Hi Chris the doc has already ordered just Crestor 5mg. I kinda wanted to start with just one med in case side effects I’d know which one plus just see first if one does the trick. If it’s not significantly down with this I’ll add to it. She wants a Re checkin 6 months but I’m thinking 4 or 5 should tell the tale don’t you think?
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I can’t give you specific advice, but I’ll discuss in general terms - but discuss with your doctor. I’m in my late 50’s … and keep up with stuff and then some. Sorry your doctor hasn’t spent his or her time staying up - very easy to do with corporate practice of medicine.
So you’ve made it so age 71 possibly with no vascular disease … possibly with vascular disease. If you have no vascular disease, you’re in great shape and yes, if you are Lp(a) negative, maybe we like to see someone in your situation goal for ApoB’s in the 70’s to try to avoid forming any disease.
Overall, the comments of @Dr.Bart are really relevant as the CT Calcium score of zero is very reassuring, but isn’t necessarily answering the question of whether you have vascular disease.
A head/neck MRA paired with a CT Cardiac Calcium gets us a much better review of both large vessel disease and small vessel disease and could have a recommendation to be more aggressive with treatment if those were abnormal. The MRA is available self ordered as part of a whole body plus scan from SimonOne.
That would be my approach if I were seeing someone with the information provided in your initial message. Hopefully this is helpful for you - and again - talk with your doctor about it, as I don’t know all your details, and can only give my general sense of what a sensible approach would be.
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Thanks so much DrFraser.
Re aggressive treatment, are you mostly referring to getting my numbers down? I do intend to shoot for 60 or 70 and if the crestor ( ha, that first came out creator) alone doesn’t do that, I’ll add to it. Or maybe you’re referring to other risk factors too and make sure they’re ok. I’ll ask for Lp(a) and fasting insulin to get more info, but other than some weight loss/more exercise think I’m ok, and if I do all this with the assumption I have vascular disease, would getting the extra tests still be beneficial? I just hate taking tests unless really necessary I’ve had so many the past 4 years due to broken femur, knee replacement gone bad, and superior canal dehiscence. ( rare ear disorder.) Thanks again.
You’re welcome. Having a decent day in the ER, so getting some time to provide some free input!
There is a value to saying you’ve had your lipids likely like this for many years … did you form disease? If not - so long as you monitor, this is no compelling reason to treat. If however, you are worried about this - then yes, go for a low dose statin, but no reason to goal any lower than in the 70’s if you have no vascular disease and are Lp(a) negative.
If you have vascular disease - and MRA Head and Neck is a great way to look at this … then yes, you’d target your ApoB 20 points less. If Lp(a) is elevated then goals with no disease are more in the 50’s, and with disease 20 points less.
A less invasive review to add to the CT cardiac calcium is a Carotid Intimal thickness on ultrasound. You can possibly get your doctor to order this and see if it is covered - otherwise get through MDSave - you’ll likely still need a physician order for this.
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My brother’s best buddy was an ER doc! 77 now. It takes a certain kind of person to do that. I once asked him don’t you get rattled, scared etc when a trauma comes in? He said no, he knows what he needs to do and just does it. Still, seeing folks come in mangled or young kids losing their lives, thank goodness for people like you who can do that❣️
Yes my lipids have always been a bit high but creeping up more lately. My doc went by my ratio which was always ok due to good triglycerides and HDL but now I know ratio is not what to go by, look at LDL and ApoB/Lpa. Writing down your suggested the tests for future but now just glad I learned and took initiative or else I’d be going happily along knowing I have a good ratio. 
I did think of another question at grocery today buying beans and seeing the low salt can. I love salt. I’ve always thought that the issue with it and heart disease was the blood pressure correlation and my BP is ok, is there more to it than that? Should I decrease salt? Maybe I should for other reasons too actually. A man who went to MIT and was a neurosurgeon for 10 years recently quit - his long boring unedited but very telling youtube got 6 million views in a week. Great guy, but he did have a video about seeing clumps of stuff during spine surgery in those who ate a lot of salt. I need to listen more closely to that.
Maybe this is too much “over the fence” talk if so I apologize and will be more succinct and on point from now on.
Yes - worried about people using HDL/LDL ratios - it really isn’t a good measure, and HDL is not protective. So ApoB, and a one time screening Lp(a) is sensible. Tracking should just be with ApoB, nothing else needed. All of the stuff with particle sizes, LDL/HDL/TG are all trumped by ApoB. You can always order both, but for cost effective monitoring, don’t need more testing.
Increases in amount of salt consumed increase risk of heart attack and stroke - so keeping it in the 1500 mg of less is often advised. I use potassium chloride - which isn’t as nice as sodium chloride, but it is certainly healthy to increase potassium (for most people) in one’s diet.
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curt504
#68
We are 71, go to metabolic conferences around the US. They are in nice places and we like sitting in a smallish room with smart folks listening to this topic.
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At 71 what are you willing to do? This is more or less the crux. At 71+ what radical protocol makes sense.
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Folks with your numbers had radically better covid outcomes. Since our research finds that your (and our) numbers make for better immune function.
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Just our view from our education and same numbers: in nature we get to have these numbers by design. We have decided its a gift not a negative.
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you will have to decide. Attia is not a “God” on this topic (IMHO)
PS folks who are much younger often give different advice when they too reach our same age. LOL LOL we are much more calm about Apo-B and LDL today.
Good luck, curt
AnUser
#69
What about Allan Sniderman?
He has studied lipidology, researched it, published probably thousands of scientific publications and cited much more than that.
He has studied it longer than many people who’ve been alive in these low carb conferences.
The important thing regardless is to read the actual scientific papers and understand the arguments. If you cannot tell anyone or even yourself, the arguments these ‘mainstream’ doctors are putting forward, how do you know?
Tell me the flaws in Allan Snidermans arguments, if you can’t, what are you doing? Why are you actually not interested in the truth? Are you just interested in stories? Why not be pragmatic?
How about Eugene Braunwald, a 95 year cardiologist who is still publishing papers?
Find the flaws in the argument below by him.
Doesn’t really matter since the truth and reality is set in stone. Can’t really fake health and people will find out sooner or later.
If you are not interested in truth, you are a sophist. That’s a term for people who are just working on crafting their rhetoric with fallacious arguments – just like most speakers in these low carb conferences. Sophist conferences.
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Oh I hate to read this as I love my salt, so looked up my sodium serum/plasma the normal range is 137-145. Last year it was 137 and this year 142. But googling I’m seeing you can still have too much salt even if levels are normal. How one knows this I don’t know but I’ll cut down. Geeze you guys are great but leading me down rabbit holes.
Ha, yes my doc ordered some big lipid panel with all the particle sizes and I’m the one who asked to add the ApoB. She did tell me she was starting to listen to Peter Attia so that’s good, and she’s not offended when I learn something and bring it to her. I will check out potassium chloride thanks. Haven’t read what Admin sent yet but plan to read up.
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Hi Curt, if I’m understanding, you’re ok with your numbers? It’s true I’ve not had COVID and haven’t been acutely sick in many years. And age certainly is a factor now in everything I decide, but there is longevity on both sides into 90’s even a 102 in there, so I will likely make another 20 years. I feel more comfortable getting the numbers down, as I don’t care so much about dying but sure don’t want a stroke disabling me and causing family to have to deal with it. Thanks for your input.
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That shot with the flu shot sounds like a good idea.
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Now that all has been said re my question I just wanted to thank you all for your thoughts, advice, and videos/articles which I will start reading/listening to today. Will get my Crestor today and check back in 6 months to let you know how it worked, as well as reduce salt intake (will try potassium chloride) and work on that 20 pounds I could lose. Thanks again you guys are great!
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JKPrime
#75
Lp(a) and ApoB may be dramatically different. e.g, my untreated apoB is 150 mg/dl (high, arguably a concern) or more while apo(a) is 12 nmol/L (low, safe)
Do you mean your Lp(a) on the second item? If so … yes the ApoB is a vascular risk, but luckily if your Lp(a) is negative, that at least doesn’t have an enhanced risk.
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JKPrime
#77
Yes, I meant Lp(a) on the second item.
This is related to my past posts but a personal story in case you’d rather stop reading now. Have said I’ve been told twice I might have had a heart attack and once that it’s conclusive. Just remembered about 13 years ago I went to an Urgent Care don’t remember why but guess she did an EKG because she told me I’m having a heart attack. I said I’m not having a heart attack but she persisted so said I’d drive over to the hospital and get checked. Oh no, might get in a crash and hurt someone else. Of course with that guilt I agreed to go in an ambulance. ER doc gave a very noticeable and big eye roll and said you’re not having a heart attack - did that blood test which confirmed it and they did a test where they stressed my heart while laying down - all ok. The only good that came out of it is that my D-dimer was falsely high which the ER doc said is not uncommon so they did some test that showed I had a lung sequestration which could have turned into cancer so got it out. Anyway I doubt that’s the time other folks are confused about because it would be in the record I was cleared. Guess I should ask for a copy of episode folks are confused about given this episode even an Urgent Care doc got wrong.
Got my Crestor yesterday - pharmacist hadn’t heard of ApoB either. If this 71 year old of average intelligence can find out about it……you’d think the medical profession could do better at getting latest research to Doctor’s offices.
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Your frustration with the medical system is warranted.
Urgent care is often ran by non-physicians and often by less than stellar educated physicians if you are seeing one. I’m used to seeing this 100% staffed by NPs, which is a serious issue. Managing non-differentiated conditions is not in the training of NPs or PAs - yet they are commonly hired in those roles.
The number of times I see patients referred from urgent care due to “concerning EKG” and I look at it, as an expert and have no concerns, is a weekly issue. If someone cannot interpret a test, they shouldn’t order it. So for most urgent care facilities I see no logic for them to have a EKG machine.
The sparsity of expertise with physicians scares me. God help me if I need expert care. The further sparsity of this with “providers” who have a tiny fraction of the training, but keep being put on par with physicians is a real challenge.
I work with NPs and PAs regularly, and they are great at dealing with the volume of simple things, but the knowledge base is dramatically different.
A d-dimer is a non-specific test - in a patient presenting with pleuritic chest pain, shortness of breath … tachycardia - about 1/7 patients with a positive d-dimer has a pulmonary embolism. In patients without a classic presentation, as this test is ordered, the odds of abnormality is much lower, and the risk of harm (e.g. a positive d-dimer in a low probability chest pain patient getting a false positive reading - which for sub-segmental PE’s is a common issue - then being committed to treatment for something they don’t even have).
Anyway, this topic is complex, and something I’m an expert in, having worked EM for 27 years … but also a frustration in seeing the silliness that goes on in the community.
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Wow I sure had the wrong idea re Urgent Care, thought they would be staffed by MD’s, or at least have one or two on board, with specialized training to handle urgent situations and read EKG’s etc. And the fact you have EKG’s brought to you from those facilities on a regular basis that are normal - very interesting.
At least with my high d-dimer was treated for something I’d not otherwise known about vs unnecessary treatment. Wish I could remember why I went to Urgent Care to begin with - might have been PVC’s, but that’s another story of my disappointment with medicine. Finally did get someone (in this case a cardiac NP paid attention over a cardiologist) and had an ablation, but I think not before damage was done, as saw on my chart “secondary cardiomyopathy.” Not sure when that appeared on chart but can’t think of any previous condition it could be “secondary” to. I can’t tell you how many doctors just waved me off with “oh, everyone has those….” Thank goodness there are some excellent docs like you out there, but the profession needs a lot more. Thanks for your reply and information-really interesting DrFraser.
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