Cardiovascular Health 2026

#286

FWIW, pitavastatin, unlike other statins doesn’t significantly lower blood levels of CoQ10. Whether that’s part of its lesser impact on myalgia, I don’t know. It is not proven that CoQ10 depletion causes myopathy. I am on 4mg of pitavastatin and do not supplement with CoQ10. Max dose of pitavastatin is 4mg/day and doesn’t appear to lower plasma CoQ10 significantly.

Comparison of Effects of Pitavastatin and Atorvastatin on Plasma Coenzyme Q10 in Heterozygous Familial Hypercholesterolemia: Results From a Crossover Study

“An open, randomized, four-phased crossover study using 4 mg of pitavastatin or 20 mg of atorvastatin was performed to compare their efficacy and safety, especially regarding plasma levels of coenzyme Q10 (CoQ10) in 19 Japanese patients with heterozygous familial hypercholesterolemia. Pitavastatin and atorvastatin caused significant and almost comparable reductions in serum levels of total cholesterol (-35.4 vs. -33.8%), low-density lipoprotein cholesterol (-42.8 vs. -40.7%), and triglyceride (-26.1 vs. -29.4%), and significantly increased serum levels of high-density lipoprotein cholesterol (12.1 vs. 11.4%). Under these conditions, plasma levels of CoQ10 were reduced by atorvastatin (-26.1%, P=0.0007) but not by pitavastatin (-7.7%, P=0.39), although no adverse events or abnormalities of liver and muscle enzyme were observed after either statin treatment. It remains to be seen whether the observed changes in CoQ10 levels are related to the long-term safety of this drug.”

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#287

Yea and that was one of the many reasons I decided to switch to Pitavastatin. I do take 200mg Ubiquinol but I know there are doubts about whether that helps with myalgia anyway, which would make sense if reduced CoQ10 isn’t the cause of the myalgia.

That being said, if lower CoQ10 is the cause of myalgia, it would also make sense that Pitavastatin has a lower risk of myalgia

#288

image

https://x.com/MichaelAlbertMD/status/2039322728746930649#m

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#289

PSA:
I imagine this is only for those in the US

Good labs (one of the best places to buy your own labs at outstanding prices) now has a new service that allows you to pay $1 (so you don’t cancel) and have a meeting with one of their specialists to answer your lab/health related questions. Not a doctor.

I was curious, so I signed up and had a zoom meeting. A great service for the average person who might need a little extra guidance and who does not have easy access to a doctor.

Also, he said I have the best lipids he’s seen… awww gee shucks :slight_smile: (I’m otherwise a mess, so I had to brag!)

The reason for my post:

They want to start getting involved in studies in order to offer people potential access to drugs they might otherwise not get.

He said if I know anyone with Lp(a) over 175 and is not already on a pcsk9, contact them because you might be able to enter a study to monitor how repatha lowers lp(a), and you’ll have a 50% chance of getting repatha for free. (Obviously if you can get it on your own, that is what you want to do).

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#290

Everyone,

To say that I’m distraught is an understatement.

I’m here in hopes someone can offer some suggestions.

Since I arrived here in 2024 and added EZ and BA to my repatha (thank you!), my ApoB has been below 50. (43 to 49 to 43 and back to 49 to be exact)

It went up to 49 10/25 after being 43 1/25.

I had my lipids tested 1/26, but the lab botched my apob, so while I didn’t see that result (ARGH!) everything else looked good.

I just had my Apob tested 4/6 and it’s 69… up 20 points since Oct!!!

Does anyone know how it can change so drastically so quickly? Can it? Or is this prescription related?

Could my repatha be bad (not likely) or my Brillo EZ from India is (would not shock me, but no one here ever reports anything from India not working)…

Can our bodies change that quickly?

I guess I should add a statin, but I also know they put me in a funk. (The feeling of being glued to the sofa).

If you were me, would you get some US sourced EZ/BA (which I can easily do),

Is taking extra repatha a thing? AI says no.

Would you perhaps add a statin short term and deal with the trade off to just get this back down asap Which one do you recommend? I see a lot of talk about two of them here.

Other ideas?

FYI, for those who don’t know… this is hereditary… while my diet is not perfect, it’s pretty good. And with my high Lp(a) and CAC of over 400 at 50yo, I’m feeling a fragile about this.

Thank you in advance!!

#291

Check your other labs like triglycerides to try to figure out what’s causing the higher apoB.

I would work to get apoB to 30 mg/dl and RW-ApoB as low as possible if I were you. Statins are a lifesaver and have such good data it should be preferred over Bempedoic acid IMO.

So Repatha, then Statins+Ezetimibe. If you believe you’ll have side effect from the statin you could even do a blinded experiment, it depends how quickly you have the side effect. Of course monitor liver enzymes as recommended, add kidney markers, and CK.

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#292

Hi Beth, things that spring to mind:

Timing since your last Repatha injection? Based on my numbers, it takes a few days to kick in, is at the strongest around 14 days, and slowly wears off after that.

The Indian (assume generic?) Brillo EZ is definitely a possibility. Did you ever listen to the Katherine Eban interview with Attia?

But also there can be lots of benign reasons - something you ate recently, maybe some sickness/infection.

And also, remember that atherosclerosis takes years and years. I wouldn’t get too upset about a single result. :slight_smile: If it were me, I’d find some prescribed EZ/BA from a US pharmacy for peace of mind, and re-test in 3 months. Only if it’s still unchanged I would start to think something changed physiologically (unlikely IMO).

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#293

Thank you @relaxedmeatball and @A_User! I’m feeling much calmer now.

@A_User, I’ve been aiming to get my ApoB to 30 ever since hearing Attia suggest it, but alas, I haven’t broken 43.

Years ago, I tried various statins. even half a pill 3x per week, but they always affected me. My doctor said I have a ‘great ratio’ so I didn’t have to torture myself (sigh). I felt worse back then, so even a little move made a big difference. I could probably handle a little ‘less great’ these days. I’ll give this some thought.

@relaxedmeatball I never knew about the troughs post injection!!! Fascinating.

I did take it 4/1 and tested 4/6, so that wouldn’t be the case this time, but now I’ll know to try to schedule labs days to be more consistent with injection days.

And yessss, I saw the Eban interview! As a result, I refused to buy anything CVS branded in the cold and flu aisle for several years… I talked a big game until it came time to pay for branded drugs behind the CVS pharmacy counter :).

On that note, when I first arrived here, I thought buying drugs from India was nuts, but then I saw how many of you very smart people do it, and with great success, so I happily followed.

Thanks again!!!

I didn’t know it takes years and years, so now I will sleep better tonight, thank you.

And, because I have been incessantly AI’ing, I discovered going off t3 might contribute to a change in ApoB!

It’s relevant because I did just go off for a month as an experiment to see if I really needed it. My thyroid labs came back fine, so I’m not sure it is related, but maybe… hopefully!

#294

If you do, give pitavastatin (Livalo) a try, @DeStrider recommended it for muscle pains, or some other – usually switching around might work.

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#295

I may be wrong and obviously I get results every week, but I tend to expect a certain amount of variation in biomarkers. The variation depends in part on the biomarker. Obviously a shift from 49 to 69 may mean something, but mine varies quite a bit by the week.

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#296

Your numbers are just fine and nothing to worry about and as @John_Hemming pointed out you’ll have variances on the markers every time you take a test. ApoB at 69 is still ok especially if other markers are good also (LDL-C, Triglycerides etc.).

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#297

This is dangerously bad advice for a patient with high Lp(a) and a high calcium score who wants to live as long as possible without a CVD event.

I had issues with Indian bemp acid/ezetimibe (seemed like it didn’t work) and have long switched to branded Nexlizet, which it turns out was covered by my insurance the whole time!:roll_eyes:. I also like the idea of trying low dose pitavastatin.

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#298

Looks to me like you are in the optimal range in the opinion of most doctors.
image

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#299

Thanks for that @desertshores

All of you have calmed me down… I was pretty upset last night!

My large jump for no apparent reason was/is concerning, but also, for high risk patients (I’m the poster child), the advice seems to be to keep apob below 50… Attia and others of course say 30 is even better.

For the general population and without high lp(a) or known disease, they do say around 70 is a great goal.

@Davin8r good to know you had issues because I never notice anyone else saying anything but glowing things.

And sigh, my insurance (or as I like to call it, my ‘non-insurance insurance’) would cover it for me… but also, my deductible is aprox 8k, so I’m still paying cash… curses! But if I must, I must…

I think I’ll give low dose infrequent statins another try… if this was a t3 issue, it will go back down because I’ve started taking them again, but statins would get me to the unicorn apob in the 30’s I dream about…

And if AI is correct, which he usually is not, here is a fun fact…
T3 is a net negative for heart and bones, so my heart disease-osteoporosis self did a one month no t3 experiment to see if I really needed it (still on t4), but then I learn from AI that no T3 can make my lipids worse… *head explodes.

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#300

What is lp(a)?

#301

It started at 191, but repatha brought it down to 134.

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#302

Ok I just got my results back. On 2.5mg Rosuvastatin & 10mg Ezetimibe, LDL was 47. After switching to 2mg Pitavastatin and keeping Ezetimibe, my LDL went up to 57.

So it’s a 10 point increase. I want to continue this particular statin since I believe it is the reason a lot of of my weight lifting joint pain went away so I will ask to increase it to 4mg. I would imagine that would get it back down to under 50.

I am awaiting the ApoB result but it is usually about 10 points higher than my LDL, and I don’t like to see my ApoB over 60 so that’s why I intend to increase to 4mg Pitavastatin.

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#303

Pitavastatin is considered a moderate intensity statin, with 4mg being roughly equivalent to 10mg rosuvastatin. Of course, there are individual reactions, some people’s lipid levels react stronger to one statin vs another. I take 4mg pitavastatin, and get slightly lower LDL than from my previous 10mg atorvastatin. But that’s the upper limit on pitavastatin (there were some studies in Japan where 8mg was used successfully), if you want to go high intensity statin, you have to go to atorvastatin 40/80mg or rosuvastatin 20/40mg. If you don’t need high intensity statin, pitavastatin is a great option.

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#304

For whatever reason, my LDL was 27 I think when I was on 5mg Rosuvastatin (w/ Ezetimibe). So clearly for me, Rosuvastatin is much stronger. I have seen some funky LDL peaks and valleys though so who knows. I just love that I have been able to lift pain free and back to my heaviest weights again simply from switching to Pitavastatin (unless there is another cause but that’s the only thing I changed)

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#305

Check your RW-ApoB as well, it could be the difference from developing atherosclerosis or not.