#435

I read in a Peter Attia article about this, I think it is paywalled, but he uses OGTT which seemed much superior based on what he said.

#436

Yes OGTT is great but it takes 2 to 6 hours. I did both (2h and later 6h) and it was a nightmare. You can’t do that regularly. So I only do HOMA-IR every 6 months now.

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#437

If your LDL is 70 why are you taking a statin? HDL 40 is not good.

#438

Cause at 70mg/dL you can still have CVD
40mg/dL of HDL is okay for a man. Not amazing, just okay.

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#439

But your LDL 70 is not great, but also is OK. Not sure about HDL 40. May be too low? Trying to get my LDL 70. Mine is 95. Started alternating ezetimibe and rosuvastatin in lowest doses.

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#440

Atherosclerotic coronary plaque regression from lipid-lowering therapies: A Meta-analysis and Meta-regression 2024

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while the addition of ezetimibe seemed to significantly increase the PAV reducing effect of LIS while decreasing the PAV reducing effect of HIS, these inconsistent results were driven by the significant heterogeneity in the LIS plus ezetimibe subgroup (τ2 = 0.88, I2 = 61.8%), and possibly the limited number of included studies in the HIS plus ezetimibe subgroup. In fact, previous studies demonstrated that the addition of ezetimibe do not contribute to a significant increase in PAV reduction. While the role of statins on plaque regression have been discussed above, we emphasize that HIS was the only LLT subgroup which provided significant reductions in both TAV and PAV.

Perhaps, the more significant finding of our study in PAV reduction is the role of EPA. […] While many previous studies have demonstrated that the addition of EPA to statin contributes to increased plaque regression, our pooled analysis showed that the addition of EPA to LIS is superior even when compared to other multiple classes of LLTs, supporting the hypothesis that EPA contributes to plaque regression in mechanisms beyond lipid-lowering, giving emphasis to the role of its anti-inflammatory effects in plaque regression. However, the question on whether the overall results translate to a clinically meaningful reduction still remains.

They didn’t define LIS and HIS though :thinking:

Bempedoic acid not included in the review. Would be interesting to test low-intensity statin + ezetimibe + EPA (+ bempedoic acid?). Or just wait for obicetrapib…

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#441

V.Interesting. Do you have a link to full paper?

I think this is particularly notable: " Compared to high-intensity statin monotherapy, moderate-intensity statin with ezetimibe combination significantly reduced the risk of composite outcome [hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.77–0.92, P < 0.001]"

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#442

I pasted the wrong link :grimacing: Now fixed…

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#443

17105896519515705693763805565061
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Ezetimibe 10mg, pravastatin 10mg!
Pretty good!
HDL 60
LDL 53
Triglycerides 37
GGT 8
ASAT 27
ALAT 25
CRP below 1

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#444

Below is interesting for perspective on CAC scores

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https://twitter.com/paddy_barrett/status/1768924452484456513?

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#445

I have switched to 10 mg Lipitor (atorvastatin) from 5 mg Crestor (rosuvastatin) because of lower causal diabetes risk and cataract surgery: Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised LODESTAR trial (2023)

Whether I will increase the dose or not, dunno, it is a separate question.

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#446

Are you considering adding ezetimibe?

#447

I was on Lipitor, but stopped because of muscles pain. Now I’m on 5mg Rosuvastatin every other day, alternating it with 10 mg ezetimibe. Works great for me with no muscle pain, and it does lower lipids gradually. Doesn’t affect my glucose level as well.

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#448

Yes but I would have to look at the largest clinical trials, I have heard they have detected an improvement in cardiovascular mortality (but not all-cause) and the MR studies you posted before will help. I don’t know what to think of higher doses of atorvastatin either.

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#449

There is no cost to adding ezetimibe but there are lots of potential upsides

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#450

More on ezetimibe: Combination Moderate-Intensity Statin and Ezetimibe Therapy for Elderly Patients With Atherosclerosis 2023

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Third, the rate of the all-cause death was numerically higher in the ezetimibe combination therapy group than in the high-intensity monotherapy group among patients aged >=75 years. However, the difference was not significant, and the comparison of individual component of the primary or secondary composite endpoint was difficult because of the small number of events; therefore, the results should be interpreted with caution.

[Full text]

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#451

The error bars are so wide that I think the paper is useless.

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#452

We don’t know whether ezetimibe caused the trend towards slightly higher acm or whether high intensity statin usage caused a lower acm compared to combination therapy. If it’s the latter, combined high intensity statin therapy and ezetimibe would yield even better results.

#453

That’s the whole point of the paper… :person_facepalming:

Moderate-intensity statin with ezetimibe combination therapy showed similar cardiovascular benefits to those of high-intensity statin monotherapy

It’s not useless to be able to reach that conclusion.

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#454

Unfortunately, according to this recent paper ( What's the best statin to take? - #440 by adssx ), adding ezetimibe to high-intensity statin seems to yield worse results.

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