Help with Cholesterol and BP Meds

[egruberman]

Do you understand the mechanism behind this?

From the JAMA article:Association of Bempedoic Acid Administration With Atherogenic Lipid Levels in Hypercholesterolemia

Hypercholesterolemia itself is associated with tendon pathology and increased risk of tendon rupture, particularly among patients with HeFH. A causal relationship between bempedoic acid and tendon rupture has not been established.

My best guess is that the people on aggressive lipid management tend to be old and in poor physical condition. As a result, slightly elevated incidence of tendon rupture is observed.

There is definitely something there with regard to statins and adverse side effects related to myalgia, but that remains a controversial topic with no consensus as to what is happening. Statins at elevated doses inhibit collagen synthesis to some degree and also lower CoQ10 levels, but i suspect that's not an issue in an otherwise healthy population.

 

[Ghoul]

I was reassured statins are fine by this. for about ten seconds until I read the comments of clinicians all mentioning personal experience with muscle pain, brain fog, and ruptured tendons.

Majority of Muscle Symptoms With Statins Not Due to Treatment

A new Cholesterol Trialists Collaboration meta-analysis shows that in 14 of 15 people who experience muscle pain or weakness when taking a statin, symptoms are not related to treatment.

www.medscape.com

It may be worth the trade off vs a heart attack, but I think there are new injectable cholesterol treatments like once every 6 months Leqvio that don't cause these problems.

Seems like another early GLP situation. "Yes this is a superior treatment but extremely expensive and most insurance won't cover it, so let's not talk about it too loudly unless the patient is rich.".

 

[buck]

One of the things i tend to see not mentioned is that the brain produces it's own cholesterol as it needs it. And cholesterol is to large of molecule to pass through the blood brain barrier. Yet stating are small enough they can pass through. Which would lower the amount of cholesterol in the brain it would seem. and with brain shrinkage, dementia ect. on the rise i wounder how much of that is due to stains? When ever i ask cardiologists about that or the life expectancy of people on statins. They tell me that is something to consider. But they have seen no data about it. If statins actually helped people live longer i would think that would be a selling point for big pharma. And they have decades of data available but they never talk of people actually living longer only how there is less heart attacks.

 

[Ghoul]

One of the things i tend to see not mentioned is that the brain produces it's own cholesterol as it needs it. And cholesterol is to large of molecule to pass through the blood brain barrier. Yet stating are small enough they can pass through. Which would lower the amount of cholesterol in the brain it would seem. and with brain shrinkage, dementia ect. on the rise i wounder how much of that is due to stains? When ever i ask cardiologists about that or the life expectancy of people on statins. They tell me that is something to consider. But they have seen no data about it. If statins actually helped people live longer i would think that would be a selling point for big pharma. And they have decades of data available but they never talk of people actually living longer only how there is less heart attacks.

That's a brilliant point. It seems like the general medicine complex is hyper focused on cardiac outcome stats, and not the "I'll be retired by then" long term effects like neurodegeneration.

As usual, most doctors can provide more life, but only a few (or more likely, only yourself), consider maximizing. quality of life.

Also, another benefit of the new treatments. Their mechanism of action is less brute force and more of a modification of existing cholesterol regulating systems, and I don't believe have the same potential to deprive the brain of cholesterol.

 

[egruberman]

It may be worth the trade off vs a heart attack, but I think there are new injectable cholesterol treatments like once every 6 months Leqvio that don't cause these problems.

Yet stating are small enough they can pass through.

There are tendon ruptures observed in PCSK9i users at a similar rate to statins.

Rosuvastatin and other hydrophilic statins have a lower potential to cross the blood brain barrier and in any case, work directly on the liver to reduce cholesterol production by inhibiting HMG-CoA reductase.

 

[Ghoul]

There are tendon ruptures observed in PCSK9i users at a similar rate to statins.

Rosuvastatin and other hydrophilic statins have a lower potential to cross the blood brain barrier and in any case, work directly on the liver to reduce cholesterol production by inhibiting HMG-CoA reductase.

Well then let's just hope it's the result of "I'm taking care of my cholesterol, I should start exercising too.".

Similar to men starting on TRT having a higher incidence of broken bones in the first year, lol. "Wow, I can do ANYTHING!"

 

[buck]

There are tendon ruptures observed in PCSK9i users at a similar rate to statins.

Rosuvastatin and other hydrophilic statins have a lower potential to cross the blood brain barrier and in any case, work directly on the liver to reduce cholesterol production by inhibiting HMG-CoA reductase.

On the first run of the ski season last year a friend had his Achilles rupture and he has been on statins for years and was in the gym regularly till then. which supports what i have read over the yeas.

As usual, most doctors can provide more life, but only a few (or more likely, only yourself), consider maximizing. quality of life.

Also, another benefit of the new treatments. Their mechanism of action is less brute force and more of a modification of existing cholesterol regulating systems, and I don't believe have the same potential to deprive the brain of cholesterol.

It may not even be more life as the Dr.s appear to have no data showing statins on the average lead to any longer of a life span then if they are not taken.

Are you saying that the new medication is a large enough molecule that it can not pass the blood brain barrier?

 

[Ghoul]

On the first run of the ski season last year a friend had his Achilles rupture and he has been on statins for years and was in the gym regularly till then. which supports what i have read over the yeas.

It may not even be more life as the Dr.s appear to have no data showing statins on the average lead to any longer of a life span then if they are not taken.

Are you saying that the new medication is a large enough molecule that it can not pass the blood brain barrier?

Let me preface this is a theory based on a very superficial look at the relevant info.

The brain produces lipids, mostly fatty acids, essential for proper function. Statins interfere with the liver's ability to produce cholesterol. including triglycerides built on fatty acids. Statins crossing the bbb may be interfering with the brains endogenous lipid producing function.

PCSK9 inhibitors block molecules that would occupy LDL receptors, so LDL can activate them instead, resulting in a downregulation of LDL production via the natural feedback systems intended to keep LDL in check. I suspect this natural cholesterol feedback loop does not interfere with the brain's own capacity to make critical fatty acids.

A lot of assumptions here, I'll read more, but that seems like it might explain the much lower incidence of brain fog on PCSK9 inhibitors.