Rapamycin and risk of cardiovascular disease

[DeStrider]

Salt substitutes shown to reduce CVD risks.

Destroying The Salt Controversy

[tongMD]

The potential for negative cognitive effect appears to be tied to HMGCRi in the brain, perhaps confounded by positive cerebrovascular effects - so we seem to observe a net near zero (but probably present) negative cognitive effect.

I’m not sure hydrophilic statins like rosuvastatin would be an issue since it basically doesn’t cross the BBB. Very much hepatoselective.

Ultimately, one can capture a bulk of the effect of rosuvastatin with low-dose intermittent once weekly - active for ~4 days with ED50 at ~2 mg. But ultimately I’d like to see someone at least close to borderline indicated before Rx statins personally.

[rivasp12]

Always about the benefit/risk assessment of course.

For secondary prevention, or in those at high CV risk, I do see the advantage of crestor . I like the low dose option as well.

For primary prevention, the absolute risk reduction of total mortality is so low with statins that the benefit/risk no longer works. I’ve seen both mild and severe cognitive issues . This study is also concerning:

Mendelian Randomization Study of PCSK9 and HMG-CoA Reductase Inhibition and Cognitive Function | Journal of the American College of Cardiology (jacc.org)

For the low risk rapa user, I think fiber and citrus bergamot are good choices if concerned over lipids.

[AnUser]

Dr. Brad Stanfield is actually quite based.

[forceofnature]

You think he’s based or biased?

[AnUser]

Yes, based.

20 characters

[desertshores]

I take K2. But there is no evidence that it is a substitute for statins.
The Framingham study was also funded by the pharmaceutical industry as most drug studies are. However, the results of the Framingham study,
" The FHS cohorts now comprise three generations of participants (n ≈ 15,000) and two minority cohorts. The FHS cohorts are densely phenotyped, with recurring follow-up examinations and surveillance for cardiovascular and non-cardiovascular end points"
has been used by thousands of researchers. Many other studies have backed up the Framingham study

I don’t have any interest in whether you personally take a statin or not.
Survival was significantly increased among subjects treated with statins versus no statins at ages 78 to 85
The protective effect of statins observed among the very old appears to be independent of TC.
So, I am not arguing for or against the effect of statins in lowering cholesterol.

A small insight into the European view of statins:
"The most important reasons for statin discontinuation (and non-adherence) are statin-associated adverse effects (statin intolerance, SI) as well as anti-statin movements, fake news relating to statin therapy, and a lack of patient education resulting in a fear of adverse effects.

Framingham Heart Study (FHS)

Europe PMC

[sol]

I have a friend (>60yo male) who was diagnosed 1.5 years ago with advanced Coronary Artery Disease (CAD). He had multiple stents put in, which really helped his symptoms. (Blood to the heart–not just a good idea, but a great idea. ). He takes all the Rx his cardiologist team recommends. (A team with an excellent reputation.) He made all the lifestyle changes they wanted (no more nicotine, etc.) He has excellent ND support on supplements, and has made major diet changes, exercises regularly, etc.

I’d like to hear from others in similar situations, or anyone with deeper knowledge about CAD, as to whether they’d recommend rapamycin to him, and if so, under what conditions. Thanks! (If this should be a new topic, @RapAdmin feel free to move; I wasn’t sure.)

My focus here is rapamycin, not so much how he should deal with his CAD. Rapamycin. Please comment on that, if you have insights. Thank you.

[tongMD]

@mike666

never proffer the reverse guarantee

Or maybe one should actually read before making biased, factually incorrect overarching claims with words such as “never” - clinical outcomes you describe are tied to payment.

See 30-day hospital readmission rate (risk-adjusted) and mortality rates are a factor for payment. You leaving AMA is actually just inadvertently helping the hospital get more payments.

They are not liable for natural deaths in the hospital - that’s a given of the court system - the hospital did not cause harm and making such a guarantee can lead to abuse similar to life insurance fraud. Hospitals aren’t insurance companies. But liability exists for malpractice - that would be due to harm caused and the tort system deals with that.

What one should be more concerned about is the private equity takeover of medicine. Good luck navigating that without deep knowledge of the system.

https://data.cms.gov/provider-data/topics/hospitals/linking-quality-to-payment#hospital-readmissions-reduction-program

I have doubts that you’d consider the opposing arguments but I’ll put it here for others. Feel free to block me. Steve Jobs relied on an “alternative” naturopathic diet and herbs instead of the “mainstream” early surgery.

Here’s a citation from 60 Minutes:

“Everyone else wanted Steve Jobs to move quickly against his tumor. His friends wanted him to get an operation. His wife wanted him to get an operation. But the Apple CEO, so used to swimming against the tide of popular opinion, insisted on trying alternative therapies for nine crucial months. Before he died, Jobs resolved to let the world know he deeply regretted the critical decision, biographer Walter Isaacson has told 60 Minutes”

Moral of the story: contrarianism is usually wrong, and most of the time those going against the tide are a form of fashionable nonconformist conformism without an informational advantage. Generally, that’s part of the appeal of “alternative medicine” - a popular belief that one has obtained unique knowledge when it is often illusory superiority, as opposed to pursuing experimental interventions where plenty of open-minded research scientists cross-country are ready to try anything that appears to have a decent probability of success, albeit a tiny base success rate.

Being contrarian for contrarian’s sake is not true contrarianism and a rigorous contrarian should consider the base rate of being factually incorrect, especially when it’s a field where the stakes are high, such as medicine. Recognizing where exactly one has deep information asymmetry and knowledge gaps is the first step to wisdom. The greatest enemy is illusory knowledge.

[AnUser]

This has happened a lot in this thread:

[sol]

Thanks. What about supplemental rapamycin for my friend? (No, his stents didn’t have rapa on them; I checked.)

[John_Hemming]

That’s an amusing image, but does not identify what you think is BS. Not to say that you are wrong, but as it stands all we have is an amusing image.

[rivasp12]

Yeah, this BS thread has had 14,000 views and 1400 responses ( many of which have been from you).

[AnUser]

I never said it is a BS thread. I have also had my own BS refuted, that’s how we learn. Just wanted to point out the difference in the effort required between making spurious claims and having to refute it. And that it has happened here a lot, and elsewhere.

[desertshores]

Throughout my life, I have seen many a cardiologist because of an underlying anomaly I’ve had since childhood. And, I have yet to meet a cardiologist that didn’t want to install a stent.
Still ticking and so glad I never had a stent inserted. The useful thing a stent might do is, possibly and I say possibly, improve the quality of life in some people. Stents do not prevent heart attacks, end of story. The Steve Jobs reference is a completely different story. I don’t think, and I often disagree with Mike666, that he is advocating for treating cancer with alternative medicine.

[tongMD]

I would be skeptical about the strength of evidence in stents preventing heart disease in general for CCS, but I mean if one has chest pain and it’s related - sure - symptomatic improvement in select cases can be worthwhile. Not sure what your anomaly is so can’t really speak for it.

A reasonable decision could be a carefully selected second opinion from a different cardiologist familiar with the strength of the evidence. Not defaulting to taking a bunch of things without evidence, especially with a source of information or intervention with a reputation or pattern of health fraud, such as mike666 is claiming.

[Jerry_Cahill]

I just bought an extensive lab test and had my labs done. I bought 2 of them so I will have them done again in a few months. I am also starting 3 months of Rapamycin so maybe I can see how it impact LDL. I had done 6 weeks of 5mg of Rapamycin at the end of last year.

I previously had a Cholesterol test done in early Nov 22. My LDL was high and was 1 point different on this recent test. However I suspect diet changes caused my HDL to go from 55 to 70 and my ratio dropped into a very healthy range. And my triglycerides stayed in the 80s which I am told may be the most important number. I am not taking statins. I may have this - genetic familial hypercholesterolemia
I am not concerned about the LDL levels at this time but I will continue to monitor.

As an aside my Vitamin D level was a little over 100 which is considered high but from what I can tell not in the toxic range yet. Anyone know more about this?

[jakexb]

Just did my Apob test after about 6 months of weekly rapa. I’m at 91, which is missing “optimal” by 2 points.

Now Peter Attia says everyone should be under 60, which is definitely more extreme, but I understand the point. There’s no benefit to high atherogenic particles. Not sure if it’s worth a low dose statin or not. I’m pretty good about exercise and diet already.

[AnUser]

Definitely worth it if you don’t get any side effects.
On the topic, age reveral will have zero effect on ASCVD if it doesn’t affect apoB concentration. Or if it can’t reverse ASCVD. The latter would be curing ASCVD, not longevity per say.
So ‘1000 year’ longevity like Aubrey says will actually result in 90 year longevity due to ASCVD.

People don’t seem to see the significance in this. If ASCVD is the bottleneck it doesn’t matter how many organs are rejuvenated.

[rivasp12]

There’s a recent study using statins in premature infants.

These infants have poor lung development leading to the use of high dose steroids. This is extremely beneficial, but unfortunately it leads to premature cardiac aging. In this study, statins reversed the cardiac aging when given along with the steroids.

Was this benefit due to LDL lowering? Obviously not.

Statins are dirty drugs , so they act through a myriad of mechanisms, so the benefits are hard ,to impossible, to sort out. And like all dirty drugs, the potential for side effects is high. Clozapine is a great example.

So, in the healthy rapamycin user where LDL is somewhat elevated, does the benefit/ risk work? No, since the absolute reduction in total mortality is very low in that instance - assuming primary prevention.

If you believe that statins are cardiac protective due to their myriad functions, and not necessarily LDL related, then it may make sense to add them to rapamycin as a synergy, though this has yet to be proven.