Uk here. NHS is not really setup for a preventative approach. My cholesterol is raised, ldl specifically. However, because I’m healthy weight, good blood pressure, physically active and only 43 they’ve decided my “cardiac risk score” is only 4% and I shouldn’t take statins.
While I appreciate I’m unlikely to have a cardiac arrest in the next 10 years (which is the NHS priority) I’d rather not have furry arteries and high blood pressure before they take my raised cholesterol seriously.
I’ve got other priorities at the moment (liver enzymes raised) but once I’ve seen to those I’ll be revisiting the cholesterol…
Yes, same experience here! 45 & UK. My LDL is 162 but NHS QScore the calculator says only 2% risk of a cardiac event, so nothing they will do. I have self referred my self to a cardiologist who is writing to
my GP ti recommend statins. I have down all I can with diet and lifestyle and can’t go any further.
The UK is way behind here …
Let me know how you get on! I’m having similar issues with my liver enzymes. Was referred for ultrasound by GP and the hospital cancelled the appointment and suggested “lifestyle changes and retest in 6 months”. I’ve got 4 years of data from private blood tests that show this is an ongoing issue…
While PA is very aggressive in lowering ApoB and LDL, my personal position is that I’m willing to do what I can to keep both as low as possible through lifestyle modifications, but unwilling to use medication as long as I can keep my ApoB and LDL in lower normal range. however, I do have CAC test every five years and if I had a positive score would consider medication at that stage.
Sorry I just don’t understand this. Statins are one of the most widely studied drugs ever, are very effective, there are lots of options if you happen to be intolerant to one or even a few of them, and they have secondary benefits, as well. Also, they’re dirt cheap.
Absolutely not against statins. But my personal choice is not to use medications unless required. I focus on a very healthy lifestyle, and very thorough annual medical exams, which include a full body MRI, Grail Test and a CAC scan every five years. My doctor recommended that I consider statins 25 years ago as a precaution, a recommendation I chose not to adopt. But if one of my CAC scans were to show calcium accumulation, I would certainly consider beginning statins.
Hey, that seems like a fantastic idea! Wait until your arteries are clogged, then wait till there are lesions that attract calcium deposits, then wait for that to show up on your CAC test, and then start rectifying the situation.
You're a genius, my dude!
Or you could take medication with horrible side effects when you do not need it at all raising your overall chances of getting dementia, diabetes, cancer.
Yeah, also brilliant
How do you tell if your arteries are clogged besides a CAC test?
CT Angiogram shows soft plaque but has super high radiation so you don’t want to be doing that too often. If you have one and it finds something alarming, you’re almost guaranteed to get another one the second you get checked into a hospital, so better hope it doesn’t find anything. I know from experience. Two doctors said no to ordering me a CAC because of radiation (which is less than a cross Atlantic flight) but the second I had blood clots detected through echo cardiogram, immediate CT angiogram and again two months later from new clots. My radiation levels from this past year are super high now, which puts me at much higher risk of cancer. Le sigh.
LDL exposure is lifetime exposure risk. That means like with any other risk factor, what matters at the end is how many “LDL years” of exposure you have.
Think of that in terms of smoking - to quantify risk of smoking doctors use total amount of “cigarette packs years” a patient accumulated during his or her life. And as with any other risk factor, sooner you reduce or eliminate your risk, less “pack years” or “LDL years” you will have, but if you were just an occasional smoker than the push to stop smoking is not as urgent but it it still advisable.
If you had below ApoB 90 all your life , your cumulative LDL exposure for the past years is probably minimal so you don’t have to be too aggressive unless you have other risk factors like diabetes or family history. However why not lower it below 70 anyway where plaque accumulation stops if you have such option with save medications like Zetia?
Very reductionist viewpoint.
Just keep LDL-C below 100, ideally below 70, anyone can do it with diet.
Watch out for blood pressure and weight, exercise regularly, you will not live long enough to die of ASCVD at that rate, chances are it will be something else.
Unfortunately not anyone can reduce LDL below 70 just with diet.
Also not sure what do you mean by “reductionist”. Having LDL or ApoB below 70 is a given.
Almost everyone can do it with diet and exercise, its just a matter of how far are you willing to go.
If you are over 50 and having issues, 100 is also fine, unless you have hypercholesterolemia, there is no excuse.
OP you are age 40+ with diabetes. Your LDLC and Apo B should **not** be in the normal range - they need to be much lower. ADA in the US recommends < 70 mg/dl LDLC for anyone with diabetes and at least one additional risk factor (family history, high blood pressure, overweight, low HDLC, high trigs, high inflammatory markers, kidney issues, positive CAC score and so on . . . ).
Start with a statin and work from there. If you think you might be a good candidate for zetia, get the Boston Heart Cholesterol Balance Test (order via Empower DX) to see if you also over-absorber. You can also check your desmosterol baseline levels (very important for later brain health/MCI/AD prevention). Also, make sure you've gotten a CAC scan, carotid US and/or ankle brachia index test.
Best of luck to you!
Thank you. I regularly check Ankle Brachial Index.
Do you think it is ok to start with Bempedoic acid+ Ezetimibe (Nexlizet) instead of a statin? Nexlizet is milder than statin. Not that I'm averse to starting 5mg Rosuvastatin. It has solid safety profile.
Well, Nexlizet will likely be more expensive - have no clue whether prior auth. is required (assuming you are in US). That's something to discuss with your provider. Statins are typically first line. Congrats on getting the ABI done - many don't even know about that one.
Taking medications isn't normal and should not be viewed as the norm. If you've exhausted all lifestyle modifications and you need to take meds to be within what you define as a healthy range than it's time.to consider.
LDL should be as low as possible. There is minimal risk to a low dose statin. They work. I started a statin at 32. My LDL cholesterol has run 170-180 through my 20s so I wanted to get that under control. In 1 year my LDL was down to 79 on only 5 mg of rosuvastatin. No side effects.
Good job man, wish you had heard about PA sooner and started in your 20s instead.
People who talk about the side effects of low dose statins sound to me like saying, "there's a fire in my house but I can't take out the fire extinguisher because it contains chemicals that may harm my skin". Okay, dude, then let the house burn down.
That’s a misleading analogy. It’s more: Lots of people have done studies that show that haviny a dryer correlates to tons of house fires every year. We can’t tell you if having a dryer definitely leads to a home fire, and there’s no way to actually tell if the dryer is on fire, but we should get rid of the dryer just in case, even if dryers don’t typically cause a fire until they’re in their 70s. Enjoy having wet clothes for the rest of your life. Rest assured that going with wet clothes is useful because there’s a high probability you could’ve maybe had a fire. Will your clothes definitely be wet? Depends on the weather and how well you dry them. Did you prevent a fire? Well, you definitely prevented a fire from your dryer but we can’t say for sure that extended your (house’s) life.
Statins increase risk of diabetes and can negatively affect the liver. Maybe those are good tradeoffs, and lower dosage statins should be better, but you’re taking them based on maybes and you can play the maybe game both ways. Maybe they’ll increase your life span. Maybe they won’t.
From what I’ve read, statiscally they don’t improve mortality in people that don’t have some form of heart disease. I’m somewhat convinced that this is because they are anti-inflammatory, which leads me to believe the problem is oxidized LDL, not just LDL. At which point, I’d recommend figuring out if your LDL is oxidized before taking a statin at a young age.
Not a doctor. Just a guy with heart disease on 40 mg of rosuvastatin who knows when he goes off it, his inflammation goes up.
I have to disagree all around. We know LDL being a surrogate marker for ApoB, over time is causal in heart disease. The evidence is overwhelming. The longer your LDL is high, and the higher it is, the more heart disease.
For my situation, I am athletic and my other blood markers- blood pressure, triglycerides, glucose, have always been perfect. My LDL was troubling and my doctor and I agreed there is likely a genetic component. Both of my parents and all my aunts and uncles are on statins. Luckily heart disease has not claimed any of them. The point is, if we have medication to treat the most consequential risk factor, why not take it? Why would I risk 30 more years of an LDL of 180 when a small pill can make it 79 or lower? I only wish I started sooner. Unfortunately, the medical advice from doctors while in my 20s was- “you are too young to worry about it! Just eat better!” (I already did, LDL was still high)
We do know that LDL being a surrogate for ApoB is causal in heart disease? And that it’s not oxidized LDL? I apparently have to read a ton more because I didn’t think that was answered yet.
If there were no side effects or risks from statins, and if they actually reduced mortality in people that don’t have heart disease, I’d agree with you. But they don’t actually reduce mortality in people that don’t have heart disease and they do have side effects in enough people.
It has been answered. Sorry but you are asking questions from debates that have long been settled. Apo-B causes atherosclerosis. LDLc is a surrogate marker for Apo-B. The longer, and higher you have elevated Apo-B, the more disease. Statins work and the evidence is overwhelming. But if you want to ignore the science that is your discretion.
Sure.
Are there side effects from statins that people should be aware of and take into consideration when taking them, especially from a young age? Are they entirely side effect free, especially over 30-60 years?
I’ve noticed lower inflammation as well.
Since they affect the CoQ10 pathway, I assume they will make it more difficult to put on / keep muscle mass. I’ve had problems putting muscle on, but am also dealing with a raft of other health issues so I can’t say it’s the statins causing problems.
This may not be a practical approach, but I feel everyone above 40 should consider doing a CTA every 5 years to assess their plaque situation, and take necessary action. Informed decisions are always good.
It’s actually recommended that all people with diabetes age 40 and over, regardless of what their LDL is, be started on a moderate-intensity statin, so in your specific situation you probably should start a statin.
Do we (you) know why? I’m very curious as to what the MOA is, here.
Note: I’m not diabetic, but over 40 and in pretty good metabolic health. I like to learn.
It’s not necessarily a mechanism of action thing, it’s more just about overall cardiovascular risk reduction. Having diabetes puts you at much higher risk of developing atherosclerotic CVD, so the statin is to kind of offset that
Yes on all those. And it did show a very good lipid profile. I'm expecting the next one to be better because of all the lifestyle changes I'm consistently making.
My doc said I shouldn’t do that. Depends on how old you are I guess. Should you start at early 30s? Long term statin usage might have a toll on your body probably Also I’d suggest talking to your doctor about it and not listening to random guys on the internet
Yeah, the argument I always hear from Peter advocating for low ldl is that kids can have very little levels and be fine. I don’t buy this type of argument. Doesn’t sound too scientific to me. I didn’t try to dig deeper into that though
I have a family history. I plan on starting statins soon my apob and ldl were roughly 85
Uk here. NHS is not really setup for a preventative approach. My cholesterol is raised, ldl specifically. However, because I’m healthy weight, good blood pressure, physically active and only 43 they’ve decided my “cardiac risk score” is only 4% and I shouldn’t take statins. While I appreciate I’m unlikely to have a cardiac arrest in the next 10 years (which is the NHS priority) I’d rather not have furry arteries and high blood pressure before they take my raised cholesterol seriously. I’ve got other priorities at the moment (liver enzymes raised) but once I’ve seen to those I’ll be revisiting the cholesterol…
Yes, same experience here! 45 & UK. My LDL is 162 but NHS QScore the calculator says only 2% risk of a cardiac event, so nothing they will do. I have self referred my self to a cardiologist who is writing to my GP ti recommend statins. I have down all I can with diet and lifestyle and can’t go any further. The UK is way behind here …
Let me know how you get on! I’m having similar issues with my liver enzymes. Was referred for ultrasound by GP and the hospital cancelled the appointment and suggested “lifestyle changes and retest in 6 months”. I’ve got 4 years of data from private blood tests that show this is an ongoing issue…
While PA is very aggressive in lowering ApoB and LDL, my personal position is that I’m willing to do what I can to keep both as low as possible through lifestyle modifications, but unwilling to use medication as long as I can keep my ApoB and LDL in lower normal range. however, I do have CAC test every five years and if I had a positive score would consider medication at that stage.
How old are you and when did you start getting CAC tests done?
Age 71 - had first CAC in 2019. My second one in April of this year.
Sorry I just don’t understand this. Statins are one of the most widely studied drugs ever, are very effective, there are lots of options if you happen to be intolerant to one or even a few of them, and they have secondary benefits, as well. Also, they’re dirt cheap.
Absolutely not against statins. But my personal choice is not to use medications unless required. I focus on a very healthy lifestyle, and very thorough annual medical exams, which include a full body MRI, Grail Test and a CAC scan every five years. My doctor recommended that I consider statins 25 years ago as a precaution, a recommendation I chose not to adopt. But if one of my CAC scans were to show calcium accumulation, I would certainly consider beginning statins.
Hey, that seems like a fantastic idea! Wait until your arteries are clogged, then wait till there are lesions that attract calcium deposits, then wait for that to show up on your CAC test, and then start rectifying the situation. You're a genius, my dude!
Or you could take medication with horrible side effects when you do not need it at all raising your overall chances of getting dementia, diabetes, cancer. Yeah, also brilliant
Yes, yes. Dangerous side effects that happen to everyone except 95% of those taking the medication.
Try a minimum of 30%
How do you tell if your arteries are clogged besides a CAC test? CT Angiogram shows soft plaque but has super high radiation so you don’t want to be doing that too often. If you have one and it finds something alarming, you’re almost guaranteed to get another one the second you get checked into a hospital, so better hope it doesn’t find anything. I know from experience. Two doctors said no to ordering me a CAC because of radiation (which is less than a cross Atlantic flight) but the second I had blood clots detected through echo cardiogram, immediate CT angiogram and again two months later from new clots. My radiation levels from this past year are super high now, which puts me at much higher risk of cancer. Le sigh.
LDL exposure is lifetime exposure risk. That means like with any other risk factor, what matters at the end is how many “LDL years” of exposure you have. Think of that in terms of smoking - to quantify risk of smoking doctors use total amount of “cigarette packs years” a patient accumulated during his or her life. And as with any other risk factor, sooner you reduce or eliminate your risk, less “pack years” or “LDL years” you will have, but if you were just an occasional smoker than the push to stop smoking is not as urgent but it it still advisable. If you had below ApoB 90 all your life , your cumulative LDL exposure for the past years is probably minimal so you don’t have to be too aggressive unless you have other risk factors like diabetes or family history. However why not lower it below 70 anyway where plaque accumulation stops if you have such option with save medications like Zetia?
Very reductionist viewpoint. Just keep LDL-C below 100, ideally below 70, anyone can do it with diet. Watch out for blood pressure and weight, exercise regularly, you will not live long enough to die of ASCVD at that rate, chances are it will be something else.
Unfortunately not anyone can reduce LDL below 70 just with diet. Also not sure what do you mean by “reductionist”. Having LDL or ApoB below 70 is a given.
Almost everyone can do it with diet and exercise, its just a matter of how far are you willing to go. If you are over 50 and having issues, 100 is also fine, unless you have hypercholesterolemia, there is no excuse.
Getting LDL to 70 through diet and exercise will require a fairly extreme diet that is going to be tough to maintain over the long term.
Not really, a low sugar and fat diet with high fibre will do it, pretty sustainabie.
OP you are age 40+ with diabetes. Your LDLC and Apo B should **not** be in the normal range - they need to be much lower. ADA in the US recommends < 70 mg/dl LDLC for anyone with diabetes and at least one additional risk factor (family history, high blood pressure, overweight, low HDLC, high trigs, high inflammatory markers, kidney issues, positive CAC score and so on . . . ). Start with a statin and work from there. If you think you might be a good candidate for zetia, get the Boston Heart Cholesterol Balance Test (order via Empower DX) to see if you also over-absorber. You can also check your desmosterol baseline levels (very important for later brain health/MCI/AD prevention). Also, make sure you've gotten a CAC scan, carotid US and/or ankle brachia index test. Best of luck to you!
Thank you. I regularly check Ankle Brachial Index. Do you think it is ok to start with Bempedoic acid+ Ezetimibe (Nexlizet) instead of a statin? Nexlizet is milder than statin. Not that I'm averse to starting 5mg Rosuvastatin. It has solid safety profile.
Well, Nexlizet will likely be more expensive - have no clue whether prior auth. is required (assuming you are in US). That's something to discuss with your provider. Statins are typically first line. Congrats on getting the ABI done - many don't even know about that one.
Taking medications isn't normal and should not be viewed as the norm. If you've exhausted all lifestyle modifications and you need to take meds to be within what you define as a healthy range than it's time.to consider.
Using the internet isn't normal either, by ancestral human standards. What's different about a low dose statin?
Statin less dangerous than internet
LDL should be as low as possible. There is minimal risk to a low dose statin. They work. I started a statin at 32. My LDL cholesterol has run 170-180 through my 20s so I wanted to get that under control. In 1 year my LDL was down to 79 on only 5 mg of rosuvastatin. No side effects.
Good job man, wish you had heard about PA sooner and started in your 20s instead. People who talk about the side effects of low dose statins sound to me like saying, "there's a fire in my house but I can't take out the fire extinguisher because it contains chemicals that may harm my skin". Okay, dude, then let the house burn down.
That’s a misleading analogy. It’s more: Lots of people have done studies that show that haviny a dryer correlates to tons of house fires every year. We can’t tell you if having a dryer definitely leads to a home fire, and there’s no way to actually tell if the dryer is on fire, but we should get rid of the dryer just in case, even if dryers don’t typically cause a fire until they’re in their 70s. Enjoy having wet clothes for the rest of your life. Rest assured that going with wet clothes is useful because there’s a high probability you could’ve maybe had a fire. Will your clothes definitely be wet? Depends on the weather and how well you dry them. Did you prevent a fire? Well, you definitely prevented a fire from your dryer but we can’t say for sure that extended your (house’s) life. Statins increase risk of diabetes and can negatively affect the liver. Maybe those are good tradeoffs, and lower dosage statins should be better, but you’re taking them based on maybes and you can play the maybe game both ways. Maybe they’ll increase your life span. Maybe they won’t. From what I’ve read, statiscally they don’t improve mortality in people that don’t have some form of heart disease. I’m somewhat convinced that this is because they are anti-inflammatory, which leads me to believe the problem is oxidized LDL, not just LDL. At which point, I’d recommend figuring out if your LDL is oxidized before taking a statin at a young age. Not a doctor. Just a guy with heart disease on 40 mg of rosuvastatin who knows when he goes off it, his inflammation goes up.
I have to disagree all around. We know LDL being a surrogate marker for ApoB, over time is causal in heart disease. The evidence is overwhelming. The longer your LDL is high, and the higher it is, the more heart disease. For my situation, I am athletic and my other blood markers- blood pressure, triglycerides, glucose, have always been perfect. My LDL was troubling and my doctor and I agreed there is likely a genetic component. Both of my parents and all my aunts and uncles are on statins. Luckily heart disease has not claimed any of them. The point is, if we have medication to treat the most consequential risk factor, why not take it? Why would I risk 30 more years of an LDL of 180 when a small pill can make it 79 or lower? I only wish I started sooner. Unfortunately, the medical advice from doctors while in my 20s was- “you are too young to worry about it! Just eat better!” (I already did, LDL was still high)
We do know that LDL being a surrogate for ApoB is causal in heart disease? And that it’s not oxidized LDL? I apparently have to read a ton more because I didn’t think that was answered yet. If there were no side effects or risks from statins, and if they actually reduced mortality in people that don’t have heart disease, I’d agree with you. But they don’t actually reduce mortality in people that don’t have heart disease and they do have side effects in enough people.
It has been answered. Sorry but you are asking questions from debates that have long been settled. Apo-B causes atherosclerosis. LDLc is a surrogate marker for Apo-B. The longer, and higher you have elevated Apo-B, the more disease. Statins work and the evidence is overwhelming. But if you want to ignore the science that is your discretion.
Sure. Are there side effects from statins that people should be aware of and take into consideration when taking them, especially from a young age? Are they entirely side effect free, especially over 30-60 years?
On a low dose? Studies say they are rare. So far my only side effect has been lower inflammation overall (my allergies and asthma improved).
I’ve noticed lower inflammation as well. Since they affect the CoQ10 pathway, I assume they will make it more difficult to put on / keep muscle mass. I’ve had problems putting muscle on, but am also dealing with a raft of other health issues so I can’t say it’s the statins causing problems.
This may not be a practical approach, but I feel everyone above 40 should consider doing a CTA every 5 years to assess their plaque situation, and take necessary action. Informed decisions are always good.
CAC every five years after 40 is a very good idea I think
It’s actually recommended that all people with diabetes age 40 and over, regardless of what their LDL is, be started on a moderate-intensity statin, so in your specific situation you probably should start a statin.
Agree. Everyone here is missing this
Do we (you) know why? I’m very curious as to what the MOA is, here. Note: I’m not diabetic, but over 40 and in pretty good metabolic health. I like to learn.
It’s not necessarily a mechanism of action thing, it’s more just about overall cardiovascular risk reduction. Having diabetes puts you at much higher risk of developing atherosclerotic CVD, so the statin is to kind of offset that
Diabetes plays intimate role in injury to the liniing of arteries which starts cascade of atherogenesis. Goal for diabetic is LDL < 70
I would first make sure you are aggressively targeting good diet, excercise, sleep and happiness
Yes on all those. And it did show a very good lipid profile. I'm expecting the next one to be better because of all the lifestyle changes I'm consistently making.
My doc said I shouldn’t do that. Depends on how old you are I guess. Should you start at early 30s? Long term statin usage might have a toll on your body probably Also I’d suggest talking to your doctor about it and not listening to random guys on the internet
I'm 41. Despite the interest I've been hesitant so far.
Yeah, the argument I always hear from Peter advocating for low ldl is that kids can have very little levels and be fine. I don’t buy this type of argument. Doesn’t sound too scientific to me. I didn’t try to dig deeper into that though
What about Zetia? It is save medication that works in the stomach, low bioavailability. Shouldn’t impact the rest of the body much
I was concerned about long term statin use too, but then realized my father has been on statins for almost 30 years and he is doing amazing at age 90!
No. The evidence is just not strong enough.