Right on, good write up. Yeah, you are right into thinking about PCSK9i.
Looks like you are doing the things I was going to mention.
That is odd that the fiber intake, omega fats, garlic extract, b complex hasn’t made your cardio profile better.
Only other things I can think of:
I assume you are in a good weight range (and body fat %), and doing some walking or weight training during the week.
Various stimulants from doctor or supplements (yohimbine) can help burn fat and lower TG & cholesterol levels.
But they might have other effects that might not be of benefit, and not everyone can handle them.
Yes, I’ve been slim all my life and exercise regularly, both cardio and weights. My lipids being high is not a mystery - LDL in the 140-180 range all my life - it’s genes. What’s disappointing is how ineffective LLT drugs have been for me.
I really hope you’ll be able to try a PCSK9i, and I’m eager to see the results! Is insurance coverage/cost the main deterrent, or is it the thought of having to do the injections?
Insurance won’t cover, butI’m willing to eat the cost. Injections I’m not thrilled with, but that’s infrequent. It’s my (probably excessive) fear of the AD signal based on MR. I’d love some new drugs. But I suppose if push comes to shove, I’ll break down and do it. Just that AD and dementia in general are the one thing that I would 100% not want to risk, as getting it to me is an automatic auto ejection. I wish the MR signal would be for something like cancer - just not AD. Anything but dementia.
Looks like the evidence is conflicting (one study showing increased risk, the 2nd study showing no effect) but that the second study was larger and perhaps more comprehensive (?)
Right. Which is why my concern is likely excessive. But when it comes to dementia I’m just super skittish, and any little thing is likely to send me running for the hills. Still, trying to remain rational, if everything else fails I’ll probably break down and go for a PCSK9i. I’m procrastinating because my CAC score at age 65 (two years ago) came back as zero, so I am desperately hoping some new drugs might appear not too long from now.
Try it out, and keep us updated.
If AD and dementia are a concern, could look into trying a acetylcholinesterase inhibitor if you have not done so already.
Even if it’s a low dose, and not everyday.
I’m sure you know about them already, but they would be worth trying out, perhaps each one to see if you like one better.
You already take lithium, which has some good info on it for those conditions IIRC. Citicoline is good.
I did enjoy acetylcholinesterase inhibitors from what used (donepezil and rivastigmine).
I’ve done lithium and citicoline, and think that acetylcholinesterase inhibitors are more powerful (at least to myself) for neuroprotection.
I am not aware of anything that prevents AD.
I could have added Lecanemab or Donanemab, though I’ve never tried them.
Only trying to relate to what I’ve tried from his stack or in general from his issues or concerns discussed.
Well, there are drugs which might decrease the risk of developing dementia, seems that’s SGLT2i’s including empagliflozin (which I take), possibly telmisartan especially if you have hypertension, and even possibly statins. So it’s not like I’m doing nothing, but of course it might all be fiddling at the margins. I’m mostly looking to lower the risk of dementia through a variety of strategies, and at this point I’m not sure there are many surefire ways of doing so (of course exercise, diet, little alcohol or smoking etc.).
That would be outside of my reward calculus. The juice is not worth the squezze - dialysis level hassle for what kind of returns? Hopefully Lp(a) drugs are going to be out in a year or so, I’d rather wait for that. YMMV.
Likely a bit longer until first approval, then a bit more until marketed unfortunately.
Hopefully they will then be accessible, but cost will perhaps come it at the more than 2X levels of what PCSK9i cost vs today (how they were priced when they first came out)? (And all the first ones are injectables, so not that easy to get from India (even after they are approved there).
Picture hopefully a bit better for New Amsterdam (but not really a Lp(a) med, even if a bit of impact there).
What is your thought on having a CLEERLY test to see if you have soft plaque… that might put the issue to rest one way or another… you have 0 hard plaque… if you have no soft plaque, then you know you are someone who can live with not-so-great lipids and you don’t need to consider things you are not comfortable with, like repatha
I’m sure you’ve given this thought but I just don’t recall you mentioning it.
I finally got around to writing the KC cleerly office asking about medicare coverage and whether our local hospital could do the ccta or I should use MDSave in Omaha. I’m sure they do more often and have more talent but my doc always wants to use local talent I suppose because if you don’t use them they don’t get any better. This is what they sent back:
We have not had success obtaining insurance coverage for Cleerly in the past. Unfortunately, our providers are not Medicare providers, so we are unable to pursue this type of coverage.
Any location your doctor recommends should be a good option. The locations listed on MDsave simply offer a cash-pay option. If you use a facility recommended by your provider, you will likely be able to obtain some level of insurance coverage for the CCTA.
So I suppose I should contact other Cleerly offices and possibly another AI team somewhere. I forgot the other company. But see who will deal with medicare. You wouldn’t think it would be such a big problem for them since all they do is plug it into their program, and I guess do the consult.
Your numbers look good to me, I have a lifetime of high LDL. My trigs beat you by a little bit, but I’m on no meds for this. I do take colchicine off and on. Your Neu/Lym ratio is 2.25 which is also ok, depending on your standards. Less than 2 would be better. Mine on drugs is 1.6 currently. As you say YMMV, but I think you’re doing great for a geezer.
Yes, Beth I’ve considered CLEERLY, but am frankly not thrilled with what I’ve read. I think an ordinary CT angio would be better with some very good human interpreters. The CLEERLY software leaves in my opinion a lot to be desired at this point in time.
First, I want to say that I’m currently taking 80 mg of atorvastatin, and I’m not anti‑statin. But I do appreciate observations and facts that push my thinking into a more thought‑provoking direction. These two videos might be provocative for some, but I like them - very much because they’re short. My time is valuable, so I avoid videos longer than 10–12 minutes unless they offer something truly meaningful on a personal level. These short ones gave me some real food for thought, and I may end up adjusting my focus on cardiovascular health. They argue that statins are or can be useful for managing cardiovascular function—but primarily because they influence nitric oxide, inflammation, and other parameters beyond LDL/ApoB. And they push the thoughts that measureing LDL is not something to focus on.
I feel like whoever says this is really uneducated or dumb about the topic. There’s more than just statins and they all lower rates of CVD and atherosclerosis. There’s also genetic studies showing what the effects from lowering LDL have.