Luke Skywalker: Is the dark side stronger?
Master Yoda: No, no. Quicker, easier, more seductive.
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Yes. That was actually my best LDL. I had done a five day water fast in May and switched to a healthier diet. 5/22 - 140; 2/21 195, 9/19 119. HDL is always high. This is a problem I should’ve dealt with earlier. I always took false comfort from extremely good ratios of triglycerides to HDL. Now I want my LDL down as low as possible by any means.
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Some of us prefer to take the scenic routes. 
My functional medicine doc put me on Pantethine 450 mg 2 x per day. I have been on it 3 months, I will have my blood work checked and report back. I wanted a Statin and she said no, for now. However I did get approved on AgeLessRX.com ATORVASTATIN 10 mg/day, which I will start if needed after I get my bloodwork back.
I also take 6 mg Rapa per week for the last 9 months, I am 105lbs, 65 y/o eat mainly protein, work out, and ride and jump horses competitively. I had Advanced stage Ovarian cancer 11 years ago so have had no estrogen since my surgery.
Analyte Value
CHOLESTEROL, TOTAL 233 H Reference Range: <200 mg/dL
HDL CHOLESTEROL 47 L Reference Range: >49 mg/dL
TRIGLYCERIDES 119 Reference Range: <150 mg/dL
LDL-CHOLESTEROL 162 H Reference Range: <100 mg/dL (calc)
CHOL/HDLC RATIO 5.0 H Reference Range: <3.6 calc
NON HDL CHOLESTEROL 186 H Reference Range: <130 mg/dL (calc)
Analyte Value
APOLIPOPROTEIN B 135 H Reference Range: <90 mg/dL
Risk: Optimal <90 mg/dL; Moderate 90-119 mg/dL; High >= 120 mg/dL;
CARDIO IQ® LIPOPROTEIN (a)
LIPOPROTEIN (a) 16 Reference Range: <75 nmol/L
Risk: Optimal <75 nmol/L; Moderate 75-125 nmol/L; High>125 nmol/L.
A1C 5.0
INSULIN 2.4 uIU/mL
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We seem to have the same problem. Bad ApoB! I’m glad they tested your fasting insulin. I asked my primary to add that to my tests. Mine was 2.4 uIU also last year. No one had ever tested it before. I want to watch that closely.
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Im currently not taking a statin (age 42, apo b 62) but my research indicates that pitavastatin (brand name Livalo) is the least deleterious of the statins in regards to insulin resistance. The drug was long ago approved in Japan and is more favored there. Some studies:
If insulin resistance was an issue, this is the statin Id opt for.
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I take 40mg rosuvastatin, plus Repatha (PSK-9 Inhibitor) which for me results in a LDL of 15 to 20. Repatha alone results in a LDL of about 75, so the combo really works.
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James - thats impressive lowering of the LDL. Do you also measure APOB?
And what is your dosing and schedule for rapamycin these days? Have you ever seen an increase in your lipid levels while using rapamycin?
My APOB before starting Repatha & Rosuvastatin was 151. After starting, 35.
Currently every 15 days I take 200mg ketoconazole, then two hours later, 3mg rapamycin, or about 15mg rapa equivalent. Haven’t noticed any increase in lipids (or glucose levels, for that matter) due to rapamycin.
One interesting LDL-P data point: I was on the keto diet, which worked great for lowering my body weight (eat as much as you want, no hunger pangs, steady and high energy levels), but my LDL-P skyrocketed to 3300 (below 1100 recommended). When I went on the Repatha/Rosuvastatin combo, my LDL-P went down to <300, or basically undetectable levels.
I do suggest the keto diet, but suggest transitioning to a Mediterranean diet when at your target weight.
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I totally agree, Many people just do not get this. Though for myself, TRF lets me eat almost anything.
Exercise +Keto > TRF > +Mediterranean diet = lower BMI = lower lipids.
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statins help to increase NO though, hence helpful to the heart overall
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Good point. I hadn’t considered that.
I recently started Rosuvastatin, 10mg, as my first statin. However, I’m now concerned about continuing to take it after reading this.
It’s an epidemiological study, so confounding variables are always a very real possibility. And the effect size isn’t very large.
But Im still curious if anyone has looked at statins, particularly rosuvastatin, and kidney disease in depth.
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On another note, this tome is superbly informative.
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Self prescribed or prescribed by doctor for primary/secondary prevention?
Uhh what does it matter? It’s somewhere inbetween, bc I have a very compliant PCP. I just sent him bloodwork showing my LDL was high (135) and asked to be Rxed rosuvastatin. Voila
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Looks like absolute risk here is still very low and mostly a concern for people with severe kidney disease already. Even for people with severe CKD, the most they’re recommending here is keeping the dose low and keeping an eye on markers.
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The clinical guidelines recommend starting a low dose statin if you’re at a moderate to high risk and only upping your dose if you already had an event.
Just my curiosity. Have you tried to lower your LDL-C any other way? Diet? Exercising? Stress management? IMO cumulative impact of lifestyle is much better in preventing ASCVD then taking statin. But if your decided statins are your preferred option do your homework diligently (especially elevated risks in some groups of people). I have a box of Rosuvastatin too (very compliant PCP too), but digging into primary prevention with statins in low risk individuals (such as yourself probably), I have found out that benefit does not outweigh the risks. But this is purely my opinion, there are certainly people on this forum that would strongly disagree with me.