#41

There’s no generic for Livalo (pitavastatin) currently.

#42

Why do you prefer pravastatin over atorvastatin then, or even rosuvastatin?

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#43

Lower risk of negative impact on glucose regulation.

E.g.

Statins are a class of drugs widely prescribed as frontline therapy for lowering plasma LDL-cholesterol in cardiovascular risk prevention. Several clinical reports have recently suggested an increased risk of type 2 diabetes associated with chronic use of these drugs. The pathophysiology of this effect remains to be fully elucidated but impaired β-cell function constitutes a potential mechanism. The aim of this study was to explore the effect of a chronic treatment with lipophilic and hydrophilic statins on β-cell function, using human pancreatic islets and rat insulin-secreting INS-1 cells; we particularly focused on the role of mitochondria and oxidative stress. The present study demonstrates, for the first time, that atorvastatin (lipophilic) but not pravastatin (hydrophilic) affected insulin release and mitochondrial metabolism due to the suppression of antioxidant defense system and induction of ROS production in pancreatic β-cell models.

Atorvastatin but Not Pravastatin Impairs Mitochondrial Function in Human Pancreatic Islets and Rat β-Cells

For more discussion, focused on humans:

#44

Do any of you use a glucose monitor? Attia said they’re OTC just need a script, and that it’s kinda fun to track. Wondering if a good idea esp when on a statin. Livalo is the other one Attia usually starts his patients on, that or Crestor.

#45

I have worn a glucose monitor for two weeks at a time three times in the past year. I am pretty sure the simvastatin I was taking was pushing up my fasting glucose. That’s why I was interested in this issue, and why I specifically wanted to find the statin least likely to have this impact. I added ezetimibe so that I am asking for less LDL-C reduction from the statin.

#46

The more I learn thinking I might ask for the BrilloEZ Destrider takes and leave out the extra statin since my sugar is already 100. Have you thought of that?

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#47

A new Thomas Dayspring interview on managing lipids:

If you would like to hear my real-world description on pharmacological management of apoB - Here is another chat with @aaronhartmanMD of Richmond Functional Medicine that is only 17 minutes long.

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#48

It took me a while to come around to statins. I’m 69 and fit but have had a high cholesterol and Apo B - (a little higher than your numbers). So two things changed my mind. One was realizing that I was being hypocritical by being enthusiastic to take Rapa but suspicious and negative towards all other pharma. (I blame social media where so many “influencers” are completely wrong). The other factor that brought me around was spending time researching studies and listening to Doctors as to the specific mechanics of atherosclerosis. One of the biggest influences was Gregory Sloop MD a researcher who focuses on blood viscosity and hemodynamics. Wow, did he help me understand why you want to lower cholesterol as well as eat low fat.
Anyway, I started Ezetimide daily and Atorvastatin 4 times per week. I didn’t notice any changes in my strength or endurance and had no side effects. I tested about 2 months after starting these drugs and my total cholesterol was 134, LDL 52 and Apo B 54.
From my experience I wouldn’t worry about side effects. If you get muscle cramps or any of the listed bad effects you can talk to your doctor who now have lots of options to switch you to.
Finally, I also recommend focusing on your diet. If you read books by Dr. Esselstyn or others who use nutrition to cure cardiovascular disease you’ll read about studies of people around the world who have no heart disease in their populations. The commonality they have is that don’t eat like Americans.

6 Likes
#49

Do you know what your lipid profile was BEFORE you started rapa? Important to know because if it is true that the increase in LDL with rapamycin is DOSE effect (per Joan Mannick) , then lowering the dose may make more sense before jumping to statin. That said, I would have zero hesitation starting crestor 5mg. At 71, you want the LDL as low as possible.

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#50

Rosuvastatin 5mg is significantly more effective than pravastatin 20mg.

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#51

I know Dr. Esselstyn’s propositions, they are pretty extreme with a vegan, very low fat diet, not suited to everyone. I for example, am living in a Mediterranean country with some of the best EVOOs in the world, I would never renounce my hi-polyphenol EVOO which has a preponderance of evidence of health benefits in the literature for an extreme diet which has been no subject of serious clinical analyses. AFAIK and please correct me if it is untrue.
Also, the picture of the unclogging artery is controversial. One single picture? Sometimes arteries are told to be unclogged even without such an extreme diet.
Last, it must be recognized that Dr. Esseltsyn recognized that familiar hypercholesterolemia cannot be cured by a vegan VLF diet and suggested the use of statins in that predicament.

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#52

Yes it was high before. LDL 169. Total in 220’s. My doc didn’t bat an eye so got a second opinion that blood draw came back somewhat lower and he thought I didn’t need a statin. It’s been borderline high for many years but the docs always went by my ratio which was good, but I’ve read that’s no longer a good marker to go by, just look at LDL and ApoB.

#53

I do know that guy trying to not die purposely drinks olive oil so have questioned Dr. Esselstyns take on that. I think plant based is the way to go but at my age think I need more protein than going 100% can give me. Course that’s controversial too. I think the main thing is not to quibble over these various diets and just cut out the crap, sugar processed foods etc and one will benefit greatly.

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#54

Thanks for sharing your success with that treatment. Very encouraging!

#55

What does effective mean to you?

I am aware that per mg rosuvastatin has a greater impact on reduction of apoB than pravastatin. I am also aware that, if I were seeking the most reduction of apoB possible via statin administration, rosuvastatin would be the way to go.

In my case, I have an apoB target in mind, and I think I can get there with a low intensity statin and ezetimibe. I see the appeal in nuking apoB, but I don’t want to get there at the expense of side effects, because my CVD risk is not extremely high.

#56

I can say that my father and I experience no visible side effects from Bempedoic Acid, Ezetemibe and Atorvastatin except an LDL and ApoB in the high 40s.

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#57

I think we agree on that. I meant that side effects should be compared to equally effective doses between different drugs.

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#58

I understand. I guess you were referring to the table ChatGPT made. I prompted it by asking for doses with comparable lipid-modifying effect, but maybe 2.5mg rosuvastatin would have been a more apt comparison.

Which statin is best for which person, and more broadly which drug in any class is best for which person, is a really interesting question. Sometimes you can identify one drug that seems to strictly dominate another one, but often times I suppose it is a more subtle art – and a question that might not always have a satisfying answer.

For example, I was just reading that the lipophilic statins might have a greater impact on reduction in systemic inflammation than the hydrophilic ones, related to their uptake in a broader range of cells (as opposed to the hydrophilic ones primarily entering the liver).

3 Likes
#59

Just remembered I had a carotid artery scan last year that the Lifeline company does and there was no plaque. Does anyone know if this is a good indicator of what the CAC or CIMT will show? Just curious couldn’t find answer with Google.

#60

Hello,
I was just wondering if you are taking Vitamin K. I am still researching this myself. I heard this guy on a Ben Greenfield podcast and it seems like he has done a lot of research of Vitamin K and Cardiac issues. Does anyone else have experience using High dose Vitamin K while also on Rapamycin?
Regards,

Cardiac Manifesto Deux | CAD Survivor, CAD Researcher (k-vitamins.com)