Saw a cardiologist to make sense of my lipids

[jtmarlin]

I went to the cardiologist bc I cannot seem to grasp what a bad lipids profile is. I read some posts here which makes me think I'm dying so I wanted to get checked. I'm in my early 40s.

Total cholesterol 235
Triglycerides 58
HDL 58
VLDL calc 10
LDL 167

Lipo A 10
Apo B 119

She said my numbers are fine and I'm not a candidate for any sort of medical treatment. She said the cutoff they use is 130 for Apo B, not 90 like LabCorp uses. She said that ultra low LDL and Apo B targets are used for people who have had elevated calcium scores or previous heart attacks, not healthy population w/low risk factors. I'm using 30mg of test e daily injects. She knows this and advised me on a much much bigger problem in her mind which is blood pressure. I'm 130-140/80-90 and she told me to monitor that especially due to my androgen use. This isn't advice but according to my cardiologist my lipids profile is not problematic even though my LDL and Apo B are out of range on LabCorp tests. I did push for a calcium score CT which I am getting today but she advised that it is most likely going to be zero.

 

[DugPrime]

Chill buddy, all you need is 40mg of Telmisartan + 5mg of Ezetimibe, once in the morning, why you're not on them yet?

 

[Type-IIx]

Chill buddy, all you need is 40mg of Telmisartan + 5mg of Ezetimibe, once in the morning, why you're not on them yet?

The doc said he doesn’t need these because they come with risks and he’s healthy. Those drugs are for sick people despite unwarranted “prophylactic” use

Thread 'Telmisartan and ARBs/ACE inhibitors are not a preventive cure-all for AAS users'

Jan 31, 2022

I am seeing a lot of gurus promoting these meds as a prophylactic ("preventive cure-all") for healthy AAS users without providing any cautionary disclaimers whatsoever. These drugs can harm the kidneys (and the liver). They should be used for treatment of hypertension (i.e., when your blood pressure is actually chronically elevated).

These drugs (here, looking at telmisartan specifically, but as a class, this [perhaps aside from drug-drug interactions]) can cause:

1a. potassium dysregulation, e.g. hyperkalemia (increased potassium retention despite its direct action), and 1b. electrolyte...

• Type-IIx
• kidney injury telmisartan
• Replies: 8
• Forum: Steroid Forum

• 
• 

 

[DugPrime]

The doc said he doesn’t need these because they come with risks and he’s healthy. Those drugs are for sick people despite unwarranted “prophylactic” use

Thread 'Telmisartan and ARBs/ACE inhibitors are not a preventive cure-all for AAS users'

Jan 31, 2022

I am seeing a lot of gurus promoting these meds as a prophylactic ("preventive cure-all") for healthy AAS users without providing any cautionary disclaimers whatsoever. These drugs can harm the kidneys (and the liver). They should be used for treatment of hypertension (i.e., when your blood pressure is actually chronically elevated).

These drugs (here, looking at telmisartan specifically, but as a class, this [perhaps aside from drug-drug interactions]) can cause:

1a. potassium dysregulation, e.g. hyperkalemia (increased potassium retention despite its direct action), and 1b. electrolyte...

• Type-IIx
• kidney injury telmisartan
• Replies: 8
• Forum: Steroid Forum

• 
• 

He's probably healthy overall, but with stage 1 hypertension and an LDL of 167 at over 40 years old, I’d be cautious, especially if he’s also using anabolic steroids on the side.

 

[jtmarlin]

He's probably healthy overall, but with stage 1 hypertension and an LDL of 167 at over 40 years old, I’d be cautious, especially if he’s also using anabolic steroids on the side.

The cardiologist knows all of this and didn't want to medically intervene.

 

[Grey Spartan]

The cardiologist knows all of this and didn't want to medically intervene.

I actually applaud the cardiologist for not prescribing extra drugs.

 

[jtmarlin]

Well the results of my calcium test came back already. I haven't discussed with the doctor yet but I'm a bit spooked.

FINDINGS:
CALCIUM SCORE: The observed Agatston Calcium Score is 175. The Agatston score for each vessel is as follows:
LM: 0; LAD: 147; LCx: 27.7; RCA: 0

What I really don't understand is why all of the score seems to be concentrated on the LAD (widowmaker). Will have to see what she says but she expected the test to likely show zero across the board. She also has a multi-year history of my lipids panels.

May be due for some lifestyle changes.

 

[Avies48]

I went to the cardiologist bc I cannot seem to grasp what a bad lipids profile is. I read some posts here which makes me think I'm dying so I wanted to get checked. I'm in my early 40s.

Total cholesterol 235
Triglycerides 58
HDL 58
VLDL calc 10
LDL 167

Lipo A 10
Apo B 119

She said my numbers are fine and I'm not a candidate for any sort of medical treatment. She said the cutoff they use is 130 for Apo B, not 90 like LabCorp uses. She said that ultra low LDL and Apo B targets are used for people who have had elevated calcium scores or previous heart attacks, not healthy population w/low risk factors. I'm using 30mg of test e daily injects. She knows this and advised me on a much much bigger problem in her mind which is blood pressure. I'm 130-140/80-90 and she told me to monitor that especially due to my androgen use. This isn't advice but according to my cardiologist my lipids profile is not problematic even though my LDL and Apo B are out of range on LabCorp tests. I did push for a calcium score CT which I am getting today but she advised that it is most likely going to be zero.

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…

 

[bigMoJo]

I went to the cardiologist bc I cannot seem to grasp what a bad lipids profile is. I read some posts here which makes me think I'm dying so I wanted to get checked. I'm in my early 40s.

Total cholesterol 235
Triglycerides 58
HDL 58
VLDL calc 10
LDL 167

Lipo A 10
Apo B 119

She said my numbers are fine and I'm not a candidate for any sort of medical treatment. She said the cutoff they use is 130 for Apo B, not 90 like LabCorp uses. She said that ultra low LDL and Apo B targets are used for people who have had elevated calcium scores or previous heart attacks, not healthy population w/low risk factors. I'm using 30mg of test e daily injects. She knows this and advised me on a much much bigger problem in her mind which is blood pressure. I'm 130-140/80-90 and she told me to monitor that especially due to my androgen use. This isn't advice but according to my cardiologist my lipids profile is not problematic even though my LDL and Apo B are out of range on LabCorp tests. I did push for a calcium score CT which I am getting today but she advised that it is most likely going to be zero.

Hey bro,
LDL is essentially the crap that builds on arterial walls.
BP is the "silent killer" not just because of heart attacks, but it can affect you kidneys and other organs in the long term. Regarding kidneys, the increased BP places more stress on them, and likely they decrease in function over time.

It's great you are on top of it. Personally, I have great doctors and my PCP is irreplacable, but I don't just take their word for it and let my guard down.

 

[jtmarlin]

I came across a study that discussed the risks of early onset plaque building in AAS users due to the fact that the HDL loses some of its protective abilities. Perhaps I'm paying the piper now. I cycled for 4 years or so 15-20 years ago, did nothing for 10+ years then have been on TRT mostly. I have run one other decent cycle during that time. I'm waiting to see what she says.

 

[egruberman]

LDL is essentially the crap that builds on arterial walls.

Actually, it's ApoB for which LDL is the carrier.

The cardiologist knows all of this and didn't want to medically intervene.

After seeing your calcium score, your cardiologist is an asshat.

This has me lamenting that I haven't submitted my lipids management article, but here goes.

Tom Dayspring recommends folks with no other risk factors keep ApoB at 80mg/dL or less and folks with other risk factors under 60mg/dL. You have high BP and moderate calcified plaque.

I started in a similar place. I was reasonably fit with a total around 200, high LDL and ApoB around 111mg/dL. I had a calcium score of 43. I started with all the lifestyle changes and supplements that had any proven efficacy, which did little. I added in ezetimibe which reduced my ApoB from around 111mg/dL to 98mg/dL. I tossed in 10mg/day rosuvastatin and went from 98 to 64mg/dL. From there I added bempedoic acid which got me to 60mg/dL and finally Repatha which got me to 32mg/dl:



There's some evidence that suggests that getting ApoB under 60mg/dL may reverse calcified plaque. Certainly starting a statin will increase calcium score because it will help stabilize soft plaque that is there.

So, I'll suggest some combo of these things and absolutely get your BP under 120/80.

 

[jtmarlin]

Actually, it's ApoB for which LDL is the carrier.



After seeing your calcium score, your cardiologist is an asshat.

This has me lamenting that I haven't submitted my lipids management article, but here goes.

Tom Dayspring recommends folks with no other risk factors keep ApoB at 80mg/dL or less and folks with other risk factors under 60mg/dL. You have high BP and moderate calcified plaque.

I started in a similar place. I was reasonably fit with a total around 200, high LDL and ApoB around 111mg/dL. I had a calcium score of 43. I started with all the lifestyle changes and supplements that had any proven efficacy, which did little. I added in ezetimibe which reduced my ApoB from around 111mg/dL to 98mg/dL. I tossed in 10mg/day rosuvastatin and went from 98 to 64mg/dL. From there I added bempedoic acid which got me to 60mg/dL and finally Repatha which got me to 32mg/dl:

View attachment 300171

There's some evidence that suggests that getting ApoB under 60mg/dL may reverse calcified plaque. Certainly starting a statin will increase calcium score because it will help stabilize soft plaque that is there.

So, I'll suggest some combo of these things and absolutely get your BP under 120/80.

She hasn't seen my calcium score yet. Her assumption was that it would most likely be zero. Will have to see what she says when she calls to discuss the results.

 

[egruberman]

Her assumption was that it would most likely be zero.

From my perspective, that's a ridiculous assumption. Your age, BP, and LDL are all alarm bells. I would've given you a 50/50 chance at best.

 

[MarkusLA]

I'd love to have your Lipid numbers. Man.

You have to do more homework, but like that your doc isn't pushing drugs on you. My understanding is that LDL doesn't matter -- it's inflammation in your arteries that is the first step in LDL clogging them. Triglycerides are important because (I think), they correlate with ApoB.

You can check your inflammation with a Sensitive CRP test.

I took a "heart scan" years ago with a zero score, which is ideal. If yours is not zero, William Davis MD "wheat belly author" had a protocol to reverse it -- I think it was Vitamin D, no wheat & sugar, and a couple of other things.

 

[jtmarlin]

From my perspective, that's a ridiculous assumption. Your age, BP, and LDL are all alarm bells. I would've given you a 50/50 chance at best.

This is a serious question. If 1000 men aged 43 were chosen at random and none of them had used anabolics ever, would the majority have zero calcium scores?

 

[jtmarlin]

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…

When this blood work was taken, were you taking any testosterone or other AAS and did you ever get a calcium score?

 

[egruberman]

This is a serious question. If 1000 men aged 43 were chosen at random and none of them had used anabolics ever, would the majority have zero calcium scores?

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.

 

[egruberman]

My understanding is that LDL doesn't matter

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. The reason that people say it doesn't matter is because it is correlative. The particle size and count can vary, which affects risk, but elevated LDL is still highly correlated with MACE (major adverse cardiac events).

William Davis MD "wheat belly author" had a protocol to reverse it -- I think it was Vitamin D, no wheat & sugar, and a couple of other things.

It kills me that this kind of faux science exists. There is nothing that's been proven to reduce calcified atherosclerotic plaque. There are a few trials where ApoB is managed to below 60mg/dL using PCSK9 inhibitors that show some promise, but there's nothing definitive. There's also some data for the use of vitamin k2 and lifestyle improvements. In all cases the regression is small.

I'm personally running an N=1 experiment attempting to keep my ApoB below 60mg/dL for ~5 years to see if my calcium score goes down.

 

[Avies48]

When this blood work was taken, were you taking any testosterone or other AAS and did you ever get a calcium score?

I was on nothing at all… whats odd is my cholesterol doesnt ever show movement up or down trully when being on trt…

Calcium score was a 1.5… but im awating results to be sent to me so i can understand what 1.5 means!? Last one i had done like maybe circa 2010ish and it was a zero (0)

 

[Avies48]

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. The reason that people say it doesn't matter is because it is correlative. The particle size and count can vary, which affects risk, but elevated LDL is still highly correlated with MACE (major adverse cardiac events).



It kills me that this kind of faux science exists. There is nothing that's been proven to reduce calcified atherosclerotic plaque. There are a few trials where ApoB is managed to below 60mg/dL using PCSK9 inhibitors that show some promise, but there's nothing definitive. There's also some data for the use of vitamin k2 and lifestyle improvements. In all cases the regression is small.

I'm personally running an N=1 experiment attempting to keep my ApoB below 60mg/dL for ~5 years to see if my calcium score goes down.

What are you doing to lower your apob? And how are u maning to keep it low?