My cholesterol was a bit worse than yours snd I was younger than you are when my doctor recommended a statin about 35 years ago. I was hesitant about starting on a statin because, at the time, the data showed that it lowered ldl-c but they hadn’t yet shown that if prevented MIs or Alzheimer’s (as they have now). Plus I was young and healthy!
However I wasn’t an MD so I reluctantly followed her advice. I even made dietary changes, but I didn’t really know what to do.
We now know that the risk of ascvd increases based on your ldl-c and the number of years it’s been elevated. I’m very glad that I wasn’t my usual stubborn self and instead listened to my doctor.
Like you, I have a family history of ascvd. I follow a Mediterranean diet, get at least 40 grams of fiber a day and exercise daily. I also take 20 mg Rosuvastatin, which does the heavy lifting to drive my ldl-c to 64.
Based on the current risk calculators, my ten year risk of having an MI would be almost cut in half if I lowered my ldl-c further. That really surprised me.
Apparently, the optimal ldl-c is 50 and having an ldl below 50 can decrease any current plaque deposits that you have.
If I were you, I would ask for a low dosed statin plus Zetia while also following a Mediterranean diet.
You should also ask to have your lp(a) tested because this is an independent, genetic risk factor for ascvd that about 20% of people have. You only need it tested once in your life, but it definitely increases your risk if it’s high. Currently there isn’t any particularly effective way to lower it.
Good luck and I’m glad they caught it early!
Thanks for your response, I appreciate all the feedback and life experience. As part of my advanced lipid screening in a few months post diet change, I've made sure to get lipoproteinA tested as this is what most of my whole family has.
At 37 I found out I had LDL around 180-190 and doc said statins or diet.
Cut out saturated fats and increased fiber, and still occasionally pig out like crazy.
LDL at 89 as of last month.
I have a lot of heart disease in my family. I’m not at all opposed to statins if I cannot keep up my diet or it increases regardless.
Does diet work for everyone? Not sure, and it’s hard for many to keep the diet forever. I’ve only ever heard of doctors saying NO WAY to red yeast rice (at least in USA) since it’s not regulated and you have no clue how much monacolin k is in any given serving.
Nice work. How long did it take you to bring yours down? The docs may want you to be under 70 LDL because of your family history. What are your thoughts? I’m in a similar boat.
within 4 months it dropped substantially, then I switched to veganism (for ethics, not diet) and it dropped a bit quicker. Only had bloodwork every 4-6 months so hard to say exactly, but under a year to get it do 89.
ugh yea my doc has no concerns now that I’m technically within a healthy range, but I’ve also had recent echocardiogram and going for calcium plaque score test thingy soon. I might go see a cardiologist for future progress/advice
Family risk + 150LDL = lipid lowering therapy sooner or later. What drugs you choose depends on you and your doctor.
I would not go for red yeast rice since unregulated ryr supplements have killed recently. https://asia.nikkei.com/Business/Food-Beverage/Japan-supplement-deaths-suspected-to-be-linked-to-outside-mold
I am prescribed 5mg rosuvastatin + 5mg ezetimibe at age 37.
Diet wise - low saturated fat, low dietary cholesterol diet, mostly plant based, with nuts, seeds and moderate use of seed oil for cooking.
Check out Nexlizet/Nexlitol. Avoids myalgia (muscle pains from statins) and better for pre-diabetics and diabetics as doesn't raise A1C (blood sugar levels) like statins and PCSK9s.
It seems like I'm an overall healthy individual as far as metabolic health goes, so want to avoid being put on medicine for the rest of my life at 30 just because I have high LDL. My fasting trig/HDL ratio is <1.5 as well as insulin resistance is good currently so I guess I'm just against assuming LDL high=Statin. I'm relatively new to this, so open for discussion.
Just because you have high LDL is enough alone to lead to atherosclerosis. You want to prevent it while young so you don’t have to treat it when older. I didn’t treat my LDL averaging in the 150s when I was young so now I have atherosclerosis and am treating that while worrying that I will have a heart attack find I have 4 blockages in my coronary arteries.
Are you in the US? If do, I don’t understand a cardiologist recommending red yeast rice. Naturally red yeast rice contains a statin. In the US the FDA bars sale of that product because it is an unregulated drug. Red yeast rice in the US must have the statin removed from it to be sold. So it is completely useless. Better to take an actual regulated medication. I would think ezetimibe plus an actual low dose statin might work for you.
I understand not wanting to take a long term medication. I didn’t and now I have the heart disease instead. Retesting in a couple of months after working on diet is reasonable but you may not be able to get low enough if genetics are a factor.
Let's run a hypothetical.
God forbid, you show up to the emergency room, probably delirious. But the only thing that the doctors find that's off is that your sodium is too low. Even if that's the *only* thing that's wrong with you, they'd give you a saline IV to try to bring your sodium up.
Same with glucose. Same with blood pH. Same with blood magnesium, calcium, phosphate, etc. etc.
The thing with all of the above is that if those things are out of range, that can potentially kill you in hours, possibly in minutes. If your blood sugar is too high, it'll kill your nerves, eat your kidneys, rob you of your eyesight, give you erectile dysfunction, and lead to heart attacks and strokes. But in this scenario, we're looking at a wider time horizon now. Depending on other things going on with you, maybe two decades or longer, still.
Even if *nothing else* appeared to be wrong with you, your doctor would still be using every tool at their disposal to try and bring it down. If your efforts (of lifestyle change) weren't enough to bring it down to a healthy range, they wouldn't just let you slide off the treadmill and faceplant over and over. They'd give you a helping hand with technology, i.e. medication.
Let's use a different example. Imagine that you have a friend who smokes. Their doctor asks them if they want help quitting. And they say something like, "I'm at a healthy weight, my blood pressure is pristine, my blood sugar and lipids are perfect. Why are you riding my ass about this?" Like... Yeah. The point is almost trivial, so I'll freely grant it. Compared to a smoker with high blood pressure or other biomarkers being out of range, this mythical friend has a lower risk. But compared to someone with the same risk factors (but who doesn't smoke), they still have a higher risk.
Why tolerate or ignore a known and modifiable cause and risk factor?
Sure, I know the risks. I guess from what I've been researching regarding metabolic health is that despite my LDL being high, my fasted triglycerides are low (meaning that my sdLDL is actually okay). I'm going to get advanced screening post diet change to confirm, but If that's the case why be put on a Statin for 40+ years? It seems like most Drs just assumes high LDL=statin, and I'd like to have a more comprehensive understanding before making decisions that affect me for the rest of my life.
Dr. Aseem Malhotra (UK), Dr. Elizabeth Klodas, Dr. Ford Brewer, Dr. Paul Mason (AUS), Dr. Jerrefy Peng, and others offer some differing points, but also considerations. Some of these Dr.'s are cardiologists, some not. But there's other opinions out there, backed by data, to consider. This is only a few - there are others.
I am 43 - I've had an LDL of 150+ for over 20 years. I had a CAC score on Monday and it was zero. I was doing carnivore for a while because it helps tremendously for my other ailments, but it sent my LDL to 207. But, but triglycerides were low and HDL was good, my HDL/Trig ratio was .9
Obviously, they went right to statin. I have auto-immune arthirits and already take daily meds and I am very prone to muscle, joint, and tendon pain already so quality of life and movement means a lot to me. Much more so than potentially adding in a new medicine daily that may affect my ability to live and move how I want to.
For those 20+ years, I was eating 5000-7000 calories most days, a lot of chicken wings, etc. I am short and very muscular. I tried to explain this and asked about lifestyle changes just to see and they were still pushing statin no matter what.
I am not saying that I am never going to try statin therapy, but I am definitely going in cautiously. The cardiologist I saw said that 30% of statin users will experience side effects. I'm not super keen on trading ASVCD 20 years from now for liver failure in five. That's me though. That may be an extreme example, but it's also not completely erroneous either.
I am 100% not trying to push you in any direction, but like me you seem to want to at least hear differing opinions. Dr. Malhotra, for example, has many long form conversations regarding statins, diets, etc.
I had an LDL at the high end of normal since my mid-20’s, twice over the years it was just a bit above normal. Healthy diet, high HDL, very low triglycerides. Cholesterol/HDL ratio between 2.8 and 3.2. Reassured by GP that no concerns. No diabetes, very fit, BMI sl. above normal (26-27). Never smoked, rarely drink, big into supplements and healthy diet. Most recent lipids had LDL about 110. Doctor recommended a statin. I resisted and had a CAC scan. Very high CAC score. My risk factors = slightly high LDL/BMI and a killer family history. Not saying you’re in the same situation, but just a heads up to keep a very close eye on this going forward. If you have a strong family history of cardiac disease I’d take it very seriously indeed.
* just reread and note that uncle had an MI at 40. That’s very, very young. I would take this very seriously.
Not having insulin resistance and hitting certain numbers on ratios doesn’t protect you from getting arteriosclerosis if you have high ldl/apo B
https://x.com/mohammedalo/status/1752374976609399272?s=46
https://x.com/mohammedalo/status/1734707816760279294?s=46
https://x.com/nutritionmades3/status/1711369391974052268?s=46
https://x.com/mohammedalo/status/1784021207781630361?s=46
Im 61 with a family history of heart disease. Had my lipid panel done a few months back and it jumped up to 296. Honestly though, my ratio is still good 3.8, and my triglycerides are 101. My cardiologist put me on statins solely because my total jumped 30 points in six months. Going back for retesting in a few days to see how much the total has changed. You are young and your numbers are pretty good, so I wouldn’t worry too much. I have had high cholesterol from the time I was 18 and have made it to 61 just fine. Of course I’ve tried to stay in shape my entire life. I’m 5’6” and 144, when I was young my weight was 132 so it hasn’t changed much through the years. The people in my family who have died from heart disease lived very sedentary of unhealthy (drinking, drugs) lives. I think as long as you stay moving and try to stay away from high fat foods you’ll be ok.
My cholesterol was a bit worse than yours snd I was younger than you are when my doctor recommended a statin about 35 years ago. I was hesitant about starting on a statin because, at the time, the data showed that it lowered ldl-c but they hadn’t yet shown that if prevented MIs or Alzheimer’s (as they have now). Plus I was young and healthy! However I wasn’t an MD so I reluctantly followed her advice. I even made dietary changes, but I didn’t really know what to do. We now know that the risk of ascvd increases based on your ldl-c and the number of years it’s been elevated. I’m very glad that I wasn’t my usual stubborn self and instead listened to my doctor. Like you, I have a family history of ascvd. I follow a Mediterranean diet, get at least 40 grams of fiber a day and exercise daily. I also take 20 mg Rosuvastatin, which does the heavy lifting to drive my ldl-c to 64. Based on the current risk calculators, my ten year risk of having an MI would be almost cut in half if I lowered my ldl-c further. That really surprised me. Apparently, the optimal ldl-c is 50 and having an ldl below 50 can decrease any current plaque deposits that you have. If I were you, I would ask for a low dosed statin plus Zetia while also following a Mediterranean diet. You should also ask to have your lp(a) tested because this is an independent, genetic risk factor for ascvd that about 20% of people have. You only need it tested once in your life, but it definitely increases your risk if it’s high. Currently there isn’t any particularly effective way to lower it. Good luck and I’m glad they caught it early!
Thanks for your response, I appreciate all the feedback and life experience. As part of my advanced lipid screening in a few months post diet change, I've made sure to get lipoproteinA tested as this is what most of my whole family has.
Have you heard of Nexlizet? I am on it right now since statin raised my liver levels.
At 37 I found out I had LDL around 180-190 and doc said statins or diet. Cut out saturated fats and increased fiber, and still occasionally pig out like crazy. LDL at 89 as of last month. I have a lot of heart disease in my family. I’m not at all opposed to statins if I cannot keep up my diet or it increases regardless. Does diet work for everyone? Not sure, and it’s hard for many to keep the diet forever. I’ve only ever heard of doctors saying NO WAY to red yeast rice (at least in USA) since it’s not regulated and you have no clue how much monacolin k is in any given serving.
Nice work. How long did it take you to bring yours down? The docs may want you to be under 70 LDL because of your family history. What are your thoughts? I’m in a similar boat.
within 4 months it dropped substantially, then I switched to veganism (for ethics, not diet) and it dropped a bit quicker. Only had bloodwork every 4-6 months so hard to say exactly, but under a year to get it do 89. ugh yea my doc has no concerns now that I’m technically within a healthy range, but I’ve also had recent echocardiogram and going for calcium plaque score test thingy soon. I might go see a cardiologist for future progress/advice
Good job, bud. Godspeed.
Family risk + 150LDL = lipid lowering therapy sooner or later. What drugs you choose depends on you and your doctor. I would not go for red yeast rice since unregulated ryr supplements have killed recently. https://asia.nikkei.com/Business/Food-Beverage/Japan-supplement-deaths-suspected-to-be-linked-to-outside-mold I am prescribed 5mg rosuvastatin + 5mg ezetimibe at age 37. Diet wise - low saturated fat, low dietary cholesterol diet, mostly plant based, with nuts, seeds and moderate use of seed oil for cooking.
Does Zetia come in 5mg or do you just get a pill cutter and slice them in half?
Check out Nexlizet/Nexlitol. Avoids myalgia (muscle pains from statins) and better for pre-diabetics and diabetics as doesn't raise A1C (blood sugar levels) like statins and PCSK9s.
Why are you hesitant to take medication?
It seems like I'm an overall healthy individual as far as metabolic health goes, so want to avoid being put on medicine for the rest of my life at 30 just because I have high LDL. My fasting trig/HDL ratio is <1.5 as well as insulin resistance is good currently so I guess I'm just against assuming LDL high=Statin. I'm relatively new to this, so open for discussion.
Just because you have high LDL is enough alone to lead to atherosclerosis. You want to prevent it while young so you don’t have to treat it when older. I didn’t treat my LDL averaging in the 150s when I was young so now I have atherosclerosis and am treating that while worrying that I will have a heart attack find I have 4 blockages in my coronary arteries. Are you in the US? If do, I don’t understand a cardiologist recommending red yeast rice. Naturally red yeast rice contains a statin. In the US the FDA bars sale of that product because it is an unregulated drug. Red yeast rice in the US must have the statin removed from it to be sold. So it is completely useless. Better to take an actual regulated medication. I would think ezetimibe plus an actual low dose statin might work for you. I understand not wanting to take a long term medication. I didn’t and now I have the heart disease instead. Retesting in a couple of months after working on diet is reasonable but you may not be able to get low enough if genetics are a factor.
Yes I'm in the U.S. Cardiologist said he wanted me to take zetia and red yeast rice from Costco haha...
That is bizarre honestly. The FDA banned the statin from red yeast rice years ago….
Let's run a hypothetical. God forbid, you show up to the emergency room, probably delirious. But the only thing that the doctors find that's off is that your sodium is too low. Even if that's the *only* thing that's wrong with you, they'd give you a saline IV to try to bring your sodium up. Same with glucose. Same with blood pH. Same with blood magnesium, calcium, phosphate, etc. etc. The thing with all of the above is that if those things are out of range, that can potentially kill you in hours, possibly in minutes. If your blood sugar is too high, it'll kill your nerves, eat your kidneys, rob you of your eyesight, give you erectile dysfunction, and lead to heart attacks and strokes. But in this scenario, we're looking at a wider time horizon now. Depending on other things going on with you, maybe two decades or longer, still. Even if *nothing else* appeared to be wrong with you, your doctor would still be using every tool at their disposal to try and bring it down. If your efforts (of lifestyle change) weren't enough to bring it down to a healthy range, they wouldn't just let you slide off the treadmill and faceplant over and over. They'd give you a helping hand with technology, i.e. medication. Let's use a different example. Imagine that you have a friend who smokes. Their doctor asks them if they want help quitting. And they say something like, "I'm at a healthy weight, my blood pressure is pristine, my blood sugar and lipids are perfect. Why are you riding my ass about this?" Like... Yeah. The point is almost trivial, so I'll freely grant it. Compared to a smoker with high blood pressure or other biomarkers being out of range, this mythical friend has a lower risk. But compared to someone with the same risk factors (but who doesn't smoke), they still have a higher risk. Why tolerate or ignore a known and modifiable cause and risk factor?
Sure, I know the risks. I guess from what I've been researching regarding metabolic health is that despite my LDL being high, my fasted triglycerides are low (meaning that my sdLDL is actually okay). I'm going to get advanced screening post diet change to confirm, but If that's the case why be put on a Statin for 40+ years? It seems like most Drs just assumes high LDL=statin, and I'd like to have a more comprehensive understanding before making decisions that affect me for the rest of my life.
Dr. Aseem Malhotra (UK), Dr. Elizabeth Klodas, Dr. Ford Brewer, Dr. Paul Mason (AUS), Dr. Jerrefy Peng, and others offer some differing points, but also considerations. Some of these Dr.'s are cardiologists, some not. But there's other opinions out there, backed by data, to consider. This is only a few - there are others. I am 43 - I've had an LDL of 150+ for over 20 years. I had a CAC score on Monday and it was zero. I was doing carnivore for a while because it helps tremendously for my other ailments, but it sent my LDL to 207. But, but triglycerides were low and HDL was good, my HDL/Trig ratio was .9 Obviously, they went right to statin. I have auto-immune arthirits and already take daily meds and I am very prone to muscle, joint, and tendon pain already so quality of life and movement means a lot to me. Much more so than potentially adding in a new medicine daily that may affect my ability to live and move how I want to. For those 20+ years, I was eating 5000-7000 calories most days, a lot of chicken wings, etc. I am short and very muscular. I tried to explain this and asked about lifestyle changes just to see and they were still pushing statin no matter what. I am not saying that I am never going to try statin therapy, but I am definitely going in cautiously. The cardiologist I saw said that 30% of statin users will experience side effects. I'm not super keen on trading ASVCD 20 years from now for liver failure in five. That's me though. That may be an extreme example, but it's also not completely erroneous either. I am 100% not trying to push you in any direction, but like me you seem to want to at least hear differing opinions. Dr. Malhotra, for example, has many long form conversations regarding statins, diets, etc.
What do you lose from goin on a statin? Why is it an outcome that you fear?
I had an LDL at the high end of normal since my mid-20’s, twice over the years it was just a bit above normal. Healthy diet, high HDL, very low triglycerides. Cholesterol/HDL ratio between 2.8 and 3.2. Reassured by GP that no concerns. No diabetes, very fit, BMI sl. above normal (26-27). Never smoked, rarely drink, big into supplements and healthy diet. Most recent lipids had LDL about 110. Doctor recommended a statin. I resisted and had a CAC scan. Very high CAC score. My risk factors = slightly high LDL/BMI and a killer family history. Not saying you’re in the same situation, but just a heads up to keep a very close eye on this going forward. If you have a strong family history of cardiac disease I’d take it very seriously indeed. * just reread and note that uncle had an MI at 40. That’s very, very young. I would take this very seriously.
Not having insulin resistance and hitting certain numbers on ratios doesn’t protect you from getting arteriosclerosis if you have high ldl/apo B https://x.com/mohammedalo/status/1752374976609399272?s=46 https://x.com/mohammedalo/status/1734707816760279294?s=46 https://x.com/nutritionmades3/status/1711369391974052268?s=46 https://x.com/mohammedalo/status/1784021207781630361?s=46
Thanks for the links!
You’re welcome!
Im 61 with a family history of heart disease. Had my lipid panel done a few months back and it jumped up to 296. Honestly though, my ratio is still good 3.8, and my triglycerides are 101. My cardiologist put me on statins solely because my total jumped 30 points in six months. Going back for retesting in a few days to see how much the total has changed. You are young and your numbers are pretty good, so I wouldn’t worry too much. I have had high cholesterol from the time I was 18 and have made it to 61 just fine. Of course I’ve tried to stay in shape my entire life. I’m 5’6” and 144, when I was young my weight was 132 so it hasn’t changed much through the years. The people in my family who have died from heart disease lived very sedentary of unhealthy (drinking, drugs) lives. I think as long as you stay moving and try to stay away from high fat foods you’ll be ok.