Who here is on a statin?

[egruberman]

Just recently got my results back for the Cardio IQ test after being on 5mg Rosuvastatin and 5mg Ezetimibe for around a month. I'm pretty happy with the results outside of my high Lp(a) not being an anomaly.

Other than Lp(a) those numbers are great. Remind me your calcium score?

 

[Babygeei]

That’s a huge improvement from the last set of labs. And the CAC score has got to be a relief.

Absolutely a relief. I actually forgot I did a cac scan last year so finding that helped ease my mind.

 

[BamaCrazy]

Other than Lp(a) those numbers are great. Remind me your calcium score?

It’s the 2nd photo he attached. He also got a zero.

 

[Babygeei]

Other than Lp(a) those numbers are great. Remind me your calcium score?

A zero according to the cac test. That is from last April though.

 

[Sampei]

Just recently got my results back for the Cardio IQ test after being on 5mg Rosuvastatin and 5mg Ezetimibe for around a month. I'm pretty happy with the results outside of my high Lp(a) not being an anomaly. I'm now going to add bempedoic acid and retest in 4-6 weeks. I will try to inquire about repatha but my doctor doesn't know I take anything for cholesterol so not sure how that will go. I also have a CT-CAC I took in April of 2024. I will take another one in April this year.

I don't think you need the bempoic acid. Unless you ain't blasting right now then maybe use it during a blast?

 

[egruberman]

A zero according to the cac test. That is from last April though.

Okay, that's great news. I doubt much has changed since last April.

 

[Babygeei]

I don't think you need the bempoic acid. Unless you ain't blasting right now then maybe use it during a blast?

I'm starting a blast on 2/24. But I will keep that in mind for when I come off the blast.

I saw there was the potential for ruptured tendons and some other crazy things like that while taking bempedoic acid. Is this something to seriously worry about?

 

[egruberman]

I saw there was the potential for ruptured tendons and some other crazy things like that while taking bempedoic acid. Is this something to seriously worry about?

1. I'm on BA and never had an issue
2. I did an extensive review of the literature and all reported cases of an issue were coincident with a very large dose of atorvastatin.
3. I could find no reported cases of tendon issues from BA use alone or with a low-dose statin.

 

[egruberman]

I took another pass and it's exhausting, but:

All the patients who developed tendon rupture or injury had one or more of risk factors, e.g. statin use, fluoroquinolone or systemic corticosteroid use, diabetes, gout, rheumatoid arthritis, renal failure, patients older than 60 years [26].

and then from the pooled data of the phase 3 trials:

Other adverse events: tendon rupture​

The overall incidence of the AE term, tendon rupture, was low, occurring in six patients (0.3/100 PY) in the bempedoic acid group and no cases in the placebo group. These reports of tendon rupture are from CLEAR Harmony and CLEAR Wisdom trials, as no incidence of tendon rupture was reported in the CLEAR Serenity or CLEAR Tranquility trials. Although not a prespecified TEAE of special interest, the US Food and Drug Administration conducted a separate analysis of the data and identified 10 cases of what they considered to be tendon rupture or injury (Supplemental Table 3)17; of these, six patients had an AE term of tendon rupture, three patients had rotator cuff syndrome, and one patient had tendon injury (confirmed by the investigator to not be a rupture). The majority of patients with tendon rupture had sustained injury in the setting of trauma or other mechanical stress and/or had a medical history of tendon rupture or injury. Beyond hypercholesterolemia present in all patients, additional risk factors present for tendon rupture included male sex (n = 9), diabetes (n = 4), renal impairment (n = 1), and statin use (n = 10).

 

[BamaCrazy]

I took another pass and it's exhausting, but:

Some or those can be the cause of tendon rupture regardless of what you are taking. Being old. Getting corticosteroids shots.

 

[egruberman]

Some or those can be the cause of tendon rupture regardless of what you are taking. Being old. Getting corticosteroids shots.

Yup, that's the takeaway.

 

[LawrenceofUSA]

What’s the consensus amongst you all about lisinopril?

I am not currently using anything major in the AAS department due to bp and cholesterol issues. I’ve had uncontrolled high bp since I was 18 (turn 31 this year), and that’s just when it was detected first. It’s genetic and significant. Now my cholesterol has started getting out of whack in the last year.

I’m on 40mg lisinopril and 5mg amlodipine. I’ve tried a combo of telmasartan and chlorthalidone in the past and didn’t experience any improvement.

I just ordered Ezetimibe from a telehealth place and am gonna see if I get any improvement in cholesterol. There are a lot of bp drugs and combos out there though and I’m afraid I’m gonna blow my aorta in 10 years and feel pressure to get the bp under control. I’ve been to a specialist to no avail, every doctor just wants to do cookie cutter bullshit and it doesn’t work for me. Diet and exercise seem to have no effect.

Anyone think it’s a good idea to try 20mg telmasartan with my 40mg lisinopril and titrate the telmasartan up until I see results? Or possibly keep the amlodipine in there too with the lisinopril/telmasartan combo? Or add in Nebivolol? Any advice?

Hoping someone here has had a similar struggle or some insight. Thanks

 

[Sicsemptyran]

What’s the consensus amongst you all about lisinopril?

I am not currently using anything major in the AAS department due to bp and cholesterol issues. I’ve had uncontrolled high bp since I was 18 (turn 31 this year), and that’s just when it was detected first. It’s genetic and significant. Now my cholesterol has started getting out of whack in the last year.

I’m on 40mg lisinopril and 5mg amlodipine. I’ve tried a combo of telmasartan and chlorthalidone in the past and didn’t experience any improvement.

I just ordered Ezetimibe from a telehealth place and am gonna see if I get any improvement in cholesterol. There are a lot of bp drugs and combos out there though and I’m afraid I’m gonna blow my aorta in 10 years and feel pressure to get the bp under control. I’ve been to a specialist to no avail, every doctor just wants to do cookie cutter bullshit and it doesn’t work for me. Diet and exercise seem to have no effect.

Anyone think it’s a good idea to try 20mg telmasartan with my 40mg lisinopril and titrate the telmasartan up until I see results? Or possibly keep the amlodipine in there too with the lisinopril/telmasartan combo? Or add in Nebivolol? Any advice?

Hoping someone here has had a similar struggle or some insight. Thanks

Lisinopril is a very well tolerated and effective BP drug for many people! Takes a few weeks to take full effect.

I would not take telmisartan with it, most of the time concurrent use of an ARB and ACE (telmisartan and lisinopril) is a bit redundant and sometimes dangerous.

Generally you’d want to add something from another class, like amlodipine or another calcium channel blocker likely being your next choice. From there, a third generation beta blocker like Nebivolol or a diuretic like chlorathalidone would be next, and finally whichever one you didn’t do in step three being your final one.

It’s usually better to add another drug at a low dose than max out any one drug as well.

 

[LawrenceofUSA]

I don’t think I could experience hypotension if I tried haha would you value lisinopril or telmasartan more? I know it’s going to be individual but I mean generally speaking?

Before when I tried telmasartan the doc never got me above 40mg and a small dose of chlorthalidone. Wouldn’t up the dose even though my bp was getting worse and I was on max dose of lisinopril plus 5mg amlodipine.

What “stack” would you recommend? I’m talking this bp is one tough cookie

 

[Sicsemptyran]

I don’t think I could experience hypotension if I tried haha would you value lisinopril or telmasartan more? I know it’s going to be individual but I mean generally speaking?

Before when I tried telmasartan the doc never got me above 40mg and a small dose of chlorthalidone. Wouldn’t up the dose even though my bp was getting worse and I was on max dose of lisinopril plus 5mg amlodipine.

What “stack” would you recommend? I’m talking this bp is one tough cookie

The classic “bodybuilder stack” (not necessarily the best, but certainly still pretty potent) is 40mg telmisartan/5mg amlodipine/5mg Nebivolol/12.5 HCTZ.

That said, there’s a billion different combos and more potent drugs for those who need it in the different classes. If those 4 didn’t get you to where you need to be, I’d start looking deeper to see how your blood pressure could still be high at that point.

The point regarding ACE and ARB wasn’t about hypotension, it’s that they both effectively work on the same pathway. So if you max dose one for example, putting the other in likely won’t change your blood pressure much. Hence why the 4 drug combos usually will choose one from either of the ACE or ARB classes.

 

[LawrenceofUSA]

Copy. So you would say the general rule is add in another compound before maxing the dose of one compound? Example, I would want to in theory add in low dose amlodipine before maxing a dose of telmisartan? And if not getting good results add in a third before increasing doses of the previous two?

I’ve been at this for years, I’ve read a ton, tried a ton, I’m really just digging for other informed opinions to supplement my own. I can’t tell you how many studies I’ve read on pubmed. But I just can’t get good results with anything.

I’m with you on checking into their reasons for high bp. It is genetic on father’s side. But I wouldn’t really have any idea how to go about digging into that, and there are no doctors around here that are gonna do that, nor do I have a ton of money to spend if insurance won’t cover something. Any ideas on that one?

 

[LawrenceofUSA]

Copy. So you would say the general rule is add in another compound before maxing the dose of one compound? Example, I would want to in theory add in low dose amlodipine before maxing a dose of telmisartan? And if not getting good results add in a third before increasing doses of the previous two?

I’ve been at this for years, I’ve read a ton, tried a ton, I’m really just digging for other informed opinions to supplement my own. I can’t tell you how many studies I’ve read on pubmed. But I just can’t get good results with anything.

I’m with you on checking into their reasons for high bp. It is genetic on father’s side. But I wouldn’t really have any idea how to go about digging into that, and there are no doctors around here that are gonna do that, nor do I have a ton of money to spend if insurance won’t cover something. Any ideas on that one?

It’s to the point of using telehealth sites to self medicate and experiment to try and get success.

 

[BamaCrazy]

Copy. So you would say the general rule is add in another compound before maxing the dose of one compound? Example, I would want to in theory add in low dose amlodipine before maxing a dose of telmisartan? And if not getting good results add in a third before increasing doses of the previous two?

I’ve been at this for years, I’ve read a ton, tried a ton, I’m really just digging for other informed opinions to supplement my own. I can’t tell you how many studies I’ve read on pubmed. But I just can’t get good results with anything.

I’m with you on checking into their reasons for high bp. It is genetic on father’s side. But I wouldn’t really have any idea how to go about digging into that, and there are no doctors around here that are gonna do that, nor do I have a ton of money to spend if insurance won’t cover something. Any ideas on that one?

Look up the studies Ghoul posted about quad BP medications. One of those studies compared using lowest dose of 3 different medications to using 4. All were different classes of meds. The triple group had a good improvement but the quad group did much better. I’m taking 3 low dose meds myself.

 

[Sicsemptyran]

Copy. So you would say the general rule is add in another compound before maxing the dose of one compound? Example, I would want to in theory add in low dose amlodipine before maxing a dose of telmisartan? And if not getting good results add in a third before increasing doses of the previous two?

I’ve been at this for years, I’ve read a ton, tried a ton, I’m really just digging for other informed opinions to supplement my own. I can’t tell you how many studies I’ve read on pubmed. But I just can’t get good results with anything.

I’m with you on checking into their reasons for high bp. It is genetic on father’s side. But I wouldn’t really have any idea how to go about digging into that, and there are no doctors around here that are gonna do that, nor do I have a ton of money to spend if insurance won’t cover something. Any ideas on that one?

Absolutely on the adding a drug first piece. It’s a matter of sides vs efficacy.

For example, you get ~80% of the effects of telmisartan at 40mg as opposed to the max dose of 80mg, so doubling it only doubles sides and gets you a tiny amount of BP reduction. Some are even more of a curve like Nebivolol, you get essentially all of the BP reduction at 25% of the max dose.

Many studies at this point have shown better outcomes and less side effects by adding additional drugs rather than maxing out any single drug.

As for the less common “true reasons” behind blood pressure that seemingly can’t get fixed, I’m sorry to say I’m not too well read on it. I know there are potentially adenomas that can cause things, hyperaldosteronism issues, and a few other things, but I’m frankly not the most well read on them.

Some others may know more.

 

[Sicsemptyran]

I prefer to read studies but someone sent me this and it actually dose a good job summarizing the blood pressure multi-drug combo efficacy and safety data.


View: https://youtu.be/RYS-G2d1f1k?si=076Ak4JQIeYZjM0Z