Please help, Statin advice, Lipids are off

[Scruf]

Clarification:

Lipoprotein (a) 11.2
Apolipoprotein B: 107
Apolipoprotein A-1: 61

 

[buck]

I found that as I was getting a bit older, it was getting tougher to keep my lipids in check. I had to eat perfectly, even during a bulk. I finally broke down and decided to try a very low dose of Crestor. I started at 5mg every other day, along with 300mgs CoQ10. I had absolutely no side effects. My LDL went to optimal but HDL remained low. I upped to dose to 5mg a day...still no side effects at all. My HDL is still a bit low, but better. I can also enjoy a cheeseburger and fries every other day for one meal and not worry about fucking up my values.

Every major cardiology organization in the world recognizes that low HDL and high LDL is bad for health and longevity. Might it turn out in some years that they were overestimating the risk? Sure. That's possible. But as of now, the consensus is clear. I just don't think there's any amount of PubMed articles or Dr. Google you're gonna do that trumps what these folks around the world have been studying their entire lives.

When i asked 2 cardiologists last year how much longer people live on the average after starting to taken stains. They replies that they have never seen any studies about that. I have not really seen any either and i have looked. Just small ones here and there. Big pharma has tracked people taking their medication for decade's and can post how many less heart attacks they have but don't post data about living longer. And i have to wonder why. I would be posting that stains help to extend life for those with bad cholesterol levels if that was the case as that would be one more selling point.
Drs are trained to cure disease and manage pain. as they have told me. They are not trained as to what is best for optimal health. More than 1 Dr has told me i know more about health then they do. I find the well informed patient is the best diagnostician they are likely going to run into for themselves.
The brain is 60% fat and about 25% of that is cholesterol. Brain shrinkage is a problem as people get older. I have to wonder how much cholesterol is optimal for the brain health. The same thing can be said for other systems in the body.Less may not always benefit everything.
Cardiologists say to have cholesterol levels under 200. I have seen studies that show levels under 130 have a higher death rate then over 200. And this study with 12.8 million people(and that is a big study) show longevity is best around 215-220.

Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults - Scientific Reports

It is unclear whether associations between total cholesterol (TC) levels and all-cause mortality and the optimal TC ranges for lowest mortality vary by sex and age. 12,815,006 Korean adults underwent routine health examinations during 2001–2004, and were followed until 2013. During follow-up...

www.nature.com

 

[egruberman]

When i asked 2 cardiologists last year how much longer people live on the average after starting to taken stains. They replies that they have never seen any studies about that. I have not really seen any either and i have looked. Just small ones here and there. Big pharma has tracked people taking their medication for decade's and can post how many less heart attacks they have but don't post data about living longer. And i have to wonder why. I would be posting that stains help to extend life for those with bad cholesterol levels if that was the case as that would be one more selling point.

I'll take an extra decade, please:

A method to estimate the mean lifetime survival increase of statin therapy - PubMed

Previous analysis of the same data was limited by the trials' relatively short run time. As such, we propose a method for correctly estimating the true effect of statin therapy in terms of total lifetime extension.

pubmed.ncbi.nlm.nih.gov

 

[Scruf]

When i asked 2 cardiologists last year how much longer people live on the average after starting to taken stains. They replies that they have never seen any studies about that. I have not really seen any either and i have looked. Just small ones here and there. Big pharma has tracked people taking their medication for decade's and can post how many less heart attacks they have but don't post data about living longer. And i have to wonder why. I would be posting that stains help to extend life for those with bad cholesterol levels if that was the case as that would be one more selling point.
Drs are trained to cure disease and manage pain. as they have told me. They are not trained as to what is best for optimal health. More than 1 Dr has told me i know more about health then they do. I find the well informed patient is the best diagnostician they are likely going to run into for themselves.
The brain is 60% fat and about 25% of that is cholesterol. Brain shrinkage is a problem as people get older. I have to wonder how much cholesterol is optimal for the brain health. The same thing can be said for other systems in the body.Less may not always benefit everything.
Cardiologists say to have cholesterol levels under 200. I have seen studies that show levels under 130 have a higher death rate then over 200. And this study with 12.8 million people(and that is a big study) show longevity is best around 215-220.

Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults - Scientific Reports

It is unclear whether associations between total cholesterol (TC) levels and all-cause mortality and the optimal TC ranges for lowest mortality vary by sex and age. 12,815,006 Korean adults underwent routine health examinations during 2001–2004, and were followed until 2013. During follow-up...

www.nature.com

The report concerns me because they only studied Koreans, I believe Koreans have high HDL levels.

Here is a report detailing the benefits of lowering LDL levels. Effects on 11-year mortality and morbidity of lowering LDL cholesterol with simvastatin for about 5 years in 20 536 high-risk individuals: a randomised controlled trial

 

[buck]

The report concerns me because they only studied Koreans, I believe Koreans have high HDL levels.

Here is a report detailing the benefits of lowering LDL levels. Effects on 11-year mortality and morbidity of lowering LDL cholesterol with simvastatin for about 5 years in 20 536 high-risk individuals: a randomised controlled trial

I wrote that those with a need may benefit from lowering LDL levels. As that may lower vascular issues for that demographic.

And the very next paragraph in that report you posted said

"lower blood cholesterol concentrations have been associated with higher rates of particular types of cancer, and with other non-vascular morbidity and mortality.5,6 It has been suggested, therefore, that lowering LDL cholesterol (particularly to low levels) might produce increases in the rates of cancers and other types of adverse events that take longer than 5 years to emerge."

So thank you for posting that lowering cholesterol for the average person may not be in their best interest. Which is what the study i posted in a previous thread also shows.

 

[buck]

I'll take an extra decade, please:

A method to estimate the mean lifetime survival increase of statin therapy - PubMed

Previous analysis of the same data was limited by the trials' relatively short run time. As such, we propose a method for correctly estimating the true effect of statin therapy in terms of total lifetime extension.

pubmed.ncbi.nlm.nih.gov

I did not see where that was for a large group of all people taking stains. I missed what the size of that groups was could you please point it out to me. And did that group also change their lifestyle and eating patterns?
And it also appears the study did not actually track the longevity of the people in the study. But predicted from the numbers they used that people would live longer. So that is far from a hard number.
"extrapolated out to the end of the patients' predicted lifetimes for each study."

And this study for those over 65 shows there may be no benefit to stains as life span did not noticeably go up.

Do statins reduce mortality in older people? Findings from a longitudinal study using primary care records

Objective Assess whether statins reduce mortality in the general population aged 60 years and above. Design Retrospective cohort study. Setting Primary care practices contributing to The Health Improvement Network database, England and Wales, 1990–2017. Participants Cohort who turned age 60...

fmch.bmj.com

And this projected study like you posted shows maybe 6 months more life.

https://www.sciencedirect.com/science/article/pii/S0735109702019149

Other studies point to low cholesterol of not being optimal for longevity.

Low Cholesterol is Associated With Mortality From Stroke, Heart Disease, and Cancer: The Jichi Medical School Cohort Study - PMC

We investigated the relationship between low cholesterol and mortality and examined whether that relationship differs with respect to cause of death. A community-based prospective cohort study was conducted in 12 rural areas in Japan. The study ...

www.ncbi.nlm.nih.gov

and can increase arterial calcification from cardiologists i have spoken to as well as studies

Long-term statin therapy is associated with severe coronary artery calcification - PMC

Atherosclerosis and consequent risk of cardiovascular events or mortality can be accurately assessed by quantifying coronary artery calcium score (CACS) derived from computed tomography. HMG-CoA-reductase inhibitors (statins) are the primary ...

www.ncbi.nlm.nih.gov

I think people should just look into things themselves to make the best decision they can.

I have had low cholesterol all my life with around 140 total usually, good BP 110/64 this morning. Low glucose levels healthy diet exercise etc. all my life but my arteries show calcification. So cardiologists want to prescribe me a statins to lower my LDL of 75 down ward as that is what they always suggest. Even though the cardiologists i have spoke to has said they don't think it will help me in any way. And can have side effects even though i had to ask about them as they did not bring it up themselves. But they are required to suggest it as their organization, hospital and the US government has deemed it to be policy. And they could be liable for malpractice then if they didn't. I find Dr.s tend to not talk about downsides unless you press them.

 

[Mongo966]

So cardiologists want to prescribe me a statins to lower my LDL of 75 down ward as that is what they always suggest. Even though the cardiologists i have spoke to has said they don't think it will help me in any way.

I'm confused. The cardiologists want to prescribe you statins but the cardiologists you have spoken with don't think it will help you in any way? How many cardiologists do you have and are they all fighting with each other?

 

[egruberman]

I did not see where that was for a large group of all people taking stains. I missed what the size of that groups was could you please point it out to me. And did that group also change their lifestyle and eating patterns?

The two cardiologists you mentioned said they had never seen any studies. I pointed at one. There are many, but that one gives the best estimate of individual longevity. Other studies suggest a few days and some around ten days, but that's across an entire population and doesn't seem as significant as they are for that reason. We'd have to get into the weeds on the math, the number needed to treat and so on, but the overwhelming majority of evidence shows that statins do extend lifespan. Given that nobody can predict exactly when you'll die, nobody can predict exactly the amount by which your lifespan will be lengthened.

my arteries show calcification. So cardiologists want to prescribe me a statins to lower my LDL of 75 down ward as that is what they always suggest. Even though the cardiologists i have spoke to has said they don't think it will help me in any way.

Your lifestyle doesn't matter, your diet doesn't matter, your cholesterol doesn't matter, if your CT-CAC is non-zero then you have ASCVD. You should consider treating that. The primary intervention for that is a statin.

ApoB is more closely correlated to risk than LDL-C, so you should probably get that checked. For someone at risk of ASCVD either by having a non-zero calcium score or a family history, Tom Dayspring recommends managing ApoB to less than 60mg/dL. For the average healthy population, 80mg/dL is recommended. It's probably worthwhile to have your Lp(a) checked as well, you'll get both on an NMR lipid panel. If your cardiologists can't help you understand why these biomarkers are important, find new ones with a more up-to-date understanding of lipidology.

The fact that statins increase one's calcium score is a red herring. A calcium score is a proxy for the amount of the more dangerous soft plaque in the arteries. It is presumed that the presence of more mature calcified plaque implies the presence of the more dangerous and less mature soft.plaque. When a statin is introduced, that implication changes. The soft plaque become more stable calcified plaque, the calcium score goes up, and yet the risk goes down.

Finally, there is some evidence that keeping LDL below 60mg/dL may cause regression in arterial plaque. Folks like you and me with non-zero CAC may benefit from keeping extremely low LDL (and ApoB).

For myself, I got a CT-CAC (score of 38) at 48yo and am now 51. That's "mild" ASCVD. I've tried diet, exercise, all the supplements, ezetimibe mono-therapy, statins, bempedoic acid and more recently, Repatha. Rosuvastatin 10mg daily had the largest impact on my lipids and I've seen no side effects. Presently, my LDL is 56 and ApoB is 60mg/dL before starting Repatha.

So, I've gone from "I'm going to die of a heart attack, it's just a matter of when" to "I may not die from a heart attack". I'll pay out of pocket for a CT angiogram when I'm 55 or so to see how I'm really doing.

 

[Scruf]

I wrote that those with a need may benefit from lowering LDL levels. As that may lower vascular issues for that demographic.

And the very next paragraph in that report you posted said

"lower blood cholesterol concentrations have been associated with higher rates of particular types of cancer, and with other non-vascular morbidity and mortality.5,6 It has been suggested, therefore, that lowering LDL cholesterol (particularly to low levels) might produce increases in the rates of cancers and other types of adverse events that take longer than 5 years to emerge."

So thank you for posting that lowering cholesterol for the average person may not be in their best interest. Which is what the study i posted in a previous thread also shows.

Yeah so I am not sure we are here for the same reason. It’s not a competition to see who can be righter.

Your claim that lowering Cholesterol is bad for you is not something that I agree with nor does most of the medical community.

 

[buck]

Yeah so I am not sure we are here for the same reason. It’s not a competition to see who can be righter.

Your claim that lowering Cholesterol is bad for you is not something that I agree with nor does most of the medical community.

You are reading into it what you want. I never said lowering LDL was always unhealthy. I said it may be depending on ones condition and depending on the level the person is at. Many think low levels are always healthier and they are not as those studies i posted show. Cardiologist only look at the heart for the most part and do not take the whole body into consideration. Same with all other specialist. But if you have studies showing that people actually live longer especially the average person i would like to see them. And if you do not agree with what i post i understand just do as you think is best. I just put out info so people can make the best choice for themselves. I could care less if they believe among my lines or not. We are all individuals experimenting with our bodies the way we choose to. Years ago dr.s said blood pressure levels up to 140/90 was healthy and didn't need to be addressed. and same with fasting glucose levels. Even though longevity tables showed people with levels like that died far sooner. I look at what levels people tend to die at to decide what a healthy level is. Medicine goes by their own guidelines which are often influenced by insurance companies, lobbyists and the government.

 

[buck]

The two cardiologists you mentioned said they had never seen any studies. I pointed at one. There are many, but that one gives the best estimate of individual longevity. Other studies suggest a few days and some around ten days, but that's across an entire population and doesn't seem as significant as they are for that reason. We'd have to get into the weeds on the math, the number needed to treat and so on, but the overwhelming majority of evidence shows that statins do extend lifespan. Given that nobody can predict exactly when you'll die, nobody can predict exactly the amount by which your lifespan will be lengthened.


Your lifestyle doesn't matter, your diet doesn't matter, your cholesterol doesn't matter, if your CT-CAC is non-zero then you have ASCVD. You should consider treating that. The primary intervention for that is a statin.

ApoB is more closely correlated to risk than LDL-C, so you should probably get that checked. For someone at risk of ASCVD either by having a non-zero calcium score or a family history, Tom Dayspring recommends managing ApoB to less than 60mg/dL. For the average healthy population, 80mg/dL is recommended. It's probably worthwhile to have your Lp(a) checked as well, you'll get both on an NMR lipid panel. If your cardiologists can't help you understand why these biomarkers are important, find new ones with a more up-to-date understanding of lipidology.

The fact that statins increase one's calcium score is a red herring. A calcium score is a proxy for the amount of the more dangerous soft plaque in the arteries. It is presumed that the presence of more mature calcified plaque implies the presence of the more dangerous and less mature soft.plaque. When a statin is introduced, that implication changes. The soft plaque become more stable calcified plaque, the calcium score goes up, and yet the risk goes down.

Finally, there is some evidence that keeping LDL below 60mg/dL may cause regression in arterial plaque. Folks like you and me with non-zero CAC may benefit from keeping extremely low LDL (and ApoB).

For myself, I got a CT-CAC (score of 38) at 48yo and am now 51. That's "mild" ASCVD. I've tried diet, exercise, all the supplements, ezetimibe mono-therapy, statins, bempedoic acid and more recently, Repatha. Rosuvastatin 10mg daily had the largest impact on my lipids and I've seen no side effects. Presently, my LDL is 56 and ApoB is 60mg/dL before starting Repatha.

So, I've gone from "I'm going to die of a heart attack, it's just a matter of when" to "I may not die from a heart attack". I'll pay out of pocket for a CT angiogram when I'm 55 or so to see how I'm really doing.

The study you posted did not actual track people till they died. It extrapolated out from the data they collected And depending on who paid for the study the calculations may have been skewed to reflect that. The quote form the study. Is beow.

"Gompertz distributions were fit up to the end of the trials, and then extrapolated out to the end of the patients' predicted lifetimes for each study."

But i totally support you in getting your LDL levels as low as you can if you think that is best.

 

[egruberman]

depending on who paid for the study the calculations may have been skewed to reflect that.

If there weren't a mountain of other evidence showing that statins increased lifespan, then I'd be concerned.

But i totally support you in getting your LDL levels as low as you can if you think that is best.

It's not just that it's what I think is best. It is what folks like Allan Sniderman think is best. I'll give you an opportunity to google that name, but suffice it to say, I'm not pulling this out of my ass. What's more, if you want to not die at an early age from the disease that you have, you might consider treating it.