Saw a cardiologist to make sense of my lipids

[egruberman]

I took a mere 2.5mg before bed last night and this morning I feel light tremors through my arms(similar to clen) and occasional tingling in my hands.

That's a really low dose at which to see what is a relatively uncommon side effect. If you wanted to try again, maybe take CoQ10 for a couple days first and see if it repeats. Pravastatin may be an alternative.

Do you know if it goes away over a few days or is this basically already telling me rosuvastatin is not gonna work for me? I also have ezetimibe and bempedoic acid so I can trial that next to see how I do

It may subside. If I were in your position, I'd try it for a little, coupled with CoQ10 as I mentioned, but it may be that you're sensitive to the drug. If it turns out that you're intolerant, ezetimibe plus bempedoic acid is a good alternative. If you need more aggressive lipid management, start contemplating a PCSK9 inhibitor like Repatha or Inclirisan.

@egruberman You're very knowledgeable. What are your thoughts on managing triglycerides, both through diet/supps and meds?

Putting aside genetic variation, high triglycerides are typically the result of metabolic dysregulation. Trigs are a risk factor for ASCVD in that they increase inflammation, directly damage the endothelium, and increase atherogenic particles.

Interventions include diet and exercise. Most folks with high trigs don't do enough cardio and are eating too many refined carbs. Supplements that influence trigs are berberine, psyllium husks and Omega 3 fatty acids. Drugs that lower trigs are statins and fibrates.

For trigs especially, start with lifestyle. If a statin is needed, enjoy the concomitant reduction in trigs. I wouldn't recommend fibrates unless someone had a particular genetic predisposition to high trigs.

 

[xrayphoton13]

That's a really low dose at which to see what is a relatively uncommon side effect. If you wanted to try again, maybe take CoQ10 for a couple days first and see if it repeats. Pravastatin may be an alternative.



It may subside. If I were in your position, I'd try it for a little, coupled with CoQ10 as I mentioned, but it may be that you're sensitive to the drug. If it turns out that you're intolerant, ezetimibe plus bempedoic acid is a good alternative. If you need more aggressive lipid management, start contemplating a PCSK9 inhibitor like Repatha or Inclirisan.



Putting aside genetic variation, high triglycerides are typically the result of metabolic dysregulation. Trigs are a risk factor for ASCVD in that they increase inflammation, directly damage the endothelium, and increase atherogenic particles.

Interventions include diet and exercise. Most folks with high trigs don't do enough cardio and are eating too many refined carbs. Supplements that influence trigs are berberine, psyllium husks and Omega 3 fatty acids. Drugs that lower trigs are statins and fibrates.

For trigs especially, start with lifestyle. If a statin is needed, enjoy the concomitant reduction in trigs. I wouldn't recommend fibrates unless someone had a particular genetic predisposition to high trigs.

Actually my labs just came in a few hours after I posted this and total cholesterol was only 62. Hdl was low though at 25. I was taking mast and anavar. I'm kinda shocked at the low total bc I didn't take anything for it other than psyllium husk and citrus bergamot(I'm not sure if this actually works after reading reviews). I guess genetics and strict diet plays a big role too.

 

[Sampei]

Actually my labs just came in a few hours after I posted this and total cholesterol was only 62. Hdl was low though at 25. I was taking mast and anavar. I'm kinda shocked at the low total bc I didn't take anything for it other than psyllium husk and citrus bergamot(I'm not sure if this actually works after reading reviews). I guess genetics and strict diet plays a big role too.

That HDL is fine with such a low total cholesterol, no big deal at all. How can you have a high HDL if total is 62

 

[SnowyMiami]

I find it annoying because so many are confused about the distinction between dietary cholesterol and serum cholesterol. Hint: there's very little relationship.

https://www.jacc.org/doi/10.1016/j.jacadv.2024.100924

Conclusions​

Consumption of a LCHF diet was associated with increased LDL-C and apolipoprotein B levels, and an increased risk of incident MACE.

 

[egruberman]

Conclusions​

Consumption of a LCHF diet was associated with increased LDL-C and apolipoprotein B levels, and an increased risk of incident MACE.

Dietary cholesterol and "high fat diet" are two different things. Saturated fat in particular will downregulate LDL receptors in the liver increasing LDL-C leading to worse outcomes as noted in the study you referenced. That does depend on genetic factors, the effect by which saturated fat influences LDL varies from person to person.

It's entirely possible to eat a high fat diet that does not increase LDL, it would depend on the types of fats consumed. Regardless, that's still not the same as the consumption of dietary cholesterol. Eggs, shellfish, organ meats are high in cholesterol but otherwise benign. Other sources of dietary cholesterol typically come along with a bunch of saturated fat, which may not be fine.