Update on statins

[Grey Spartan]

It does in mice:

Reduced absorption of saturated fatty acids and resistance to diet-induced obesity and diabetes by ezetimibe-treated and Npc1l1−/− mice - PMC

The impact of NPC1L1 and ezetimibe on cholesterol absorption are well documented. However, their potential consequences relative to absorption and metabolism of other nutrients have been only minimally investigated. Thus studies were undertaken to ...

pmc.ncbi.nlm.nih.gov

I'm sure this doesn't need to be said but, we are not mice. The dose they give mice compared to their body weight is usually ridiculous. That's why I ignore any studies done on mice good or bad. I wait for the human trials to make any decision on taking or not taking a drug. but that's just me. Unless it some X-Men type of gene manipulation therapy, then I'm all in. lol

 

[egruberman]

First of all these are some fascinating results - thank you for posting. It seems like you may fall into the "lean mass hyper responder" category, which is not supposed to be associated with the same negative CVD outcomes that would accompany cholesterol that was similarly high due to different causes.

Not with those trigs.

 

[lilchikin]

thoughts on rosuvastatin taken only 2-3x per week?

 

[egruberman]

thoughts on rosuvastatin taken only 2-3x per week?

Works fine, but why wouldn't you want to take a smaller dose daily?

 

[lilchikin]

Works fine, but why wouldn't you want to take a smaller dose daily?

i would but i have 20mg tabs, so I was planning 10mg EOD

 

[egruberman]

i would but i have 20mg tabs, so I was planning 10mg EOD

Makes sense and is probably fine if you tolerate rosuvastatin at all. When you exhaust your supply, maybe plan for a smaller dose if you're getting the LDL reduction you're looking for.

The lower the peak serum concentration, the less likelihood of side effects. It is a deviation from the standard of care, but my general recommendation for lipid management is to keep statin doses low and pair it with ezetimibe and bempedoic acid to achieve the desired LDL lowering effect.

Statins are great, but as an unfortunate byproduct of the approval process, the dosing guidelines are egregiously high. By that I mean, the clinical trials were focused on very high risk populations that would be most likely to show positive outcomes in which anything but the maximal dose would be unethical.

I feel comfortable with this guidance because the ACC is fucking out to lunch. They define the standard of care for such things and are *still* pushing statin mono-therapy.

In their view, "preventative" intervention should start once the 10 year MESA risk exceeds 10% which blows my fucking mind. To be clear, when there's a MACE (major adverse cardiac event), the most likely presentation of that is fucking death, for which there's 50% probability. So, if we do the math, they consider *beginning* preventative intervention when there's a 10% chance of a MACE in the next 10 years and if you hit that, a 50/50 chance of dying, with the final calculated risk of death at 5%.

So, roll a d20.

 

[Eddie.]

thoughts on rosuvastatin taken only 2-3x per week?

Many guys have good outcome with this protocol. I'm currently taking 5mg ezetimibe every day and 2,5mg rosuvostatin twice a week. Haven't done bloods yet because i'm leaving it for the end of my cycle, but there are cases who've seen improvement with just 5mg a week.

 

[BP_6]

I'd really like to just get on Repetha, however getting that approved by the insurance is a bit more difficult because of the price.

 

[egruberman]

I'd really like to just get on Repetha, however getting that approved by the insurance is a bit more difficult because of the price.

Hit up their site and apply for a copay card. There are no criteria for approval. They just dole em out.

 

[120nmol]

Man, you shouldn't use 10mg of Ezetimibe, but 5mg.

Ezetimibe 5 and 10 mg for lowering LDL-C: potential billion-dollar savings with improved tolerability - PubMed

These data strongly suggest that ezetimibe 5 mg and ezetimibe 10 mg are clinically equivalent with respect to LDL-C reduction and achievement of ATP III LDL-C goals. Widespread adoption of this low-dose strategy could result in a potential cost savings of more than a billion dollars annually...

pubmed.ncbi.nlm.nih.gov

" These data strongly suggest that ezetimibe 5 mg and ezetimibe 10 mg are clinically equivalent with respect to LDL-C reduction and achievement of ATP III LDL-C goals. Widespread adoption of this low-dose strategy could result in a potential cost savings of more than a billion dollars annually... "

there’s also study on using 20mg which resulted in greater reduction in ldl-c
Either way I have prescriptions I pay 5.33$ for 1 pack of ezitimbe I buy 3 packs every month..

First of all these are some fascinating results - thank you for posting. It seems like you may fall into the "lean mass hyper responder" category, which is not supposed to be associated with the same negative CVD outcomes that would accompany cholesterol that was similarly high due to different causes.


How does ezetimibe affect your digestion on a carnivore diet? I also eat an almost-carnivore diet and was concerned to read that ezetimibe interferes with digestion and absorption of fat. Any new diarrhea or other signs of malabsorption?

It’s all about sharing
No issue with digestion same goes with statins
Also here’s the liver and kidney results on both ez and rosu

thoughts on rosuvastatin taken only 2-3x per week?

Can be taken 2/3 times a week no issue

i would but i have 20mg tabs, so I was planning 10mg EOD

I have the 5/10/40 pills just cut the bigger one in desired dose that’s all.

 

[120nmol]

Statins are great, but as an unfortunate byproduct of the approval process, the dosing guidelines are egregiously high. By that I mean, the clinical trials were focused on very high risk populations that would be most likely to show positive outcomes in which anything but the maximal dose would be unethical.

When my doc called he was like your cholesterol is over 400 I’m putting you on 40mg crestor ..
I said I can’t give up the meat can you add prescription for eztmbe also? He agreed what he didn’t know is I took only 10mg .. unfortunately docs are against cholesterol which is a shame I’m sure if I wasn’t on testosterone I’d feel shit without building blocks for my hormones.. in a few words basically world wide health care wants us men castrated .. I’m from the Middle East yeah…

 

[egruberman]

unfortunately docs are against cholesterol which is a shame I’m sure if I wasn’t on testosterone I’d feel shit without building blocks for my hormones.. in a few words basically world wide health care wants us men castrated .. I’m from the Middle East yeah

So, that’s a great conspiracy theory, but nobody is looking to castrate men. Very low levels of cholesterol are needed for hormone production. When your LDL is under 30mg/dL you can start to become concerned.

Docs are against cholesterol because it is the biomarkers associated with the leading cause of death in this country. Seems like a rational conclusion to me.

 

[120nmol]

So, that’s a great conspiracy theory, but nobody is looking to castrate men. Very low levels of cholesterol are needed for hormone production. When your LDL is under 30mg/dL you can start to become concerned.

Docs are against cholesterol because it is the biomarkers associated with the leading cause of death in this country. Seems like a rational conclusion to me.

If that wasn’t the case testosterone levels weren’t declining from year to year
Our liver produces cholesterol no matter what hard to believe our body is designed to self destruct so fast on its own
Yeah I’m one of those who believes cholesterol shouldn’t be nuked to low numbers and is not the cause of heart disease.
Cholesterol is not relevant when you are on hrt that’s all.

 

[NotHuman]

I’m on 5mg Rosuvastatin and 10mg Ezetimibe and my LDL last time was 31 on 300mg test, 200mg deca, and 100mg primo per week. My LDL is the same even on a true TRT dose.

No side effects.

 

[jtmarlin]

I’m on 5mg Rosuvastatin and 10mg Ezetimibe and my LDL last time was 31 on 300mg test, 200mg deca, and 100mg primo per week. My LDL is the same even on a true TRT dose.

No side effects.

Is it really just this simple that we can take statins and ezetimibe and cycle without without worrying about ASCVD? When I began using AAS in the mid 2000s nobody was talking about this and I wish they were. I now have a CAC score of 175 at 43 and my usage was not egregious compared to what I see today. Outside of TRT, I'd put my lifetime usage in total milligrams at roughly 500mg total weekly androgen load for 4 years. Never used tren.

I'd read something that theorized that it wasn't the absolute number but AAS use somehow reduced the HDL's positives so perhaps it can still happen with a low LDL # I can't say.

 

[NotHuman]

Is it really just this simple that we can take statins and ezetimibe and cycle without without worrying about ASCVD? When I began using AAS in the mid 2000s nobody was talking about this and I wish they were. I now have a CAC score of 175 at 43 and my usage was not egregious compared to what I see today. Outside of TRT, I'd put my lifetime usage in total milligrams at roughly 500mg total weekly androgen load for 4 years. Never used tren.

I'd read something that theorized that it wasn't the absolute number but AAS use somehow reduced the HDL's positives so perhaps it can still happen with a low LDL # I can't say.

Well LDL, but more specifically, ApoB, is a major driver of atherosclerosis so if we can get the ApoB below 50 (or LDL below 40), we completely eliminate the lipid pathway towards atherosclerosis. Another major pathways is Lp(a), which is mostly genetic and you want that number to be low (in range). If it’s high, then you are at much higher risk. PCSK9 drugs like Repatha seem to help lower that but they are working on drugs that specifically reduce it that are not yet approved.

Blood pressure is another important thing to keep around the right number (110/75 is ideal).

So the way I see it, I can control the ability to crush my ApoB/LDL with lifestyle intervention and pharmacology. My Lp(a) is low so I don’t have to worry about that one. Blood pressure I can also control with lifestyle and pharmacology.

I know there’s a lot of folks on social media trying to argue LDL doesn’t matter, but their arguments are all bullshit. There’s an easy counter to any of their talking points, and the data is overwhelming that LDL/ApoB causes atherosclerosis.

A friend of mine who has a horrible lifestyle (gets drunk 5x per week, eats like shit, and never sleeps) told me over the weekend he got blood test and his triglycerides were 280, LDL almost 300, and a calcium score of 100. He’s only 42 but he refused to go on a statin because he watched social media videos talking about how bad they are. The reality is they probably would have prevented his calcium build up at such a young age.

 

[jtmarlin]

Well LDL, but more specifically, ApoB, is a major driver of atherosclerosis so if we can get the ApoB below 50 (or LDL below 40), we completely eliminate the lipid pathway towards atherosclerosis. Another major pathways is Lp(a), which is mostly genetic and you want that number to be low (in range). If it’s high, then you are at much higher risk. PCSK9 drugs like Repatha seem to help lower that but they are working on drugs that specifically reduce it that are not yet approved.

Blood pressure is another important thing to keep around the right number (110/75 is ideal).

So the way I see it, I can control the ability to crush my ApoB/LDL with lifestyle intervention and pharmacology. My Lp(a) is low so I don’t have to worry about that one. Blood pressure I can also control with lifestyle and pharmacology.

I know there’s a lot of folks on social media trying to argue LDL doesn’t matter, but their arguments are all bullshit. There’s an easy counter to any of their talking points, and the data is overwhelming that LDL/ApoB causes atherosclerosis.

A friend of mine who has a horrible lifestyle (gets drunk 5x per week, eats like shit, and never sleeps) told me over the weekend he got blood test and his triglycerides were 280, LDL almost 300, and a calcium score of 100. He’s only 42 but he refused to go on a statin because he watched social media videos talking about how bad they are. The reality is they probably would have prevented his calcium build up at such a young age.

My Lp(a) is 8 which so quite quite low so I ended up with calcification due to behavior it seems or some other genetic component that isn't Lp(a) related. I don't want to get into a debate with the inflammation and seed oils people bc I agree with you about ApoB and LDL being the drivers. I'm just wondering if AAS are advancing ASCVD without showing it on bloodmarkers (or reduced effectiveness of HDL).

I have recently learned of this CAC issue in myself bc my PCP basically ignore my 130 and now 160 LDL for years after doing said Lp(a) test. I did a consult with an extremely well know doctor to bodybuilders and told him my ApoB was 120 and he freaked out and advised me to adopt a diet of near zero saturated fats filled with necessary micronutrients. He also advised NOT to use statin therapy as it would lead to tubular necrosis (I'm not here to debate that either.) So I went to the cardiologist who sent me for a CAC test (she also said ApoB did not require treatment until 130+ which seems batshit insane to me. The score came back 175 and she started me on 10mg Lipitor and I will see where my chole is in a couple weeks but I'm expecting an enormous reduction. She indicated the LDL needs to be sub 100. I'm actually going for a second opinion this week to see if further testing is warranted as AAS abusers are not a normal population group and want to make sure I don't have advanced stenosis.

I will add that the absolute WORST I have ever seen my lipids was 28 HDL 193 LDL 130 ApoB on 600 test and 400 primo. These don't even seem that bad given the load but yet here I am.

 

[BP_6]

I’m on 5mg Rosuvastatin and 10mg Ezetimibe and my LDL last time was 31 on 300mg test, 200mg deca, and 100mg primo per week. My LDL is the same even on a true TRT dose.

No side effects.

Wow, that is literally exactly what I am on. Your numbers are a bit better than mine, I am high 60's, low 70's but I have found it a great combo. I was worried about all the fear you hear about statins he said most people don't get those sides but you really hear about the ones that do. He also said he highly doubted 5mg would give me any I haven't had any issues whatsoever.

 

[jtmarlin]

I’m on 5mg Rosuvastatin and 10mg Ezetimibe and my LDL last time was 31 on 300mg test, 200mg deca, and 100mg primo per week. My LDL is the same even on a true TRT dose.

No side effects.

Are these from your doctor or are you using Indian pharmacy drug etc?

 

[BP_6]

Are these from your doctor or are you using Indian pharmacy drug etc?

These are actually from my doctor along with my BP meds. However if I lost access to them, I would feel fully comfortable going with an Indian pharmacy. So many drugs in US pharmacies are actually produced in FDA approved facilities in India.