Concerned about APOB

Hi everyone,

I have just started taking Rapamycin (currently 2mg/week, working up to 4mg/week - I am female)

I had all baseline tests done prior to starting. My APOB concerns me, it is 114 mg/dL, which is much higher than I’d like.

As far as other risk factors go:

  • I’m 55YO;
  • I have very good blood pressure;
  • I don’t smoke;
  • HOMA-IR score is 0.8 (although I do have higher morning blood glucose);
  • I exercise and have gone as far as I can go in improving diet;
  • I am a healthy weight.

I’d love some advice in relation to the possibility of introducing a medical intervention, since I’m concerned about Rapamycin potentially worsening hyperlipidemia.

Am I panicking prematurely?

I’m thinking that the path of least resistance might be trying some Ezetimibe initially.

Also worried that a statin may increase my blood sugar.

Would you introduce a statin if you were me, given my stats?

What are others doing to reduce APOB?

Any advice is greatly appreciated

cheers

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FWIW I would use nician to start.

Then look at other less toxic compounds than a statin.

Review

Niacin: another look at an underutilized lipid-lowering medication

Attached is a PDF copy of the paper.

2012R117CreideretalNiacinanotherlook22349076.pdf (790.4 KB)

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@Joseph thank you for this information.

Is there a recommended dosage (for female)?
Should it be taken with food or at a certain time of day?

Also, did I read that correctly that it may make blood glucose issues worse?

I have issues with blood glucose, so I don’t want to rock the boat in that area.

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Attached is a PDF copy of a book. Should answer current and future questions.

Niacin: the Real Story: Learn about the Wonderful Healing Properties of Niacin

Niacin The Real Story Learn about the Wonderful Healing Properties of Niacin (Abram Hoffer, Andrew Saul, Harold Foster).pdf (1.3 MB)

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I have observed (here) that some people see their lipids worsen with rapamycin, while others experience a clear improvement. Either 1) rapamycin doesn’t fit with some people, for some reason, or 2) the dose must be adapted and can vary from person to person, or 3) the worsening of lipids accompanying rapamycin is benign and can be ignored.

I am not knowledgeable, I cannot recommend anything, but if it were for me, I wouldn’t accept 3) based on the evidence I was able to gather. So, I would try 2) and vary the dose and the interval (rather lower doses and longer intervals…). And if it doesn’t lead to a bettering, I would accept 1) and let it be, at least for a while. Maybe there is nevertheless something in your diet or lifestyle that disagrees, and that can change, or someone can elucidate it next month. If anything changes in your life, a new test with rapamycin would be appropriate.

Another thought: if your lipids don’t get better a couple months after having stopped rapamycin, you’ll know that rapamycin is “innocent” and you’ll can take it with good conscience (also at other doses than those already tested, which might help).

And if nothing helps, I would start with lycopene

Our meta-analysis suggests that lycopene taken in doses ≥25 mg daily is effective in reducing LDL cholesterol by about 10% which is comparable to the effect of low doses of statins in patient with slightly elevated cholesterol levels.

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With no other risk factors you could consider either amla or citrus bergamot. Amazon has both.
In the absence of other risk factors you don’t really need to intervene unless the level is greater than 130.
You could consider a coronary artery calcium score to ease your mind some.

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Seems like a low dose to cause such a strong dysregulation (don’t know pre rapamycin APOB).

Re your stats, how about the rest of your lipids panel pre and post rapamycin?

And as mentioned by @rivasp12, and discussed in other threads, consider getting a coronary CT calcium scan to baseline your journey. Not just for rapamycin, but for all current/future intervention(s) CVD risks.

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Similar (55 yo female, higher than ideal ApoB, LDL, particle number etc, BP 110/70, CAC =0, HOMA-IR 0.4, BMI 19). There is no downside and very likely upside to reducing LDL-C, ApoB etc, and statins are a great option for most people. Talk to your doctor. I am doing great on pravastatin 40 (a bit of trial and error, didn’t tolerate rosuvastatin well) and apoB came down from 120 to 86. Just started rapamycin 6mg/wk and curious to see how it will impact lipid profile. i also recommend getting a calcium score (CAC). No need to panic!

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So no other risk factors, excellent insulin sensitivity, and a CAC. of zero and placed on a statin?
Interesting decision.
So many different opinions on this.

Yep, to each their own. Not placed on a statin- I’m a physician/scientist, i read the literature, tend to listen to people like Peter Attia (and my cardiologist)

There is always a downside to a drug. “didn’t tolerate rosuvastatin well”

One of my biggest concerns of adding a statin (I don’t take any statins) is cognitive risk, my #1 prevention focus.

Cognitive Function Assessment in Patients on Moderate- or High-Intensity Statin Therapy (2020)

We analyzed the cognitive functions of adult patients who were on moderate-intensity statin therapy (MIST) or high-intensity statin therapy (HIST). Conclusions: ***We found a significantly higher association of cognitive impairment in patients who were on MIST or HIST compared to the general population. Additionally, we believe that although the muscle-related adverse effects are more commonly reported by the patients, the influence of statin on cognitive decline remains largely underreported."

If you have CAC of zero, healthy lifestyle, far away from metabolic syndrome…it’s not a given you need to add a statin.

Some additional information on Pravastatin Sodium 40 MG side effects:

https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=cba3c927-dae4-4326-9a51-435d30cc0655

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We live in a statin world, can’t tell you how many of the patients that I see are on them.
The brain issues seem to be difficulty in word retrieval and foginess.
Many don’t realize that they were having aches and pains until they stop it.

Even the AMA suggests lifestyle changes only up to an LDL of 190 if no other risks.

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No thanks. I’ll continue massive lifestyle interventions, monitor lipids, CAC, and overall CVD risk with my doc/cardiologist before ever taking a statin.

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And there’s alternatives like Amla and Citrus bergamot.

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And many other compounds / molecules;

Niacin

Grape Seed Extract

Policosanol{this is an approved medicine in CUBA]

Fermented Red Rice Yeast

*Fermented Red Rice
*Has monacolin K, the same makeup as the drug lovastatin (Mevacor} a prescribe statin.

Look around there are many more.

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I review literature, discuss with a few friends who are MD’s and make my own decision.

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Exactly! We should all do what we believe is best in our situation. Statins work for me. All good.

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@Basil_Dev - I like all of the advice above. Niacin ( not the no flush version - does not work) can help, but you can see some sugar levels increase. Start with 100mg and increase to 500mg - take with apple sauce to decrease flushing. Niacin can also increase HDL.

I am more of a fan with starting with a CIMT vs. Calcium scoring test. I like that CIMT can see soft plaque, show signs of inflammation before plaque formation and has no radiation exposure. If a CIMT is positive for findings of concern, then checking a Calcium Scoring test makes sense.

Rapamycin may increase cholesterol and although it can mean an increased risk, it does not mean that its “association” is equal to the “causation” of arterial damage and plaque. Just like your elevated am glucose is a concern, but may not be an issue when added other reassuring metrics, the same may be true for Rapamycin, just too early to know.

Hormone replacement needs to be consider by weighing risk and benefits in a 55 year young woman.

Good resources for advanced lipid testing and preventive cardiology would be Bale and Doneen who teach a method of preventive cardiology and stroke to providers all over the country and Dr. Mark Houston from Vanderbilt. You can find their books online.

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I agree! I would use a statin for many things, but with no other risk factors and no end point disease process noted, then it starts to weigh more on the risk side.

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Thank you @rivasp12 , yes I have some amla on order for Amazon. That will be my first option I think.