Cholesterol numbers on no med, then on statin then on statin + Repatha

[MarkusLA]

Considering the concern over Tryg. here, anyone ever looked at Carnitin?

600mg Carnitin keeps my Tryg at 70
1200 around 50 and with 1800mg at the moment they barely touch 45

How many days after starting daily injections does it take to see the triglyceride changes?

I know to take this big of a dose, I'm going to need to brew this up myself. Before I do that, I'm thinking of getting some from my doctor to see if I respond like you do.

 

[Nidus]

How many days after starting daily injections does it take to see the triglyceride changes?

I know to take this big of a dose, I'm going to need to brew this up myself. Before I do that, I'm thinking of getting some from my doctor to see if I respond like you do.

Never really timed bloodwork for this specifically but when running carnitin at high doses there was always at least a month between starting it and taking bloods

 

[Photon]

My fasting trigs is around 30s.
Isocapent will probably drop the trigs even lower

I'm fine with very low LDL but not entire sure about very low single digit trigs..

I'll order some coconut oil to play with lol
My HDL took a pretty big hit when i started dropping my LDL but thats to be expected.

Based off my labs it seems like my HDL didn't budge even after adding coconut oil. I used 2 tbl spoons of virgin a day, ~26g saturated fat. I'd assume it's the same as milk except milk has lower fat content (20%). My trigs went up tho.. and thats with me adding icosapent ethyl

I'll probably just drop the coconut oil, given how increasing HDL doesn't seem to improve clinical outcomes.

@Ghoul
Did you run this experiment on yourself as well?

 

[BP_6]

Based off my labs it seems like my HDL didn't budge even after adding coconut oil. I used 2 tbl spoons of virgin a day, ~26g saturated fat. I'd assume it's the same as milk except milk has lower fat content (20%). My trigs went up tho.. and thats with me adding icosapent ethyl

I'll probably just drop the coconut oil, given how increasing HDL doesn't seem to improve clinical outcomes.

@Ghoul
Did you run this experiment on yourself as well?

Yea, they are discovering more and more that HDL doesn't seem to affect outcomes either way. With the exception being if it is very high tending to lead to worse outcomes actually.

 

[Wizbang]

Based off my labs it seems like my HDL didn't budge even after adding coconut oil. I used 2 tbl spoons of virgin a day, ~26g saturated fat. I'd assume it's the same as milk except milk has lower fat content (20%). My trigs went up tho.. and thats with me adding icosapent ethyl

I'll probably just drop the coconut oil, given how increasing HDL doesn't seem to improve clinical outcomes.

@Ghoul
Did you run this experiment on yourself as well?

I keep looking into ways to raise my HDL but when I asked my cardiologist he said "based on you doing all the things suggested already...good luck"

 

[BP_6]

Raising HDL up to a normal when you are on AAS, especially any 17-aa orals can be extremely "challenging."

 

[Ghoul]

Yea, they are discovering more and more that HDL doesn't seem to affect outcomes either way. With the exception being if it is very high tending to lead to worse outcomes actually.

In part that's because there's "good HDL" and "bad HDL", which is determined by its RCT (reverse cholesterol transport) function.

Raising quantity of low quality HDL contributes to inflammation and doesn't remove cholesterol from arteries.

The main biomarkers to check HDL quality are CEC (cholesterol efflux capacity, this one is enough if you have access to it) and/or APOA-I.

In order of effectiveness for improving HDL efflux: intense cardio, Pitavastatin, Niacin, Fibrates, and Weight loss


After starting Pita (and returning to outdoor cardio after a break) HDL efflux capacity went from .90 (poor, higher risk of ASCVD), to 1.20 (excellent, top 2% of population (associated with 60% lower risk of ASCVD).

I tracked this with a Lipomap from Boston Heart Diagnostics. They offer a bunch of very advanced blood tests not available elsewhere. Any provider can arrange to have their tests done for you, or you can ask them for a provider in your area they're already working with. I paid $140 (per test) via my primary care doctor. I got a whole package of documents going over details of my lipids in incredible depth, plain English descriptions of the significance of everything and specific guidance on modifying risk factors they identified. I'm going to have some of their other tests done.

https://bostonheartdiagnostics.com/wp-content/uploads/2022/08/LipoMap_Sales_Flyer_2022_08_26.pdf

Under test types choose "Boston Heart Exclusive Tests" and scroll the through the list in the "Test Name" box below it. They've got some interesting diagnostics on offer I haven't seen anywhere else,

Boston Heart Test Menu – Boston Heart

bostonheartdiagnostics.com

 

[Wizbang]

In part that's because there's "good HDL" and "bad HDL", which is determined by its RCT (reverse cholesterol transport) function.

Raising quantity of low quality HDL contributes to inflammation and doesn't remove cholesterol from arteries.

The main biomarkers to check HDL quality are CEC (cholesterol efflux capacity, this one is enough if you have access to it) and/or APOA-I.

In order of effectiveness for improving HDL efflux: intense cardio, Pitavastatin, Niacin, Fibrates, and Weight loss


After starting Pita (and returning to outdoor cardio after a break) HDL efflux capacity went from .90 (poor, higher risk of ASCVD), to 1.20 (excellent, top 2% of population (associated with 60% lower risk of ASCVD).

Boston Heart Test Menu – Boston Heart

bostonheartdiagnostics.com

I wish I was not so hesitant on statins based on my previous history.

 

[Ghoul]

I wish I was not so hesitant on statins based on my previous history.

I had a such a terrible experience on two different statins (walking up the stairs caused muscle pain), I gave up and ignored my lipids for years. Now I'm making up for lost ground by trying to maximize regression, and have absolutely no side effects whatsoever with Pitavastatin (max dose), Ezetimibe, and Repatha.

You should give Pitavastatin a try. Start at 1 or 2mg. It's not quite as effective at dropping LDL as the much cheaper alternatives, but the entire reason they were able to charge 100x more than Rosuvastatin (before going generic) was because Pita was a statin the severely statin intolerant could use. You can always drop it. While I know sides are theoretically possible, I haven't seen any first hand reports of anyone who did.

 

[Wizbang]

I had a such a terrible experience on two different statins (walking up the stairs caused muscle pain), I gave up and ignored my lipids for years. Now I'm making up for lost ground by trying to maximize regression, and have absolutely no side effects whatsoever with Pitavastatin (max dose), Ezetimibe, and Repatha.

You should give Pitavastatin a try. Start at 1 or 2mg. It's not quite as effective at dropping LDL as the much cheaper alternatives, but the entire reason they were able to charge 100x more than Rosuvastatin (before going generic) was because it was a statin the statin intolerant could use. You can always drop it. While I know sides are theoretically possible, I haven't seen any first hand reports of anyone who did.

I had muscle pains and dark urine at points on rosuvastatin for over a year (as part of my post MI cocktail of max dose rosuva+eze+metoprolol xl+lisinopril) and every single time I mentioned it the doctor would just say "rosuvastatin doesn't typically cause are you sure it is not from something else?" on top of it not really even touching my lipids.

 

[Photon]

The main biomarkers to check HDL quality are CEC (cholesterol efflux capacity, this one is enough if you have access to it) and/or APOA-I.

In order of effectiveness for improving HDL efflux: intense cardio, Pitavastatin, Niacin, Fibrates, and Weight loss

And where does coconut milk fall in here?

I also don't think that APOA or CEC or efflux are commonly tested when evaluating increases in HDL. Do you have the change in efflux values for the compounds you mentioned?

Im curious about your rankings and if they are evaluated during studies.

Edit:I mixed up Lp(a) with APO(a)

 

[Ghoul]

I had muscle pains and dark urine at points on rosuvastatin for over a year (as part of my post MI cocktail of max dose rosuva+eze+metoprolol xl+lisinopril) and every single time I mentioned it the doctor would just say "rosuvastatin doesn't typically cause are you sure it is not from something else?" on top of it not really even touching my lipids.

In my experience doctors try to overcompensate for statin anxiety by being oblivious to the fact they got that reputation for good reason. BTW, I don't know if you have any contraindications for Pitavastatin, but since you were put on Rosu, Pita will be fine for you. The only difference is no cyclosporin (an immunosuppressant) use on Pita, while a limited amount is allowed on Rosu,

 

[Wizbang]

In my experience doctors try to overcompensate for statin anxiety by being oblivious to the fact they got that reputation for good reason. BTW, I don't know if you have any contraindications for Pitavastatin, but since you were put on Rosu, Pita will be fine for you. The only difference is no cyclosporin (an immunosuppressant) use on Pita, while a limited amount is allowed on Rosu,

should be fine, I just checked all interactions, do MDs link PCSK9i's with statins often?

 

[Photon]

In part that's because there's "good HDL" and "bad HDL", which is determined by its RCT (reverse cholesterol transport) function.

Raising quantity of low quality HDL contributes to inflammation and doesn't remove cholesterol from arteries.

The main biomarkers to check HDL quality are CEC (cholesterol efflux capacity, this one is enough if you have access to it) and/or APOA-I.

In order of effectiveness for improving HDL efflux: intense cardio, Pitavastatin, Niacin, Fibrates, and Weight loss


After starting Pita (and returning to outdoor cardio after a break) HDL efflux capacity went from .90 (poor, higher risk of ASCVD), to 1.20 (excellent, top 2% of population (associated with 60% lower risk of ASCVD).

I tracked this with a Lipomap from Boston Heart Diagnostics. They offer a bunch of very advanced blood tests not available elsewhere. Any provider can arrange to have their tests done for you, or you can ask them for a provider in your area they're already working with. I paid $140 (per test) via my primary care doctor. I got a whole package of documents going over details of my lipids in incredible depth, plain English descriptions of the significance of everything and specific guidance on modifying risk factors they identified. I'm going to have some of their other tests done.

https://bostonheartdiagnostics.com/wp-content/uploads/2022/08/LipoMap_Sales_Flyer_2022_08_26.pdf

Under test types choose "Boston Heart Exclusive Tests" and scroll the through the list in the "Test Name" box below it. They've got some interesting diagnostics on offer I haven't seen anywhere else,

Boston Heart Test Menu – Boston Heart

bostonheartdiagnostics.com

Probably my last reply to anything lipid related, it doesn't seem to go anywhere or benefit me in any way majority of the time.

Medical consensus is that increasing HDL via pharmaceutical methods does not improve cardiovascular outcomes. One may argue that it is because there is both good and bad HDL which is a valid point.

However at the same time, you are saying that the medications listed, Pita, Niacin, Fibrates, for instance improve good HDL. Pita by itself, is a statin, and improves cardiovascular outcomes, simply by lowering LDL, so it's not a good comparison as statins by itself have already been proven to improve cardiovascular outcomes.

Looking at just Niacin and Fibrates, you are essential saying that clinical trials did not use these for their evaluations which is not true, because if they did, then the medical consensus would be that HDL increases improves cardiovascular outcomes, based off what you mentioned.

Besides Boston Health, you could also take look at CCTA Cleerly. It does look like my insurance will cover part of it. I'm just glad my labwork is returning good and I'm starting on all these preventive measures really early.

 

[Photon]

Besides Boston Health, you could also take look at CCTA Cleerly. It does look like my insurance will cover part of it. I'm just glad my labwork is returning good and I'm starting on all these preventive measures really early.

For anyone interested:

CCTA Cleerly -- my insurance will cover with pre-auth, which is definitely not possible for me due to how young / no issues or family history. Without pre-auth, the physical scan is not covered but everything pre-post is covered -- consultation, review of results etc. This is supposedly less invasive than a CT angiogram.

Boston Health LipoMap -- I ordered this, total cost was $150 which includes a blood draw at a partner lab located 5 minutes away. They send you a testing kit and then you bring it to the lab. No insurance coverage. Just curious to see how Halo affects lipid composition.

 

[Nunya]

You need Pitavastatin.

Most primary care docs are unfamiliar with it, because it was $500/mo until recently (vs $5 for generics of other statins), and was very difficult to get coverage for.

It's now a generic at -$50/mo, most insurance will cover it, or buy from India pharmacy for $40/100 x 4mg tabs. Only one brand of generic available in the US or India so far, Zydus.

It's been the preferred statin for professional athletes, for good reason.

I planned to do a write up on this little known statin, so this is a little sloppy, but TLDR it provides 90% of the LDL lowering of the most potent "conventional" statins, along with unique characteristics like boosting HDL numbers (and improving HDL function, ie HDL's 'reverse cholesterol transport', the capacity to suck lipids out of your arteries, making it a great candidate for plaque regression, not just stopping further accumulation).

Uniquely, it doesn't increase insulin resistance like other statins, and often improves it(!).

It doesn't harm muscle mitochondrial function, the common issue with every other statin. Muscle related sides are very rare as a result.

It has an enhancing effect on fat lipolysis, and inhibits fat deposition, allowing for increased fat burn and recomposition, unlike the negative impact other statins have on fat metabolism.

It has no interactions with Test or GH because it's not metabolized by CYP3A4 like other statins, preventing accumulation that often leads to sides.

This was a quick and dirty summary, but aside from slightly less LDL lowering ability, and cost, this is clearly the best statin by a mile for prevention (outside of a few edge cases requiring rapid calcification of plaque due to imminent risk).

With Repatha, Ezetimebe, Pitavastatin 4mg you're looking at a 85-90% drop in LDL 10-15%. boost in HDL, and minimal, or more likely no sides.

Even just Pita 4mg and Ezetimebe it's approx 60% drop in LDL, 50% APOb, 30% triglycerides, and 10-15% boost in HDL with an excellent shot at not experiencing any sides.

The statin for statin haters like me.

Well, here I am, reading about f*n statins, because despite being the picture of health, my LDL is slightly elevated and my Ca score puts me in the 90th percentile for my age/sex group. Thanks, maternal gramma...

 

[jtmarlin]

Well, here I am, reading about f*n statins, because despite being the picture of health, my LDL is slightly elevated and my Ca score puts me in the 90th percentile for my age/sex group. Thanks, maternal gramma...

Much of it could be your AAS use IF that's the case and not granny bc I'm right there with you and nobody in my family has died of athleroscerosis.

 

[Ghoul]

Much of it could be your AAS use IF that's the case and not granny bc I'm right there with you and nobody in my family has died of athleroscerosis.

Grandma probably wasn't using gear.

 

[Nunya]

Much of it could be your AAS use IF that's the case and not granny bc I'm right there with you and nobody in my family has died of athleroscerosis.

Could be I guess but I'm a woman on prrrretty low dose TRT sooo

 

[BamaCrazy]

Grandma probably wasn't using gear.