Update on statins

[NotHuman]

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

I was self medicating and then secured prescriptions when I saw a new cardiologist and lied to him when I said my old cardiologist had prescribed them for me.

The Indian pharmacy stuff was legit. Just as good as from a CVS or Walgreens.

 

[egruberman]

She indicated the LDL needs to be sub 100.

Yeah... That still has you with a 1 in 20 or so chance of death in the next 10 years.

In answer to your earlier question, AAS use can increase plaque burden independent of lipids, or more specifically, it can cause some endothelial dysfunction, and pro-inflammatory conditions increasing the accumulation of plaque burden for whatever ApoB is present.

The good news is, if your ApoB is sufficiently low, that's less likely to occur.

If y'all are getting rosuvastatin and ezetimibe from Indian pharma, might as well throw some bempedoic acid in as well.

 

[trajtemberg]

Anyone tried Niacin?

 

[jtmarlin]

Yeah... That still has you with a 1 in 20 or so chance of death in the next 10 years.

In answer to your earlier question, AAS use can increase plaque burden independent of lipids, or more specifically, it can cause some endothelial dysfunction, and pro-inflammatory conditions increasing the accumulation of plaque burden for whatever ApoB is present.

The good news is, if your ApoB is sufficiently low, that's less likely to occur.

If y'all are getting rosuvastatin and ezetimibe from Indian pharma, might as well throw some bempedoic acid in as well.

Is there any way to test for accumulated endothelial dysfunction?

 

[egruberman]

Is there any way to test for accumulated endothelial dysfunction?

There are some simple blood panels one can get in addition to lipids that help detect inflammatory conditions. Primarily that would be hs-CRP. I suspect you're probably also getting CBC, HbA1c, and that your blood pressure is good. Homocysteine is another good panel.

In terms of direct measurement of endothelial health, one can get a PWV (pulse wave velocity) test, which is a direct measurement of arterial stiffness.

Here's a review of PWV use in diagnosing ASCVD.

I have no idea how difficult it is to find this test or get it ordered, but it seems worthwhile for someone with advanced ASCVD (i.e. >100 CAC).

 

[egruberman]

Anyone tried Niacin?

Niacin has zero efficacy in the treatment of ASCVD. It improves biomarkers somewhat, but has no positive effects on outcomes and potentially negative effects.

Niacin Therapy, HDL Cholesterol, and Cardiovascular Disease: Is the HDL Hypothesis Defunct? - Current Atherosclerosis Reports

High-density lipoprotein cholesterol (HDL-C) has been shown in epidemiologic studies to be associated with cardiovascular (CV) risk and thus significant efforts have been focused on HDL-C modulation. Multiple pharmaceutical agents have been developed with the goal of increasing HDL-C. Niacin...

link.springer.com