#1318

You can measure your degree of cholesterol absorption vs production to see if you may be good or less good candidate for Eze

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#1319

Considering switching after seeing ezetimibe was linked to lower risk of PD, whereas rosuvastatin was linked to increased risk.

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#1320

Pitavastatin 4mg can be obtained for around $0.37/pill from Jagdish as well

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#1321

I have posted a paper on synergistic or benign co-ingestion of pitavastatin and telmisartan. However I have also come across a possible note of caution when it comes to the interaction between pitavastatin, allopurinol and valsatran. There was rat verification:

Quote:

“The reporting rate of rhabdomyolysis for pitavastatin in the JADER database was 0.09, and it increased to 0.16 in combination with allopurinol. Furthermore, the rate was even higher (0.40) in combination with valsartan. Additionally, necrosis of leg muscles was observed in some rats simultaneously treated with these three drugs, and their creatine kinase and myoglobin levels were elevated. The combination of pitavastatin, allopurinol, and valsartan should be treated with caution as a multiple drug-drug interaction. Since multiple drug-drug interactions were detected with decision tree analysis and the increased risk was verified in animal experiments, decision tree analysis is considered to be an effective method for detecting multiple drug-drug interactions.”

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#1322

Damn. I think I may be intolerant to Lipitor (Atorvastatin) as well as Rosuvastatin. After using it for 2 months daily, I am developing muscle weakness in my thighs similar to what I experienced with Rosuvastatin. It’s been noticeable when I walk. It has been ever so gradually getting worse. I may have to cut the dose, try EOD or give up on statins altogether. :frowning:

I hope I am wrong. Maybe taking a statin isn’t worth the drop from an LDL of 67 to 48? Thoughts?

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#1323

Since your LDL of 67 is already normal/very good I personally would NOT take anything to lower it further if such medicine has even the slightest negative side effect. If what you are feeling is true (because of Lipitor), I would definitely stop it. and see how it goes for a while and see if any of your biomarkers change much.

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#1324

A some time ago i used pitavastatina with no legs pain. As iam wanted apob/ldl lower, moved to rosuvastatin, then the pain upset me. Discountinued and move to Repatha with good result! Mybe any attempt with PITA worth ?

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#1325

Perhaps try the statin EOD as you mentioned. Seems it is a legit way to dose statins.
I am sure you already have checked but there are some studies on statin use EOD.

I have even seen comments from people in random YouTube fitness channels say they take a statin just a few times a week.
It’s something to think about if EOD eventually causes those muscle issues.

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#1326

I think the best approach if you want to use statin is to change again to for example pitavastatin (livalo) making sure to get your labs (liver) before and after, and every now and then.

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#1327

I had the same problem with all the statin types.
Given you managed to go 2 months before it occurred, maybe try one month on and one month off. If that doesn’t work try one month EOD and one month off.
Certainly take a break now and maybe try again at the beginning of December.
(I am yet to follow my own advice as my ApoB level continues to trend down with Ezetimibe and Bempedoic Acid, but if that starts flatlining at too high a level I will try the above with a statin).

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#1328

EOD sounds like a good idea, to start with.

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#1329

If a PCSK9i is an option, I’d ditch the statin and never look back.

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#1330

I’m with RapMet, if it were me personally, I’d be fine with 67, and not bother with 48. But if you really want to, then pita is a possibility, as it specifically is not supposed to affect muscles or lower CoQ10 levels (I’m switching to pita from ator, even though I tolerate ator just fine, because pita has multiple advantages for me). I gather PCSK9i are not an option, otherwise it’s the go to for complete statin intolerance, however some can’t tolerate PCKS9i either. FWIW, after extensively studying the issue, I am content to just go below 70 (67 is absolutely fine), but again each of us has their own situation (my case, CAC at zero, at age 65).

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#1331

Did you get the LDL lowering to 67 just from Bempedoic acid and Ezetimibe? I seem to recall you were around 130 before any lipid lowering treatment.

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#1332

@RapMet The CT Angiogram is a cat scan based procedure with contrast (injected IV) and computer analysis that shows the soft plaque in the arteries for analysis. The Calcium score automatically comes with a CT Angiogram and is ONLY the calcified plaque (technically the less “risky” plaque as it’s hardened). A cardiac calcium score alone is run only on a CT scan and doesn’t use the contrast / imaging agent and therefore can’t report on any soft (risky) plaque. I would argue a calcium score is only valuable in tracking the amount of plaque a person has that is being calcified over time (meaningful increases over time signal a continuing problem). For a healthy individual looking to assess true risk, you really need to know how much soft plaque you have or your not tracking the true risk.

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#1333

Thank you @CJZ . Great info.

Does anyone have any suggestions for a reasonable ($) place ( in and around NYC, Long Island) that one can test to have such a score measured? I’ve never had mine tested and would like to try. Thanks,

#1334

Surprised that this hasn’t been posted.

Nanoparticle infusion therapy breaks down plaques in arteries

https://newatlas.com/heart-disease/nanoparticle-infusion-plaques-arteries-atherosclerosis/

And the study:

Pro-efferocytic nanotherapies reduce vascular inflammation without inducing anemia in a large animal model of atherosclerosis

https://www.nature.com/articles/s41467-024-52005-1

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#1335

Go to MDSave.com, the CPT code for a CT Cardiac Angiogram is 75574 and CT Cardiac Calcium is 75571.

You’ll still need a doctor’s order for it.

You can also call Radiology centers and ask them best cash pay. Looks like the Nearest one to you for a CT Cardiac Angiogram would be $590. The CT Cardiac Calcium looks like $183 through them.

I personally like the strategy of a yearly whole body MRI/MRA neck-head as that does an excellent job screening for vascular disease. However, if there were a specific worry or history of coronary artery disease, the CT Cardiac Angiogram is a reasonable test.

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#1336

@DrFraser Me and my practitioner viewed the CT Angio as a “baseline” for me (I’m 53), if it came back clean (which it did) perhaps it’s on the rotation every 3-5 years as we’re aggressively treating / monitoring APOB and inflammation so risk “should” remain low if I’m starting from a good baseline. I’m also on the yearly MRI bandwagon so my practitioner (had one 3 years ago, just completed one with Pernuvo, and will now continue yearly) and I can monitor.

#1337

@CJZ I’m not sure I’d bother doing another CT Angio for at least 8 years if no vascular disease evident.

Some people are being more aggressive than is necessary on ApoB. If Lp(a) negative, there is no reason to push lower than the 70’s and if positive no reason to go lower than the 50’s. Naturally optimizing BP and insulin sensitivity is important.

I prefer SimonOne to Prenuvo as their cost is a lot less $1250 and you get an MRA head and neck. They are also using a T3 magnet, whereas Prenuvo, I believe is using a T1 magnet. The T3 has better resolution.

Ultimately if you have no evidence of vascular disease in your head/neck it is extremely unlikely you’ll have it elsewhere, and I consider this adequate vascular disease screening if that is clear, and don’t bother with a CTCA or CTCC scan in most instances. If someone is very cost sensitive, then to CT Calcium + Carotid intimal media thickness - but this is probably inferior to the MRI strategy.

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