What's the best statin to take?

#69

Would you trust your health to a highly opinionated blogger?
Has your risk of ASCVD ever been assessed by a doctor?
If your assessed risk is low (based on multitude of tests and personal and family history) the best prevention is appropriate lifestyle, keeping your apoB below 80 and to have normalized omega 3 ratios in your diet. And I consulted several practicing doctors on this matter as a patient not just watching highly opinionated reviews on youtube. I also consulted a lot of available literature and guidelines on this matter additionally.

@AnUser my apoB is 84, LDL-C 112, LDL-C jumped from 99 before rapamycin, unfortunately did not measure my apoB before, but probably it was below 80. I have taken some lifestyle changes and hopefully next measurement in September will be below 80 again. Yes, I could reduce it more with taking statins, yes, it would be effortless almost, just taking a pill every day, but I would risk insulin sensitivity, risking increasing the number of (other) atherogenic particles, and would need at least test my APOE4 and probably sterols not to risk cognitive decline on statins etc. And what would my benefit be? reduced risk of around 3% until age 99. No thank you. But I told multitude of times, that if my risk would be high or if anyones risk would be high I would not blink an eye at the mention of statins. I am just challenging primary prevention with statins in low risk individuals.

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#70

“In general, there’s been an exaggeration of the dangers of statins,” says Seth Martin, M.D., M.H.S., associate professor of medicine at the Johns Hopkins University School of Medicine and director of the Advanced Lipid Disorders Center. “Statins have a solid track record. In monitoring people taking statins for decades, we’ve found that they’re safe and most people tolerate them well without any problems. But still, these misconceptions persist.”

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#71

84 apoB isn’t low at all, and you can literally stop taking statins if you notice insulin sensitivity. If you don’t want to take statins because of lp(a) increase I can buy that, if you saw it increased. What is your lp(a)? You are also fighting a disease that is way ahead of you, if you don’t take care of it now, it’ll grow. You fight with everything you got is my attitude, as long as it’s not harmful. Low apoB is psychologically nice as you know you won’t get heart disease, if you nuke it with PCSK9i you even don’t have to worry about statin side effects and speculations. And that lowers your lp(a) too.

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#72

But I also think that there is an exaggeration in benefits of taking statins. I am not saying statins are dangerous (for most people) but I am saying that benefit is at best marginal for low risk individuals.

#73

Why risk cardiovascular disease if you’re tolerating statins wells and keep monitoring your health markers? It’s by far the biggest killer in humans.

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#74

Let’s say there’s a disease called Globmoklo, it kills millions of people every year. A marker in the blood Glob-B randomly assigned show that people with a marker very low, rarely gets Globmoklo, up to 80% reduction. Since the Globmoklo disease is so common, it’s a high likelihood you will get the disease too, especially if you live longer than others, and the disease grows cumulatively over time. Some scientists have built drugs that reduce Glob-B. They find that it lowers rates of Globmoklo as expected, albeit not as much because the duration is shorter than those who naturally by randomization have lower Glob-B for a long-time, their entire lives. The drugs that reduce Glob-B become very popular, and meta analysis of randomized controlled trials show their efficacy in even reducing all-cause mortality in the elderly depending on the rate of Glob-B reduction. Experts believe that if you reduce Glob-B enough, and for a long time, you will not get Globmoklo. It seems reasonable as there is only a ~20%p catch up to near 100% reduction.

The Glob-B drugs show very few side effects. Only a few percent, to 10 percent get muscle aches, which stop after people take the drugs. These side effects are established in gold standard randomized controlled trials. Some with almost 20,000 participants with a double-blind design. Some do get blood sugar problems, which go away after stopping. Very impactful side effects are very rare.

However there are mixed results in association studies of Glob-B reducing drugs when it comes to cognition, and other things. There are a lot of skeptics about Glob-B reducing drugs, they like to post the association studies which show a negative association, not any positive ones. Even though Glob-B reducing drugs are off-patent, and available in generic forms, and very cheaply. They can think it’s just a big pharma conspiracy theory, while millions are still dying from Globmoklo. Many because they aren’t treated sooner. Most start treatment when they already have advanced disease, or will have so soon. And it’s based on 10-year risks rather than 30-year risks or lifetime risks of the disease.

You are the person posting those negative association studies, deeming them to be risky, saying it is so risky and not worth the reward, albeit for those with relatively low Glob-B levels. While others are questioning the association studies, and look at the situation holistically and in mind of the massive studies and level of evidence behind them.

Are you able to stop focusing on the “side effects”, the negative part of association studies of Glob-B reducing drugs, and see the bigger picture? You seem to be intensely focused on a very small part of the picture.

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First dose feelings - apprehension about taking an experimental drug
#75

Did not test yet Lp(a). I am doing a comprehensive physical in September and will reassess rapamycin and lipid lowering strategies. I certainly don’t qualify for PCSK9i prescription and 350 eur per month seems ATM like a investment that is not gonna bring any good return.

@Virilius ASCVD is really complex disease and thinking that just taking statins will eradicate it IMO is not only speculative but almost hallucinatory wishful thinking. And since risk reduction is so small in my case assessing today, it does not make any sense taking statins. But I am openminded and will gladly say I was wrong on this or any other matter. As I once said, I like to take scenic routes. The goal is the same anyway for you and me. Living longer, happier and healthier.

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#76

We do know from studies at least that older populations taking it does strongly decrease cardiovascular risks.

And since risk reduction is so small in my case assessing today, it does not make any sense taking statins.

The risk reduction for cardiovascular diseases is great. The risk reduction for all cause mortality is moderate. Since statins are cheap, easily available and generally well-tolerated and safe, I don’t see why anyone interested in longevity would elect to not take them.

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#77

Look, clearly you don’t read my posts. Let me make this short. Have a look at absolute numbers. In my case if I reduce LDL-C by 60% my overall risk for ASCVD up to age 99 is reduced by about 3-4%, low dose statin should reduce it by 25-30%, my overall risk reduction in that case would be 1-2%. Does that make sense taking it?

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#78

It’s impossible your absolute risk reduction is 1-2% because 32% of all deaths in 2019 were from CVD, and if you live to 99 where 99% have advanced cardiovascular disease (positive CAC), it cannot be that low.

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#79

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Here are the cut points.

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#80

Has your ASCVD risk ever been assessed by cardiologists in a clinical setting?

I can give you some further details, but it is hard to communicate if we are using different perspectives. You are mostly citing studies done in high risk population and relative risk reduction, but absolute numbers are actually really low for low risk individuals (even in high risk individuals statins prevent 1,6 MI in 100 people-years). Also note that ASCVD is still more prevalent in US than the rest of the world.

I was recently assessed in clinical setting for risk of ASCVD and my risk in next 10 years was assessed to 2%. There are also some tools available online and my risk is calculated mostly the same (1-4% depending on tool). Average risk in my age group is around 10% I was told (online tools vary in this but again 6-11% was the number I got using online tools). Reducing my LDL-C would reduce that number by marginal value in the next decade.
If I keep my lifestyle and biomarkers the same for next 30 years my risk would rise to 14% if I remember correctly. And if only variable would be LDL-C I would get this 1-4% reduction. This was a clinical assessment, based on my personal and familial history, current biomarkers, lifestyle and tests including CAC etc. Clinical assessment was made up to age 80, but I was told that even if the trajectory would be extended it would most probably stay under 20% which is in terms of cardiology low risk.
But this completely changes with poor lifestyle (smoking, not exercising, overweight etc.) highly dyslipidemic patient. I had done tests with a friend who is much younger, but smokes, is overweight, doesn’t exercise, has high LDL-C, is prediabetic… he was offered statins and just reducing LDL-C reduced his lifetime risk by 30% and his risk in current decade by 90% if I remember correctly.
Sure, his absolute numbers were still higher than mine, but his relative reduction with projected statin use is tremendous comparing to me. That is why I was questioning statins for primary prevention in low risk individuals. Not advocating that statins are bad. They come with a set of risks, but in certain groups of patients they are really the way to go. But if in future I come upon evidence that clinical assessment does not correlate with current scientific standards / data I might reconsider my decision.
In the mean time my objective is to keep apoB below 80, continuing my lifestyle and concentrating on eating more omega 3 from food sources not supplements. I will probably repeat my ASCVD assessment in 5 years.

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#81

You’re operating under the assumption that those ASCVD risk assessments are sought after, that they are 10 year risk should tell you enough. It’s lifetime risk that matters.

#82

Do Statins even work?! | Relative vs Absolute risk - YouTube

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#83

Well, I just got my latest lab results back, and things are not good.

My LDL went from 81 to 122 over the past year that I’ve been on Rapamycin and my ApoB is 102 (first time measured).

This puts me at high risk of ASCVD.

All my liver numbers are excellent. Therefore, I believe I must take a statin and put an extra load on my liver or stop taking Rapamycin IMHO.

My HBA1C is now 5.7, barely in pre-diabetes. Also not good.

My aging.Ai results are 29, in-line with where they were a year ago 28 yo and 26 yo 3 years ago). I am shocked my higher LDL and higher HBA1C did not negatively affect my age by this calculator which has made me lose faith in it.

Mice don’t die of heart attacks, but I might!

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#84

You did it again. It is not worth discussing this further with you.

#85

Did what? Start of your post is about 10-year risks. I’m not going to read the rest in detail if you are extrapolating from that. Go back to the drawing board and stop using 10-year risk calculators is my opinion. :wink:

#86

You probably have too much adipose tissue (body fat) than what your pancreas can handle, causing the HbA1c to increase. Statin might make that situation worse. If you ever wanted a reason to get on a hippie californian healthy diet, now is the time. (also calorie counting).

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#87

Funny thing is that I’ve been dropping weight and my LDL is going in the wrong direction along with the HBA1C. Although for the latter, I have cut down my Metformin use which could be the cause.

#88

You should try zone 2 exercise also, Inigo San Millan on Peter Attia talks about that a lot. It really nukes the blood sugar after exercising IIRC.

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