Saw a cardiologist to make sense of my lipids

Majority? Yes. At 45, there's a 25% chance of a non-zero calcium score for all white males. With an LDL >160mg/dL and elevated BP that probability changes dramatically.
The thing I don't understand is that I presented these lipids for a long time and my yearly primary care doctors only did one extra test. A Lipo a test which was 8. Never a talk of stations nor anything else.
 
My levels are just right around yours… i went for a repatha script due to having this high of cholesterol for almost 20 yrs… im in my upper 40’s and its something i want to prevent before something happens… IF anything is going to happen? Dunno and nobody knows…
What is that panel called with all the LDL markers and ApoB ("10 markers").
 
What is that panel called with all the LDL markers and ApoB ("10 markers").

That was a functional health care place i purchased s hit ton of blood work thru… dr mark hyman has his hands in the company… if u want an invite i can send u one… it seems to some to not be affordable… some feel its worth it as u have a doctor actually give u a review but wont do anything beyond that…
 
This is patently false. LDL matters in the sense that it traffics ApoB which, coupled with inflammation, as you pointed out, is causal of atherosclerotic plaque.
I don't think we're saying that different things. To put my comment another way.. Without inflammation, does LDL matter?

I watched a video with Dr. McClain (HRT doc) and Mike O'Hearn on YT recently and I think he was saying that without the inflammation, the LDL doesn't cause disease.
 
I would be much more worried about the BP then the cholesterol levels
Having calcium deposits in the arteries is fairly normal as one ages. Seems by age 40 at least half of people will have deposits. Just depends on the degree.
I have calcium deposits even though all the traditional blood markers cholesterol, LDL, VLDL, ( i assume ApoB as it was low last i checked only checked recently) BP, glucose, inflammatory markers etc . have been in ranges that are considered very good. Studies i have seen show people that train hard from weights and aerobics usually have more calcification then average. I tend to think that may be from the higher BP that occur during training or from all the catabolic/stress hormones that are produced at that time.
 
That was a functional health care place i purchased s hit ton of blood work thru… dr mark hyman has his hands in the company… if u want an invite i can send u one… it seems to some to not be affordable… some feel its worth it as u have a doctor actually give u a review but wont do anything beyond that…
I very much appreciate the offer. I use Fitomics. If you havn't seen their thread, they offer the lowest lab prices I've seen.

I looked though alot of my lab reports and didn't see an ApoB marker. However, I didn't have a chance to go through all 10 years of them (on the weekend the computer belongs to the kids, lol). I get bloodwork done at least every 30 days now and want to add that on the next go.

What @egruberman shared was eye-opening, as heart disease runs in my family and I have spent the last 4 years ultra-conscious about keeping my lipids down.
 
I very much appreciate the offer. I use Fitomics. If you havn't seen their thread, they offer the lowest lab prices I've seen.

I looked though alot of my lab reports and didn't see an ApoB marker. However, I didn't have a chance to go through all 10 years of them (on the weekend the computer belongs to the kids, lol). I get bloodwork done at least every 30 days now and want to add that on the next go.

What @egruberman shared was eye-opening, as heart disease runs in my family and I have spent the last 4 years ultra-conscious about keeping my lipids down.

Whats the cost for fitomics?? Sometimes u have to request certain items as they are not cart blanche…
 
Whats the cost for fitomics?? Sometimes u have to request certain items as they are not cart blanche…
Actually bro, they have extensive LabCorp labs, and will add—usually within a day or two upon request—unlisted labs that you request. Just give them the LabCorp lab code and they do the rest. They just added Quest as well, but the selection of labs is lacking, more expensive too. They have indicated they are growing Quest labs.

You can just order through them without a plan, but there are additional fees, such as "Dr. Order," and "draw" charge, and not as big a discount. They also have two subscriber plans, Monthly and Quarterly. I think monthly is $30.00 and quarterly $75.00. With these subscription plans you don't pay any of those fees. So, If your running labs every 2 to 4 weeks, the subscription fee pays for itself multiplied.

I have the quarterly plan, I'm happy with the pricing, speed, and cust. service.

Full discolsure: I am NOT compensated in any way from them.
 
I don't think we're saying that different things. To put my comment another way.. Without inflammation, does LDL matter?

I watched a video with Dr. McClain (HRT doc) and Mike O'Hearn on YT recently and I think he was saying that without the inflammation, the LDL doesn't cause disease.

On an individual basis, it may not matter. On a population level, it very much matters.

Elevated LDL is highly correlated with the progression of ASCVD. There are examples of people that have elevated LDL and even elevated ApoB with no plaque burden. One potential explanation for that is an absence of inflammation, other explanations include genetics, but what specifically is unknown. There are also lean mass hyper responders for which there is some ongoing research.

Those things all being true, they get latched upon by science deniers, conspiracy theorists and people on a carnivore diet. Basically all nut jobs.

In summary, those people are outliers. The science behind lipids is pretty well settled, though not as well understood as it could be, which I blame the medical community for. Lipids are biomarkers, that suggest a certain amount of risk. There’s still more or less probability that ASCVD will develop and more or less probability that a MACE will occur.
 
Those things all being true, they get latched upon by science deniers, conspiracy theorists and people on a carnivore diet. Basically all nut jobs.
This is quite problematic because it's hard to discern what's real and what's not. Is egg yolk truly a spectacular fat or is it destroying my lipids profile at an egg or 2 per day? Are seed oils really killing me bc I just got an update from Arnold's Pump club that canola oil is a healthy fat (based on the current research) whereas the guys eating 2 ribeyes per day covered with ghee tell you 2 tbsp of canola oil is killing you. IT'S SO CONFUSING.

I literally asked the cardiologist, "If I have the choice to eat salmon w/high healthy fats or white fish w/no fats which choice do I make?". Her reply, "we don't know."
 
This is quite problematic because it's hard to discern what's real and what's not. Is egg yolk truly a spectacular fat or is it destroying my lipids profile at an egg or 2 per day? Are seed oils really killing me bc I just got an update from Arnold's Pump club that canola oil is a healthy fat (based on the current research) whereas the guys eating 2 ribeyes per day covered with ghee tell you 2 tbsp of canola oil is killing you. IT'S SO CONFUSING.

I spend an inordinate amount of time sifting through the bullshit. Even still, the best answers are likely to change.

As far as eggs go, they're high in dietary cholesterol, but relatively low in saturated fat. Means they're fine for most people, because dietary cholesterol has little to do with cholesterol produced in the liver beyond the fact that one can be used as a source of materials for the other, but one doesn't stimulate the other. Some people have a genetic predisposition to react poorly to saturated fats, an excess of which will wreck their lipids. Other folks not so much.

Seed oils are fine. There is no plausible evidence that they are harmful.

Omega-3 fatty acids have a number of benefits for joint and cognitive health. They reduce triglycerides, are anti-inflammatory and help stabilize plaques. Supplementation is beneficial for those with further along with ASCVD. There are trials that show positive outcomes in a high risk population. For folks that are otherwise reasonably healthy, higher doses (~4g EPA daily)may pose risks that outweigh the benefits. I think I aim for about half that.
 
What are you doing to lower your apob? And how are u maning to keep it low?

Missed this question:

I’m on all the things: rosuvastatin 10mg daily, nexlizet, which is a combo of ezetimibe and bempedoic acid as well as bi-weekly Repatha injections.

Currently, it at least before I started blasting, my LDL was 17mg/dL and my ApoB was 32mg/dL
 
I would be much more worried about the BP then the cholesterol levels
Having calcium deposits in the arteries is fairly normal as one ages. Seems by age 40 at least half of people will have deposits. Just depends on the degree.
I have calcium deposits even though all the traditional blood markers cholesterol, LDL, VLDL, ( i assume ApoB as it was low last i checked only checked recently) BP, glucose, inflammatory markers etc . have been in ranges that are considered very good. Studies i have seen show people that train hard from weights and aerobics usually have more calcification then average. I tend to think that may be from the higher BP that occur during training or from all the catabolic/stress hormones that are produced at that time.

I'm also wondering in what world is that BP ok?

There's a reason preventative cadiologists are pounding the table at conferences.

The most recent guidelines based on the comprehensive data of long term outcomes had led to 120-129/70-79 now being considered "elevated", and first line treatment above that is pharmaceutical, not merely lifestyle intervention.

The longer one is in elevated or above the worse things get down the line.

Too many frontline doctors don't keep their skills current once they get their medical license.
 
I'm also wondering in what world is that BP ok?

There's a reason preventative cadiologists are pounding the table at conferences.

The most recent guidelines based on the comprehensive data of long term outcomes had led to 120-129/70-79 now being considered "elevated", and first line treatment above that is pharmaceutical, not merely lifestyle intervention.

The longer one is in elevated or above the worse things get down the line.

Too many frontline doctors don't keep their skills current once they get their medical license.
From his post it seems his Dr is much more concerned with the BP then the cholesterol just don't see what is being done to address it though.
 
Missed this question:

I’m on all the things: rosuvastatin 10mg daily, nexlizet, which is a combo of ezetimibe and bempedoic acid as well as bi-weekly Repatha injections.

Currently, it at least before I started blasting, my LDL was 17mg/dL and my ApoB was 32mg/dL

Holy fudge thats super low ldl… wow… and all that plus repatha? Ever have a cac and or soft plaque check? I doubt u have any calcium build up or soft plaque anywhere but damn…

How bad was ur total ldl and cholesterol that lead u to be on

Statin
Cholesterol reducers for the gut &&
Repatha…

Im afraid my brain would die from not enough cholesterol…
 
Holy fudge thats super low ldl… wow… and all that plus repatha? Ever have a cac and or soft plaque check? I doubt u have any calcium build up or soft plaque anywhere but damn…

How bad was ur total ldl and cholesterol that lead u to be on

Statin
Cholesterol reducers for the gut &&
Repatha…

Im afraid my brain would die from not enough cholesterol…

Fear not! The brain produces its own cholesterol, just in case.

Also, that's what makes cholesterol lowering drugs that can cross the blood brain barrier very dangerous, incidentally.
 
Ever have a cac and or soft plaque check? I doubt u have any calcium build up or soft plaque anywhere but damn…

How bad was ur total ldl and cholesterol that lead u to be on

Statin
Cholesterol reducers for the gut &&
Repatha…

Im afraid my brain would die from not enough cholesterol…

LDL wasn't that bad. Apob was >100. CT-CAC was 43. My aunt had an MI in her 40s with plaque in the LAD. Mine is also in the LAD.

And so... I'm running a 5 year experiment to see how low I can get LDL and ApoB with the goal of possibly reversing the calcified plaque.

I started with diet and exercise, then supplements like psyllium and a very high dose of EPA, which had me at 112mg/dL ApoB. Then I added in ezetimibe. After about a year I was hanging with a friend who is metabolically unhealthy, never exercises, shit diet etc.. He showed me his lipids and they were better than mine. He was on 20mg Rosuvastatin, and so that sealed it for me. I tried Rosuvastatin at 10mg/day after learning about the dose response curve, which goddamn it, I'll write about in an article shortly, but most of the efficacy comes from 25% of the max dose. Here:

1730084953607.webp

I ran that for quite some time watching for adverse side effects. Seeing none, I moved on to bempedoic acid. In parallel with that, I was working on getting Repatha. The Rx was easy, but it's expensive as hell. I applied for a copay card which is easy to get, but found out my company's pharmaceutical benefit includes a special rider for "preventative" care and so Repatha was covered with no pre-auth.

After a year on all of that, my lipids are in good shape. Just in time to.... blast my face off, which is what I'm doing presently.

As for cholesterol in the brain, as @Ghoul pointed out, the brain makes its own cholesterol and it's best to run a statin that doesn't cross the blood brain barrier. Those would be hydrophilic statins like Rosuvastatin or Pravastatin.
 
Fear not! The brain produces its own cholesterol, just in case.

Also, that's what makes cholesterol lowering drugs that can cross the blood brain barrier very dangerous, incidentally.
And that was and is my concern, blood brain barrier cholesterol lowering, which would be?

I mean to lower ur ldl that low, im not sure thats healthy… but i dont know much… so there’s that
 
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