Those are really good prices! Hopefully having it sent would not degrade it too much of these semi summer months. As I said above, I take a half dose every two weeks instead of the full dose with 10 mg per day of Ezetimibe…LDLC is 31 and ApoB is 42, so for me the half dose makes sense, u could do that w Praluent and get it for $150 a month, very doable!!
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Could use some advice for those of you who are more well-versed in this stuff than me.
BACKGROUND: 46yo APOE 3/4 and cardiologist put me on statins for ApoB in the low 100s. Pravastatin didn’t move the needle much, so he put me on rosuvastatin 20mg (which I understand now is a relatively high dose) for last three months. Just got my EmpowerDX results back:
REALLY BAD desmosterol levels! So, looks like I should stop statins entirely, right? Get on ezetimibe and maybe PCSK9? Is there anything I should be doing to bring desmosterol levels up (other than quitting statins)? Thanks so much for any ideas!
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Lower your rosuvastatin dose to 5-10mg and add ezetimibe on top of that instead of quitting it altogether.
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Seems you are an overabsorber so ezetimbe is the way to go. This should be very effective stand alone therapy in your case. If not consider low dose statin as proposed by @Virilius and possibly PCSK9i or Bempedoic acid as a replacement for statins.
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Yes, I agree. It seems like Ezetimibe would be very beneficial to you.
Ezetimibe alone won’t lower apoB enough though, if that is what you mean.
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Ezetimibe seems like a no-brainer, for sure, but worried that it won’t be enough. I suppose I could try it alone for a few months to see what happens before trying to add something like Praluent. Given my very low levels of desmosterol, I don’t think I’m comfortable taking any amount of rosuvastatin.
I previously asked my cardiologist to prescribe a PCSK9 inhibitor and ezetimibe, but he wouldn’t do it. I’m hoping the Boston lab results change his mind, else I guess I’m in the market for a new doctor.
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Why don’t we have massive dose dependent data on hydrophobic Vs lipophilic, Atorvastatin, rosuvastatin 1,2.5,5,10mg etc. And the effect on desmosterol, lathosterol, absorption markers?
Perhaps it is lack of knowledge about desmosterol by cardiologists. My cardiologist did not even know what this was. Crazy.
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Ezetimibe for sure. While it might be worthwhile trying out low-dose statin as others suggest (because it’s cheaper), I doubt that will fix your desmosterol: even 5 mg of rosuvastatin gives you 72% of the effect on total cholesterol of 40 mg (TC being the relevant outcome as the effect on desmosterol is an output of tissue HMG-CoA inhibition per se).So if EZE doesn’t lower your apoB enough, you’re probably going to want bempedoic acid or a PCSK9 inhibitor.
Do you think he/she is educated enough about the possible risk of low desmosterol (as a readout of tissue cholesterol synthesis) that he/she would switch you on that basis? And how much of this is about your cardiologist’s medical judgement vs. your insurance requirements?
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Well, I just got my doc to prescribe Praluent, but he’s only willing to do the 75mg, even though the 150mg is same price at Amazon Pharmacy. Sigh. He does not subscribe to Attia’s view that lower is better. I think he’s basically trying to treat me to ApoB between 80 and 90.
And along those lines, he wanted to see levels on Praluent alone before prescribing ezetimibe. Says he thinks ezetimibe will be unnecessary. I think I’m just going to go around him and get it from India, if I can.
I may need to go doctor shopping. If anybody knows of a good/pliant doctor in the Washington, DC area, let me know!
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After a further email exchange with my doctor, he agreed to prescribe 150mg Praluent so that I could one injection every 4 weeks. Through Amazon Pharmacy, that brings my cost down to $180/mo, which seems worth it to me to avoid the statins given my APOE4 gene. He still doesn’t want to prescribe ezetimibe, so I’m going to need to get that through other channels. But feels like progress!
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You can buy Bempedoic Acid and Ezetemibe from India. That’s what I did. For Bempedoic Acid, I’d go with the Brillo or Brillo EZ (Bempedoic Acid + Ezetemibe in one pill).
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Is anyone concerned about shipping Praluent and Repatha given the temperature storage requirements? Seems that if you ordered overseas, Europe could make more sense than some Indian cities that are sporting 80F+.
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Are there any European sources for these drugs? I’ve not seen any (that you can purchase from in the US or elsewhere).
Ordering these drugs that need to be refrigerated, from India, definitely are a risk. There are multiple levels of risk too… have they been stored in refrigerated environments? Will they travel well from India given the lack of cold shipment options?
Given the low cost, it seems like it would be worth a try from India and test before and after to see if they work as advertised.
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Wow @DeStrider, I just checked in with my Indian source for rapa and the bempedoic acid/ezetimibe is like $10/mo! Definitely going to stock up on some and run a side-by-side – 3 months on PSCK9/ezetimibe and 3 months on bempedoic/ezetimibe. And maybe 3 months on all three just for curiosities sake (I think that’s what Attia does to get his ApoB <40).
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@RapAdmin
While I’m a big fan of Indian imports generally, I’m not sure I would want to get PCSK9 inhibitors from there due to the refrigeration/heat issues you mention given that you can get Praluent for $175/mo from Amazon Pharmacy (if you dose 150mg every 4 weeks). If somebody needs more apoB lowering than that, seems like it would be more cost effective to add bempedoic acid to the stack (from India) rather than increasing the dose of PCSK9 to 150mg every 2 weeks.
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Does anyone have insights into the plusses and minuses regarding the PCSK9’s Repatha vs Praluent?
There was a big discussion a while ago on ALM and PCSK9i studies a while ago and FOURIER trial in Rapamycin and risk of cardiovascular disease. From what I remember alirocumab might have better safety data. But check the thread, it was discussed in mid December.
It’s worth remembering that the low-desmosterol/Alzheimer’s connection is still only associational data, and people are hypothesizing that low DES from statin use could therefore drive AD. Yet despite this reasonable-sounding mechanistic case, statins have been robustly demonstrated to lower risk of Alzheimer’s and all-cause dementia, with no significant difference between lipophilic statins (which are more likely to reach the brain) and hydrophilic statins:
https://www.nature.com/articles/s41598-018-24248-8
If it were me making my own health decision, I would still lean toward DES testing and use of a hydrophilic statin. But the case is too weak to launch a major research investigation or have these become standard of care.
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