Hi everyone, I’ve been on rapa for 4 months and this group encouraged me to get glucose and lipid panel done. Glucose up only a bit to 100 but lipids are not good. I’m not sure how much is the rapa as they’ve been creeping up (I’m near 71) but have been reluctant to go on a statin, but now total is 257 and LDL 171 and I asked her for ApoB - 127. Peter Attia would not like those numbers. My HDL keeps going up too now in 80’s and I’ve recently read it’s not good for even that to be too high. Only fairly acceptable number is 118 triglycerides. Does anyone have any advice? Attia says he usually starts with Crestor and that there is an efficacy curve eg although Crestor is made in 40mg, they’ve found 5mg takes away 85% of the ApoB. But someone posted an article here re azitia or something like that, it’s not a statin, works differently, but is said to decrease getting dementia. Has anyone gone on that? Thanks for any advice.
The first question would probably be what is your diet and have you optimised that for lipids? Regarding medication a common combination is a statin like rosuvastatin or atorvastatin combined with either a PCSK9 inhibitor or ezetimibe. Bempedoic Acid is also popular. The reason being exactly what you stated that statins have a non linear effect on lipids with smaller doses giving you most of the benefits then diminishing returns.
This thread has a ton of info and discussion on it:
Could be worth asking there also, I don’t personally take any cholesterol lowering medication so others on the site will have way more experience.
This is a frequent topic of discussion (generally). I encourage you to review these threads:
I would of course consult the threads indicated by previous posters.
The condensed advice from hours and hours of Tom Dayspring’s podcasts, with and without Peter Attia, would be probably to start trying with 5 mg Crestor (the baby statin) which may be the best bang for the buck (40% improvement in ApoB or LDL on the average). This is what I’m going to do if I’ll decide to lower my ApoB to the lowest percentiles of population.
If there are nontrivial side effects like myalgia, elevated liver enzymes, faster upward trend in blood glucose, then it must be ceased, falling back to other statins or other classes of lipid lowering drugs.
Ezetimibie or Zetia works well with the hyper absorbers, less so with the hyper synthesizers.
Bempedoic acid is a good alternative if statins cause myalgia.
Ezetimibe and bempedoic A are often taken together.
PSK9 inhibitors are very costly and sometimes inaccessible, although very effective.
Diet and supplements constitute the soft approach which may work or not to some extent, the dietary approach is good in overweight people (less total fat, less saturated fats.
Yep, far better and more detailed than my answer. Regarding diet and cholesterol I was very fit before and after my diet switch (from healthy omnivore to WFPB) and I got a 50-60 point ldl reduction in a year from just under 100 to the low 40s. So I don’t think it is just overweight people who see large benefits but your mileage may vary.
Congratulations, if just by dieting, that’s an exceptional value, perhaps you are one of those individuals who naturally express higher PCSK9 inhibitors, the opposite of familiar hypercholesterolemia.
I tried a WFBP diet for 18 months but my cholesterol strangely increased, maybe for other unknown causes, anyway, there was no reduction as I expected. I never went below 70 LDL.
Moved answer onto the original thread
Yep, biology is weird and unpredictable, both my parents are on statins and both my grandfathers died of heart disease but maybe I got a lucky gene from somewhere! Many people who eat like me end up in the 50s or 60s so I seem to respond better than average
I would say you should see whether you are getting plaque. Do a CAC, or a CIMT? If your arteries are not plugged then do nothing. I have found the colchicine to be very easy to take and helped with inflammation. No side effects yet.
People think low LDL is the goal and feel great when they get that. High Five!! The drugs work! But somebody your age without any previous heart attack should not worry too much about LDL. Reducing carbs will reduce triglycerides. JMHO, do what you like.
Why reduce carbs when he didn’t have a previous heart attack? Someone his age shouldn’t worry about triglycerides.
Berberine may have worked for me. I stoped taking it and lipids jumped up to pre-Berberine. I restarted and will post here in 3 months when I’ve had blood work done. Mine went up 40 points and LDL also went up with rap/without Berberine but this may be conjecture… I was trying to stay off supplements and also wanted to see the effect of the Rapa. Pretty random experiment, but may be helpful in the whole mess of experimentation that we’re all up to!
Glucose/A1c also up into pre-diabetic, I’m hoping the Berberine will help with that as well.
Of course diet - I don’t eat sugar or drink sodas or alcohol. Quit white rice this week, that was the only thing my doctor and I coud find in my diet that could be a culprit.
Will post - everyone is different, but also the same enough that we can all learn from each other 
Thanks so much everyone you are all so helpful I checked out one of the links will read other two. I read one member say she cut her Zetia in half to 5mg due to increase in certain dementias and the fact that it decreases fat soluble vitamins. I just listened to an Attia podcast and Huberman asked if there were any side effects to Zetia and he said no - guess he doesn’t know everything. 
Right now I’m thinking to ask doc for 5mg Crestor with 5mg Zetia. IF it can be combined with Crestor - I haven’t seen that statin mentioned in combo with Zetia but suppose it’s ok or just missed it. I do take berberine but will up dose. Thanks for all the suggestions re testing. I don’t get much exercise due to fatigue that’s why I’m taking rapo to see if it helps- so far no. In fact, I quit taking 6mg each week to 4mg as think it was making me worse. I noticed some folks here take a month break after a few months so will do that now. It seems a lot of folks in this group must have PhD’s in chemistry. Wish MD’s were so knowledgeable. Anyway thanks again!
You can take a statin, Ezetemibe and Bempedoic Acid together. I do. My LDL and ApoB dropped from 120 to 48 using those 3 drugs. Each provided a significant reduction.
Wow, 3 - how much do you take of each and how long did it take to do that? I’ll listen to a Tom Dayspring podcast today that mccoy mentioned and those other two threads before doc appt. I’ll ask doc for that CAC bicep mentioned. Two folks mentioned I hadn’t had a heart attack which reminded me I have been told I might have had one but it was inconclusive.
I take the combined Brillo EZ Bempedoic Acid and Ezetemibe and a 5 mg Atorvastatin. So it’s two pills. However each treatment was highly effective and I am very happy with a 48 LDL and ApoB. Based on this chart it appears I won’t have arteriosclerosis.
Thanks I’ll ask about that pill. How does one know if they’re a hyper absorber or hyper synthesizer? Actually I should listen and read more first before bothering you all, might find answer there. If not I’ll be back. 
Statins may have some benefits beyond lowering cholesterol. There is some evidence that statins can up regulate klotho, one of the most important longevity genes.
With your glucose already up to 100, I’d not start with statins. Instead try pcsk9 inhibitor like Repatha first. Use it for 3 months if well tolerated, then redo your lipid panel. Also you may do coronary calcium scan and depending on outcome you may adjust your lipid strategy.
Thanks I didn’t know they increased blood sugar. I’ll take all this to my doc, will suggest the combo pill DeStrider takes.
257-171-80 = 6
Your remnant cholesterol is 6 and that number is excellent!