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.