心血管健康

[Neo]

@amuser

Subdividing Repatha doesn’t apply if taking to reduce LP(a). correct?

You can try and see if there are dose repose curves for that from the trials (also look at Praluent and triangulate).

The most comment effects we see in other contexts could either be linear or that the first small amount as the big effect and then it is diminished

At the end of the day you might want to just try it as an N=1 and see how your individual body responds. Should see effects in 45-90 days

(Just make sure you test at the same interval since your shots, perhaps 10 days after or so).

[mccoy]

@AnUser

Lower LDL is the best move against the Chess Master, even better than Rapamycin.

I tend to agree on that but am still sitting on the fence. If you already have an unfavourable lipid panel, or have genetic predisposition, no doubt that there is no time to waste in pharmaceutical interventions.
On the other side, people like me with relatively low values of LDL/ApoB and non-HDL cholesterol, no genetic predisposition (from lack of events in the family), favourable outcome of various cardiac checks…
On yet another side, if I want to live in good health and activity, 94 is a very plausible target and that is 30 years apart, so it’s a long term strategy on the 10-30 years time horizon (timespan of development of arterial plaques) and this would surely justify a pharmaceutical intervention even in a subject with very low risk appetite like myself.

Right now what would definitely tip the scale would be higher values of lipids next blood draw, which I’ll have to schedule pretty soon.

By the way, what kind of side effects do you guys usually check for when taking cholesterol-lowering drugs beyond liver enzyme elevations…?

[DeStrider]

FYI, when an elderly person dies of “natural causes” it’s usually a heart attack or stroke in their sleep.

[ng0rge]

I’ve wondered about this, since here we’re bombarded by statistics all the time. I looked up death by dementia and it says that it’s usually “aspiration pneumonia”. But for the statistics, how do they determine what to list as “cause of death”? In your example, would they say “natural causes”?

[adssx]

Impact of cardiovascular health on biological aging: evidence from UK Biobank 2024

Aging represents a pivotal risk factor for cardiovascular disease, and the Life’s Essential 8 (LE-8) score, encompassing physical activity, diet, nicotine exposure, sleep health, BMI, blood glucose, blood lipids, and blood pressure, has been associated with age-related diseases.
After adjusting for potential confounders, the LE-8 score exhibited significant correlations with the ocular aging clock (moderate vs. low LE-8: β: 0.25; 95% CI: 0.02–0.48; high vs. low LE-8: β: 0.68; 95% CI: 0.20–1.16; P trend = 0.001), phenotypic age acceleration (moderate vs. low LE-8: β: 0.27; 95% CI: 0.22–0.33; high vs. low LE-8: β: 1.47; 95% CI: 1.35–1.58; P trend < 0.001), and frailty index (moderate vs. low LE-8: β: 0.01; 95% CI: 0.01–0.01; high vs. low LE-8: β: 0.02; 95% CI: 0.02–0.02; P trend < 0.001). Furthermore, nicotine exposure and blood glucose scores were correlated with all four biological aging metrics. Overall, the LE-8 score and its components were inversely associated with biological aging., suggesting that maintaining an optimal LE-8 score may attenuate the aging process.

[ng0rge]

@adssx

the Life’s Essential 8 (LE-8) score, encompassing physical activity, diet, nicotine exposure, sleep health, BMI, blood glucose, blood lipids, and blood pressure, has been associated with age-related diseases.

These are certainly the basics, although for people here, nicotine (smoking) is probably long off the table. And I would add inflammation (Hs-CRP) as a basic. When people here obsessively focus on lowering LDL-C or ApoB til they’ve nuked it out of existence, I think their effort would be better served by looking at a bigger picture of cardiovascular health. Get ApoB into the 50s or low 60s then look at other factors - particularly HbA1c, blood pressure, BMI or body comp.(DEXA) and Hs-CRP. Optimize those and you’ll probably do more good than driving ApoB to low infinity and beyond.

[mccoy]

@ng0rge

When people here obsessively focus on lowering LDL-C or ApoB til they’ve nuked it out of existence, I think their effort would be better served by looking at a bigger picture of cardiovascular health. Get ApoB into the 50s or low 60s then look at other factors - particularly HbA1c, blood pressure, BMI or body comp.(DEXA) and Hs-CRP. Optimize those and you’ll probably do more good than driving ApoB to low infinity and beyond.

That’s the difference between optimization and minimization (or maximization in some other areas).
In the words of Peter Attia, there are other horsemen of death beyond CVD…
But then, we should wonder what in this context constitutes optimization, if we suspect an advanced atherosclerotic condition, a very low ApoB in the region of 20-30 may perhaps entail some dissolution of plaques. Perhaps.
I agree that too much effort in lowering Apob may result in neglecting the other horsemen of death and being killed by one of’em. the best strategy is probably as low as reasonably possible, where the entity of ‘reasonable’ depends on individual situations.

[ng0rge]

@mccoy

I agree that too much effort in lowering Apob may result in neglecting the other horsemen of death

Maximizing healthspan and lifespan is complicated and I want to prioritize my effort and resources to get the best return on investment. That means going after a number of targets without obsessive focus on any one. If you have reason to be particularly concerned about cardiovascular, then after getting ApoB into “good” range (50-60) and getting HbA1c, Hs-CRP, blood pressure, BMI also into “good” range, the next thing I would do is a CIMT and/or CAC test to assess your actual plaque build up. Then you can better prioritize whether to continue to work on lowering ApoB or shift to say, improving brain health or your gut microbiome.

[Phillipe]

I just got results for some tests and my internal medicine PA is not concerned. But they raised some concerns for me (non-diabetic, no meds, No HBP, Age:73:

Carotid Ultrasound-No evidence of hemodynamically significant stenosis bilateral cervical internal carotid arteries.
Right carotid artery: Mild atherosclerotic plaque identified in the carotid bulb. Peak systolic velocities within normal limits, measuring 76.9 cm/s in the common carotid artery and 77.7 cm/s in the internal carotid artery. Right ICA/CCA ratio measures 1.0. Right vertebral artery demonstrates antegrade flow.

Left carotid artery: Mild atherosclerotic plaque identified in the carotid bulb. Peak systolic velocities within normal limits, measuring 88.7 cm/s in the common carotid artery and 71.4 cm/s in the internal carotid artery. Left ICA/CCA ratio measures 0.8. Left vertebral artery demonstrates antegrade flow.

CT Calcium Score:
Total calcium score is 83.1, which is between the 25th and 50th percentile.

What could I do to improve this profile?

[Virilius]

Crush your apoB/LDL-C with medication.

[RapAdmin]

I agree with Virilius, and I think most cardiologists would agree (see Attia and Dr. Lipid/Thomas Dayspring), get your ApoB and LDL-c as low as reasonably possible. At worst this will stop (or greatly slow) the progression, at best it may make things a little better.

[Bicep]

You’re 73 with a calcium score of 83. I don’t think you have a problem. If you decide to take a statin, should take GG with it. Take colchicine. Will reduce inflammation and therefore plaque building. Good Job.

[Virilius]

It’s not a problem if he only wants to live till 80.

[Bicep]

Lol.

You guys that think health is inversely linearly correlated to LDL. He’s gone 73 years and only accumulated a CAC of 83, but will be dead in 7 years from plaque.

Don’t worry Pfizer will save him!

[DrFraser]

Your PA will be excellent at repetitive guideline driven medicine. Sadly, so many physicians have headed this direction with the corporatization and time limitations of visits - and lack of inquisitiveness to provide cutting edge care.

The current guidelines have men in the U.S. on average dying at 75 years of age.

So if you want better outcomes, oftentimes you’ll need to seek care optimization, not “routine guideline based care.”

Your results show that you have vascular disease - the progression of that is often unpredictable - the only reassuring finding is one with no evidence of vascular disease. So if I have someone with lipids that are questionable, we an empirically treat to target or we can image. If imaging says no disease - then we can continue to monitor and repeat imaging if they are adverse to medication. Either is a safe strategy. One strategy that isn’t safe is to demonstrate disease and not recognize the risk of progression and the unpredictable nature of that.

[Phillipe]

Thanks for the input on this, all. I do need to update ApoB and LDL-c tests. Indeed, I don’t rely on my PC physician for any pursuit of longevity advice. I’ve been following the related medication discussions here with interest and have that high on priority now.

[Virilius]

Pfizer also produces rapamune

[ng0rge]

@Virilius

Pfizer also produces rapamune

So, do you agree with what @AnUser said above?

@AnUser

The more drugs someone takes, the healthier they become, the more they slow down the speed of aging and preventing disease

How about you @RapAdmin ? Is this pharmaceuticals appreciation day?

[Virilius]

I am firmly in the camp that believes that by taking enough medications you can extend your healthspan, lifespan and youthspan.

[DeStrider]

Honestly the pharmaceuticals I take are probably going to extend my life by a far greater extent than my supplements.