, and none more than BPC-157. I keep seeing three different claims about it: that it has never been tested in humans, that there are exactly three human studies, and that a Phase 2 trial proved it works. They can't all be right, so I went through the primary records myself: the FDA briefing document from the July 2026 compounding advisory committee meeting, PubMed, and ClinicalTrials.gov.

What's actually documented:

- 2002-03: Phase 1 safety study, rectal enema, 24 healthy volunteers. Survives only as conference abstracts.
- 2005: the one real RCT. Double-blind, placebo-controlled, ulcerative colitis, 53 randomized. The between-group result was not statistically significant (95% CI -4.84 to 1.62). Never published beyond an abstract, and the sponsor walked away from the program.
- 2021: knee pain chart review, 17 patients, no control group, some got a combination product.
- 2024: interstitial cystitis pilot, 12 women, single arm.
- 2025: IV safety pilot, 2 people.

That's the entire documented human record. Roughly 80 people, and not one study of tendon, ligament, or muscle injury, which is what nearly everyone actually injects it for.

And the "recruiting Phase 2 hamstring trial" that started circulating this year (NCT07437547) is sponsored by a peptide vendor whose other registrations describe themselves as fictional or mock studies in the official ClinicalTrials.gov text. Google's AI Overview is already repeating it as a real trial.

Full write-up with the study table and the FDA numbers: BPC-157 human trials, all five studies

What would change your mind on a compound like this, in either direction? For me it's a published RCT from a sponsor that actually exists. Curious where everyone else draws the line.

What’s your Why? Keeping in mind why I am embracing this healthy lifestyle helps power my choices!

Every “cheapest ApoB test” page I found was either an affiliate site or a lab company ranking itself first. Bloomberg just ran a piece on the app that turns everyone’s recommendations into affiliate links (gift link: Bloomberg/ShopMy), which is exactly the world I kept encountering. It finally annoyed me enough to do this properly: one standalone ApoB test, priced at every self-order service I could find, same day, writing down what checkout actually charges instead of the banner price.

Short version: nobody sells the $12 test they advertise. Goodlabs’ $12 becomes $24 with its venipuncture fee. Mito’s $11.34 becomes $26.34. The one honest sticker is Own Your Labs at $17.20 all in, and it can’t do walk-in draws in MA, MD, NJ, RI or NY. Meanwhile Quest’s own consumer store sells no standalone ApoB at any price, only a $221 panel, while running the identical assay for $24 reseller orders. Labcorp charges $69 direct for the test resellers sell for $17 to $27.

Confession: I had been ordering direct from Labcorp and Quest, and through DiscountedLabs, for a couple of years. All of them sit in the expensive half of my own table. I guess I missed out.

And because I have been enjoying the AI coding tools lately, I built a small pipeline that re-checks every price weekly and keeps dated screenshots, so this table shouldn’t rot the way these pages usually do.

Full table, fees, state traps: https://dadstrengthdaily.com/apob-test-cost/
Every price as a dated screenshot: https://dadstrengthdaily.com/apob-test-price-screenshots/

Anyone found a walk-in option under $24 all in that I missed?

On August 19 Moderna’s stock closed up almost 177 percent on a joint press release with Merck: their personalized mRNA cancer vaccine, intismeran, plus Keytruda met its endpoints in a Phase 3 melanoma trial. It has since given back a chunk of that.

Here is the part that got buried in the excitement. The release contains no effect size. No hazard ratio, no percentage, no confidence interval, no count of who relapsed. It says two endpoints were met and stops. The “49 percent reduction” now circulating is from the older, smaller Phase 2b study, not this trial.

I am not a skeptic looking for a reason. I read the BioNTech founders’ book, I think mRNA is one of the more elegant ideas in medicine, and I have been called a big-pharma shill for saying so (I take an Eli Lilly drug every week and own the stock). I want this to work. I am just waiting for the actual numbers, which is what three practising oncologists said the same morning, and what even Bloomberg’s bullish columnist conceded.

The part I think men my age should take away is about melanoma itself:

**•** It flips sex around 50. Before 50 it is more common in women; after 50 it is more common in men, and the gap widens every decade.  
**•** The dangerous subtype, nodular melanoma, is about 14 percent of cases but 43 percent of the deaths, and it breaks the ABCDE rule you were taught. It is often symmetric, one even colour, and small. Some dermatologists teach EFG instead: Elevated, Firm, Growing.  
**•** A lot of male melanoma sits on the back and scalp, the parts you cannot see. Get someone to check your back.

Full write-up, with the charts, the sources, and where the real numbers will show up: https://dadstrengthdaily.com/melanoma-in-men-over-50/?utm_source=reddit&utm_medium=social&utm_campaign=melanoma-mrna

Abstract

Background: Dietary carotenoids and vitamin A may contribute to gastric cancer (GC) prevention through anti-inflammatory and antioxidant mechanisms; however, epidemiological evidence remains limited. We investigated the associations of total and individual carotenoid and vitamin A intakes with GC and their relationships with inflammatory/oxidative stress biomarkers. Methods: The case-control study included 177 adults (82 GC incidence cases/95 controls). A validated 168-item food frequency questionnaire assessed dietary intakes of individual carotenoids and preformed vitamin A. Metabolic biomarkers, lipid profile, inflammatory/oxidative stress markers (e.g., high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-α), interleukins 6/1β/10/4), total antioxidant capacity (TAC), and malondialdehyde (MDA)) were measured. Multivariable logistic regression models estimated odds ratios (ORs) for GC risk; linear regression models examined associations between carotenoid intakes and biomarkers. Results: Total carotenoid (mg/d) (OR: 0.86, 95%CI: 0.81-0.98), β-carotene (mg/d) (OR: 0.77, 95%CI: 0.65-0.90) and vitamin A (mg RAE/d) (OR: 0.29, 95%CI: 0.09-0.95) intakes, as continuous variables, and also as binary variables (based on the median cut-offs), in all models (also adjusted for age, sex, smoking, education, marital status, physical activity, cancer history, H. pylori, NSAIDs intake, body mass index, total energy intake), were inversely associated with GC odds. In fully adjusted models, higher total carotenoid intake (mg/d) was associated with lower LDL-c (β: -1.60, 95%CI: -2.91, -0.25) and IL-6 (β: -7.92, 95%CI: -14.00, -2.00); lycopene (mg/d) with higher LDL-c (β: 2.030, 95%CI: 0.27, 4.31) and vitamin A intake (mg RAE/d) with lower TNF-α (β: -12.12, 95%CI: -24.71, -0.47) and higher TAC (β: 0.64, 95%CI: 0.001, 1.27). Conclusions: Higher intakes of total carotenoids and vitamin A were associated with lower odds of GC and more favorable profiles of inflammatory/oxidative stress biomarkers. These findings support an inverse association between carotenoid-rich dietary patterns and gastric carcinogenesis.

Keywords

Absorption, Apoptosis, Carotenes, RAR, Transcription Factors, Xanthophylls

Frontiers | Dietary Carotenoids and Vitamin A Are Associated with Lower Gastric Cancer Risk and Favorable Inflammatory and Stress Oxidative Biomarkers: An Incident Case-Control Study

I was this person - up at 3am unable to sleep sleuthing on reddit for answers to my woes. I was rigorous in testing and getting to the bottom of why I couldn't sleep, why my skin was insane and why out of countless doctors everyone just kept telling me every test was "normal". I'm a product manager for work - I've been doing it for over 10 yrs and I decided I was going to build something to help with this situation instead of using excel and countless apps that all tracked different things. I'm 3 weeks into beta and I'm seeing promising results and the software is finding patterns like it's supposed to. I want to expand the beta and find a few more people to test! If you know anyone that's in this boat - searching for answers to their health troubles - please send them my way as I would love to see if this software can help! DM me! Thank you! ❤️

We Turned Blood Tests Into Hype. What Comes Next?
A blood test used to be a commodity.
Today, it can be a €500–€1,000+ “longevity experience.”
We’ve seen this before:
Food → restaurants → gastronomy.
Clothing → fashion → luxury brands.
Travel → hotels → luxury hospitality.
Now we are doing the same with health.
But I believe the next step is bigger than simply packaging more tests.
Longevity is not a snapshot. It is a trajectory.
The future is about combining biomarkers, wearables, medical expertise and technology to understand not only where you are today — but where your health is heading.
And then doing something about it.
That is the ecosystem we are building.
Measure. Understand. Intervene. Track. Improve. Repeat.
The blood test is just the beginning.
#biohaking #longevity #wellness

I inject Zepbound every week, so I understand the retatrutide FOMO. Reta is Eli Lilly's triple agonist, the next molecule up from tirzepatide, still in Phase 3 trials and approved nowhere in the world. That is what got me looking at where people actually buy it.

Sam Sulek, one of the biggest fitness YouTubers, says on camera that he co-owns a peptide company called NewBioRx. The storefront sold a $285 pre-filled retatrutide pen under the standard research-chemical disclaimer: "Bodily introduction of any kind into humans or animals is strictly prohibited by law." A second website carrying the NewBioRx logo published a milligrams-to-units conversion table for that pen and a twelve-photo walkthrough titled "How To Give Yourself a Shot." One site swore no human may ever use the product. The other assumed a human was using it.

The timing matters. On August 12, Eli Lilly sued six US sellers of retatrutide, and its complaints lean on exactly this kind of material, the dosing calculators and injection guides, as evidence that a "research use only" label is a fiction. NewBioRx is not one of the six defendants, and nobody has sued Sulek's company. It is the same pattern, though. The FDA has separately said retatrutide cannot legally be used in compounding at all.

Then, on Sunday afternoon, while I was finishing the write-up, the pen's product page went 404 and the entire instructions site was replaced by a NewBioRx-branded "Coming soon" page. The 16 mg and 30 mg vials are still for sale. I don't know who took the pages down or why. I had archived everything first, and the write-up links to the archives.

I documented the whole paper trail, the product pages, the instructions site, the corporate filings, and Sulek's own on-camera explanation that research-only products are not "held to the same quality standards" as FDA-regulated ones, with screenshots: full write-up on my blog with the details.

The disclaimer itself is what bothers me most. It does not describe the product, and the seller's own instructions contradicted it. Its practical effect is that when something goes wrong, the person holding the pen owns the outcome, not the company that sold it. I think that is the real product being sold: deniability. Curious whether anyone here reads "research use only" differently.

• Lipoprotein(a) [Lp(a)] has evolved from a biochemical curiosity to a central player in cardiovascular risk assessment, with elevated levels affecting approximately 1.5 billion people worldwide as an independent and causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve disease.
• If your Lp(a) level is 125 nmol/L (50 mg/dL) or higher, it can promote clotting and inflammation. This can increase your risk of heart attack, stroke, aortic stenosis and peripheral artery disease.
• Long-term studies have shown a possible connection between high Lp(a) levels and the risk of calcific aortic valve disease.
• Lifestyle changes don’t affect your Lp(a) level.
• There is currently no medication approved just to lower Lp(a). Some medications, such as PCSK9 inhibitors, have been shown to lower Lp(a) and LDL cholesterol. 

I've got severe hallux rigidus, arthritis of the joint at the base of the big toe. The first randomized trial for it just came out in Annals of Internal Medicine: 90 people, half got the joint fused with screws and a plate, half got watchful waiting. Walking pain a year later: 1.3 out of 10 fused, 5.7 waiting. Almost 90% of the surgery group was satisfied. 20% of the waiters were.

Nobody in this trial was blinded, though, and the endpoint is self-reported pain. What intrigues me is what happened the few times orthopedics actually blinded a surgery trial, with sham operations. Moseley 2002 randomized 180 arthritic knees to arthroscopy or a placebo operation, meaning skin incisions and nothing else. At one year the placebo group actually had the best pain score of the three groups, 48.9 vs 51.7 for the real cleanup (0-100, higher is worse). Sihvonen 2013 did it again with degenerative meniscus tears, 146 people, real keyhole surgery vs sham, and the sham group improved a hair more on all three main measures (Lysholm +23.3 vs +21.7). Fake surgery matched real surgery. Twice.

I don't think fusion is fake. Removing a worn-out joint has a mechanical rationale that scraping cartilage never did, and five points is a lot. But with no sham arm, nobody can say how much of that swing is the operation and how much is having had one. I wrote up the full trial, and why my own severe X-ray still doesn't make me a candidate.

Everyone in those two knee trials consented to maybe getting fake surgery, all 326 of them, and it's the only reason we know any of this. Would you sign that consent form?

Because a bunch of things we take for granted just… leave. Quietly.

You don’t get a calendar invite. You’re fine, you’re fine, you’re fine, and then one day a push-up feels heavier than it used to. Sit-ups get weird. Putting on socks on one foot turns into a little balancing act. Running becomes jogging, sprinting becomes “yeah no”, jumping becomes optional.

Getting off the floor is the same story. Nobody knows when it starts. First you need a knee. Then a hand. Then a chair. Then you get to the point where you’d really rather not fall, because getting back up isn’t guaranteed anymore.

None of that shows up on a streak counter. You can still “work out” and miss the whole thing.

That’s why I built a small iOS app. Pretty simple idea: check a few things your body can actually still do, and keep an eye on them over time. Not medical. Not a transformation challenge. Just a way to notice the quiet stuff before it gets loud.

It’s early, so if you’ve got an iPhone and you try it, I’d genuinely like to hear what you think.

https://testflight.apple.com/join/fKnRxvf6

And if you don’t, that’s okay too. Sit on the floor later. Try a slow push-up. Stand on one foot to put your socks on. If it feels easy, nice. If it doesn’t, at least you know what to work on.

Be kind to your future you.

Retatrutide is Lilly's next weight-loss drug, still in Phase 3, not approved anywhere. So when Lilly filed six lawsuits this week against sellers of it, there was no "real" version being counterfeited. Everything sold as reta is gray-market by definition.

To be honest I am glad that the peptide bros who sell stolen/unapproved drugs under the sketchy “research only” label, are finally getting wiped out. I suspect they will move to Dubai or go back to crypto scams.

The actual complaints make it pretty clear that these folks were obviously selling for human consumption.

What caught my eye: Lilly isn't only suing the vendors. It's leaning on the payment processors, card companies and shippers they rely on. Gray-market peptide sellers already can't keep a card processor (hence crypto/PayPal), so that's probably the bigger squeeze.

Writeup: https://dadstrengthdaily.com/is-retatrutide-legal-to-buy/

A new patient‑run effort focused on real lipoma research.
Here’s the link if you want to check it out:
https://forms.cloud.microsoft/r/BFT9pLwStw

The FDA approved mFLUSIVA on August 5, Moderna's mRNA-1010. It is the first mRNA flu vaccine licensed anywhere, for adults 50 and older, expected for the 2026-27 season. Same platform as the COVID shots: instead of growing influenza virus in eggs, the vaccine is synthesised from a genetic sequence and your own cells make the target protein.

The headline from the pivotal trial is 26.6% better than a conventional flu shot. That is the relative number. In absolute terms, across 40,303 adults analysed, confirmed flu went from 2.8% to 2.0%. So less than one percentage point, or roughly 137 people switching products to prevent one case.

I first read 137 as the number needed to vaccinate. It isn't. Everyone in that trial already got a flu shot, comparison group included, so 137 is how many would need to switch products to prevent one extra case.

Two things surprised me in the NEJM paper. The comparison shot was a regular egg-based vaccine, not one of the high-dose ones people over 65 usually get steered toward. And the interesting property of mRNA, that you can pick strains later because manufacturing takes two or three months instead of six, was never used. mFLUSIVA was formulated against the same February WHO strain call as everything else on the shelf.

You also feel it more. Grade 3 reactions, meaning bad enough to interfere with your day, ran 6.4% against 1.0%.

If you already get a cell-based shot like Flucelvax, the comparator question gets more annoying, and I went into that in the full write-up

I am getting a flu shot in October either way. Undecided on which. Anyone planning to ask for this one, or waiting to see a second season first?

I posted the STAT investigation here back in May. I finally went through the underlying papers myself, and the part that surprised me was not the criticism. It was that the two men who found the original Blue Zone no longer describe it the same way.

Michel Poulain, the demographer who co-coined the term, has asked twice in print for validation that has not been completed. His 2011 Okinawa paper is literally titled "A plea for in-depth validation," and he repeated the plea in 2024. Giovanni Pes, his co-author on the original Sardinian work, wrote in a 2025 rebuttal that the ages have "been extensively validated." Same finding, fifteen years apart, and the founders land in different places.

The science holds up better than the critics say. An independent 2025 review of 65 records graded Ogliastra, Okinawa and Nicoya "well-characterized," and Sardinia has the strongest documentation of the lot. The same review excluded Loma Linda outright: no epidemiological studies, just Buettner's own narratives. Which fits how it got in. Buettner told the New York Times his National Geographic editor said "you need to find America's blue zone," and told Science "I never bothered to delist it."

The business side bothers me more. Keeping the certification runs a city about $100,000 a year. Fifteen Iowa communities signed up, ten of them under an insurer sponsorship. When that ended, Cedar Rapids, Iowa City and Marion left. Cedar Rapids asked what renewal would cost and was told the fee was "considered proprietary information." I could not find any peer-reviewed evidence that one of these projects has added a year to anyone's measured lifespan.

Buettner himself said on Rich Roll's podcast that Okinawa is now "the least healthy prefecture in all of Japan." The Blue Zones website still tells visitors that women there live longer than any women on the planet.

My honest read: some of these clusters were real, the evidence varies enormously from one to the next, several of the advantages have since gone, and none of it establishes that nine lifestyle rules caused anything. The full write-up, with the records and the money, is here (https://dadstrengthdaily.com/are-blue-zones-real/?utm_source=reddit&utm_medium=post&utm_campaign=are-blue-zones-real).

Has anyone here spent real time in one of the five? I am curious whether the day-to-day looks anything like what gets sold.