Risk is kinda low when your CAC score is 0 but when it’s suddenly not 0 anymore you’re at high risk. Given lifetime expose to apoB particles, risk is accumulative. That’s why you should aim for a LDL-C below 70mg/dL. If you can achieve that without a statin that’s fine too. Why not start with ezetimibe first and then reevaluate?
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What would be the advantage of ezetimibe over a statin?
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The risk of side effects with ezetimibe is the same as in the placebo group.
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LukeMV
#539
I was one of the people who decided to take Ezetimibe first. It definitely lowered my LDL substantially. I want to say it went from like 100 to 75 or something like that. Then 5mg Rosuvastatin added on top it down to the low 40s, I don’t get any side effects from either drug, and I take them both before bed.
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I prefer bempedoic acid to statins. Same benefits with no side effects (for most people). Bempedoic Acid is pricey if you don’t order from India. It also lowers inflammation (hsCRP) a lot as a bonus and won’t cause T2D or muscle soreness.
So, I order the Bempedoic Acid + Ezetemibe pill (Brillo EZ by Sun Pharma - India’s largest pharmaceutical company) which reduces LDL by 45% and inflammation by 50-75%. These results are consistent for both me and my father. N=2
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adssx
#541
I chose ezetimibe for this reason (and especially the low risk of diabetes vs statins). After 6 weeks of ezetimibe 10 mg daily:
- ApoB decreased from 100 mg/dL to 60,
- LDL decreased from 130 mg/dL to 70,
(Although I’m skeptical about the strength finding, the potential AD risk reduction with ezetimibe would be a very welcome side effect.)
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Paiva
#542
Congratulations! This meds did great job for you ( adssx, De Strider). Unfortunately not all reaps it. I take BA + ezetimibe + Rosuvastatin 10mg + Panthetine, my LDL 70 and Apob 57. I guess that my sirolimus weekly (8mg) impact my lipid profile. My goal is Apob 40. The coronary stent put 12 y ago request it. Will evaluate Repatha soon …
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Neo
#544
Anyone have thoughts on APOC3 targeting for lipid management?
https://www.nejm.org/doi/full/10.1056/NEJMoa2404143
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Neo
#545
Conclusions
DNA methylation‐based epigenetic age scores mediate the associations between the LE8 score and incident CVD, CVD‐specific mortality, and all‐cause mortality, particularly in individuals with higher genetic predisposition for older epigenetic age.
https://www.ahajournals.org/doi/full/10.1161/JAHA.123.032743
Beth
#548
I love the ZOE podcast!
Even though I know the science is really not ready for prime time, I assumed their testing would at least be better or as good as anyone’s, so I signed up and did their gut test a few months ago (depressing results!).
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L_H
#549
Sadly… There’s always something extra you can do.
You’re so close to target ldl-c (apoB is a better metric), if you’re hesitant about statins, why not have a crack at one of the following. You’re probably doing most of them but maybe not everything…
Increase fibre to 40g a day ( pulses every day makes it very doable)
Extra virgin Olive oil
Fish " In a study of 20 people, a diet that included fish at least two times a week reduced ApoB levels by 23% over 24 weeks"
Nuts " A study of nearly 200 people found that eating 43 g of walnuts a day for 8 weeks decreased ApoB by 7 mg/dL"
Fry less “Less Fried and Roasted Foods/Saturated Fats
Compounds in fried and roasted foods called advanced glycation endproducts (AGEs) are able to raise ApoB levels. When 26 people consumed diets low in AGEs, their ApoB levels decreased by 25%”
Exercise “Resistance exercise decreased ApoB levels by 50 mg/dL over 3 months in 52 people with type 2 diabetes”
And if that doesn’t work very low dose rosuvastatin (1 mg) + low dose ezetimibe (2.5mg) has a big % impact.
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Thanks for this response. Very helpful. I do try to do most of those things. My apoB is 75 for what it’s worth, which is decent but I’d like it to be better. Maybe a low-dose statin just 1x per week is something to consider?
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LukeMV
#551
I’d take it every day. 5mg rosuvastain or 10mg atorvastatin
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L_H
#552
From memory very low dose daily is better than weekly for statins (in terms of impact on apob)
This graph is interesting. Very low dose rosuvastatin (say, 1mg per day) has a big effect
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Yes there’s no question that statins even at lower doses will lower LDL-C and apob. But ultimately I’m more interested in their impact on adverse cardiac events/mortality. And there the only data I’ve seen (like the study I referred to earlier) indicate no benefit for someone in my circumstances. But perhaps I’m overthinking this and there’s a certain leap of faith that needs to be taken.
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AnUser
#554
There’s no leap of faith, if you want to try to prevent positive CAC (advanced cardiovascular disease) you need to start early. Waiting for it to happen is like stopping smoking once you get lung cancer.
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If that were true we would expect to see a benefit from statins in low risk patients with a CAC score of 0. But we don’t.
