It’s a challenge as the the cholesterol balance looks at peripheral cholesterol precursors. My experience is everyone on atorvastatin or rosuvastatin has low desmosterol. The drugs do a great job. For folks with an ApoE4, I think we should be pursing Ezetimibe/Bempodoic acid and if needed add minimal dose Rosuvastatin. This however is advice specific to individuals with an ApoE4 (or two).
I however am changing my approach toward favoring rosuvastatin over atorvastatin. It seems like a lower risk drug.
If you get bempedoic acid off shore, it is cheap … on shore not so much.
Unfortunately, the expense and the travel is not practical for me at the moment. I have a stubborn and severe type of sciatica and a recent surgery was not successful, as a consequence I cannot work or move around very easily. I will do my best on the next best thing assuming a CAC score is still considered useful.
That really is unfortunate on your back issue. Sorry to hear that.
A CAC is useful, but is looking at hard plaque, which correlates with soft plaque, but we have seen cases of low CAC and extensive soft plaque, it just isn’t common. However, if you get a non-zero score, I’d encourage management in the pathway to assuming you have CAD.
So if you have a non-zero CAC, then if Lp(a) is negative, I goal for ApoB in the 50’s, and if Lp(a) is positive I goal for Lp(a) in the 30’s.
Thank you very much. All fantastic information. I have learned so much from you on this forum. I believe I can get stronger and maybe one day beat the sciatica, so I want to be prepared for my next life when it comes.
My Lp(a) is 39 nmol/L so that is within the normal range as I understand it. I will stop taking the atorvastatin and maybe retry pravastatin as that works similarly to rosuvastatin iirc. If I don’t get on with that I will have to have another rethink.
https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.13543
How do you square the fact that they found statins more protective in apoe4 carriers specifically, with the fact that most apoe4 on statin have low desmeratol? Doesnt add up for me if low desmeratol causes Alzheimer’s.
I think it is a matter of choosing the best approach. Overall mortality might improve with lipid treatment as most ApoE4 carriers have dysfunctional lipids. I think the issue is whether decreasing lipids in the brain is a good thing? It seems not, and this is the issue.
The study wasnt finding better mortality but better brain health, but only in apoe4 carries. Statin non carriers didnt get brain benefit. But doesnt seem to report if apoe4 users had greater reduction, but it looked like avg mg of statin was similar 25 vs 27 of users
@Joseph_Lavelle is that in the wrong thread? I don’t see how it relates to statins/cholesterol.
Evolocumab study showed even <25 mg/dl cholesterol had no negative brain effects. No mention of APOE4, but seems many were on statins and other stuff as well. https://evidence.nejm.org/doi/full/10.1056/EVIDoa2400112
Median LDL cholesterol across the overall population was 35 mg/dl. Their conclusion “Exposure to very low levels of LDL cholesterol, achieved via PCSK9 inhibition and statin therapy, was not associated with cognitive impairment through long-term follow-up. Further studies are needed to assess the generalizability to adults at higher risk of dementia.”
My colleague Joel Proskewitz is in London and was trained by Stu McGill. Tell him I sent you and get you back sorted so you can up your activity level. Low Back Rehabilitation — PerformanceRx
Thank you for your suggestion and sorry it took me so long to reply. I would love to pursue this, but unfortunately, it’s not my only battle. I also struggle with a chronic pain condition that starts in my left trapezius and escalates to severe facial pain through some sort of spasm. Despite my efforts over nearly five years, I haven’t found safe and effective relief for this condition. The pain severely limits my mental abilities and my movement. I was extremely fit and healthy before all this started. One GP has told me I might never recover, but I’m determined not to give up. I’ve consulted 7-8 different neurologists and received various diagnoses, but none seem to fully explain the symptoms. It feels like a massive waste of life, but all I can do is focus on the things I have some control over - my diet, supplementation, and whatever physical activity I can handle. Currently, that’s about 12 minutes of low-impact walking after each of my two main meals and another 10 minutes in the evening. I can also manage some minimal strength training for my legs and grip, but any other upper body movement eventually triggers terrible facial pain. That’s where I am now at 43 years old, but I continue to hold out hope for improvement.
For someone young (below 40) whose apoB is not too high, but around 90, who wants to lower it to 60 or below, do you think something like 5 mg rosuvastatin 3x/wk could move the needle while reducing risk of side effects?
2.5mg a day or 5mg every other day is just barely less effective than 5mg every day, like maybe 30% vs 35% reduction., but its easy enough to test on yourself. I am just switching from 5mg to 2.5mg because my desmosterol was low and ill know more in 3 to 6 months.
Given that at least 90% of people have no side effects - you can start 3x/week with 5 mg and get a pretty good effect. If you have no side effects and don’t make your goal (which it is unlikely that you’ll not get into the 70’s) going daily is fine.
Also, if Lp(a) negative, and you have no vascular disease, keeping ApoB in the 70’s is adequate - however if you have disease subtract 20 points for the goal, and if you are Lp(a) positive subtract 20 points from the goal.
Frankly I’m a layperson and don’t have the knowledge to sort through the literature on the effects of statins on desmosterol, but I’d hate to trade ASCVD for a neurodegenerative disease. I’m only 39, surely to God a low dose statin and ezetimibe will be fine for 5 or 10 years until I can get a PCSK9i for less than $500 a month?
