what are your thoughts on high cholesterol, statins, etc. 46/male and have had higher cholesterol for few years now. Total 276, TRI 228, HDL 45, LDL 187. TRI was 132 last year. I've read where some doctors think statins are one of the best meds out there.. and I've read that you should avoid them at all costs. BP is normal. Did heart scan couple years ago and calcium score of zero. Hit the gym 5 times a week. Was thinking of just trying fish oil and cholestoff (supplement) and see how that goes.

6 foot, 195lbs. My diet could use some work for sure.

Have you gained weight over the last year?

Good point.

Fatty15. I dare you to look it up.

Okay, I think I understand. I was thinking the poster thought there was some huge flaw with the statin but really it is more of a fix the problem not apply the bandaid approach.

Ragoo said:

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Okay, I think I understand. I was thinking the poster thought there was some huge flaw with the statin but really it is more of a fix the problem not apply the bandaid approach.

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Always better to fix the underlying issue if you can. For most people its probably lifestyle, but for some people the cholesterol the body naturally makes can be the culprit and there isn't really a choice but to intervene.

If I were you, I would consider a statin while you lose weight and clean up your diet. No reason you can't do both.

I would agree that diet, exercise, weight loss is superior to statin use - and based off your numbers (especially the high triglycerides) you can probably benefit from the above. But some people just flat out need to be on a statin. And remember that a coronary artery calcium score is only a screening test to determine if someone needs to be on a statin or not. It doesn't indicate how much atherosclerosis and vessel narrowing you have, only shows calcified plaques. So be careful in using that as a marker for coronary health.

All drugs have side effects, the question is what dose is optimal to minimize the side effect while maximizing the benefit. And that does is different for everyone. Sometimes some people do better on one statin that is perhaps fat soluble while others do better on one that is water soluble.

Also, did you by chance get an A1C? That'll help guide therapy as well.

I am currently taking a low dose statin, Rosuvastatin 5mg. There is alot of hype about how bad they are, but most of it is misinformation. I absolutely do not believe in driving LDL to ridiculously low numbers and I only take it for the inflammation lowering effects it has. It is useful to people with certain health situations.

In terms of LDL reduction, I am not sure why doctors are pushing any statin doses higher than the minimum dose. You get like a 45% reduction for with the minimum dosage and then another 2-3% with every *doubling* of the dose from the minimum. The data sets are out there, just Google it.

Diet and exercise are way more important than most other things.

A1c was 5.6 and LP(a) 8.6. For what it's worth, I also drank all weekend in Galveston and then split bottle wine for dinner the night before bloodwork was done. Just wandering as well how much the numbers can vary on what you ate/drank in the days leading up to bloodwork.

Bonfire97 said:

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In terms of LDL reduction, I am not sure why doctors are pushing any statin doses higher than the minimum dose. You get like a 45% reduction for with the minimum dosage and then another 2-3% with every *doubling* of the dose from the minimum. The data sets are out there, just Google it.

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You're correct, that there is a diminishing return on higher dosing in terms of LDL reduction. However, statins are often discussed in terms of intensity more so than dosage. For example, 5mg rosuvostatin is actually moderate intensity, similar to 40mg of pravastatin or 20mg simvastatin. As far as I know, there is evidence that suggests that higher intensity regimens to decrease risk of recurrent major cardiac events, even if it's not driving the LDL down as much, since it does help stabilize plaques.

Oh ok. LP(a) is good. A1C not so much. You are almost at "pre-diabetes" level. Could consider starting metformin. The combination of high cholesterol and high blood sugar is not good. If you have high blood pressure and/or smoke, significantly worse as well.

It generally takes anywhere from 1-3 months for diet/weight loss to have a significant effect on lipids and A1C. However alcohol is associated with elevated triglycerides I believe, as well as some other metabolic derangements, especially if drinking on a consistent basis.

Blood pressure is completely normal. Don't smoke. 1-2 drinks probably 4 times a week. Follow up with dr later this week. It is probably time to get serious with a diet (right now I basically eat whatever. Mexican food at least weekly. Pasta, ice cream couple times a week) Maybe a low dose statin, fish oil, and realize I'm 46 and need to watch what I eat. Check again in 6 months and possibly quit the statin and see how it goes.

springagg said:

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A1c was 5.6 and LP(a) 8.6. For what it's worth, I also drank all weekend in Galveston and then split bottle wine for dinner the night before bloodwork was done. Just wandering as well how much the numbers can vary on what you ate/drank in the days leading up to bloodwork.

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The A1C test is a 3 month average of your blood sugar level. You are just about to pre diabetic levels. I would be more concerned with that than cholesterol at this point. Fix your diet and you should see both numbers improve

springagg said:

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Just wondering as well how much the numbers can vary on what you ate/drank in the days leading up to bloodwork.

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What you eat and drink can certainly cause your triglycerides to spike.

Alcohol temporarily suppresses fat oxidation and increases hepatic triglyceride production for 24-48 hours after heavy drinking with carb-heavy meals.

Here's a challenge for you:

• No alcohol for 30 days
• Drop ultra-processed foods (ice cream, chips, tortillas, etc.)
• 30-40g protein per meal (to improve satiety and triglyceride response)
• Eat real food: veggies, meats, fish, eggs, olive oil, some berries
• Get 78k+ steps daily in addition to lifting
• Fish oil

Retest

I'm 63. My cholesterol was 273 at EOY. I cut that # in half in 4.5 months by:
No alcohol, Mediterranean-ish diet, overnight oats, and as supplements I took red yeast rice, phytosterols, bergamot, circumin, black seed oil, and psyllium husk…all these in pill or capsule form that I got mostly at grocery store.
Also apple cider vinegar, flax seed, and extra virgin olive oil. I also lost Bout 15 pounds

No, I challenge you to walk 35 miles a day. You'd definitely lose some weight.

Yes, 7-8k steps per day.

I'm averaging around 13,000 and have been quite surprised at how much of an impact it is having on my body composition.

Bonfire97 said:

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Quote:

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As far as I know, there is evidence that suggests that higher intensity regimens to decrease risk of recurrent major cardiac events

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The one thing to point out is that statins do not reduce heart attack or all cause mortality risk anywhere near what they are advertised. They "lie" with statistics because they list relative risk reduction as opposed to absolute risk reduction. For instance, with Rosuvastatin, the trial showed an actual event reduction of 2.8% placebo vs 1.6% control. That's 1.2% or 1.2 people of 100. However, they claim a 44% reduction looking at the difference between 2.8 to 1.6. All drug companies advertise like this and it's really criminal.

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Well, no, they do reduce it to what they're advertised, the issue is that the average person doesn't understand statistics enough to realize that relative risk reduction is used instead of absolute risk reduction. And while some doctors aren't that good with statistics, more and more med schools are increasing statistics in their curriculum. But the real issue here is advertising directly to the public. People go to their doctor and want that drug that reduces their risk by 44%, regardless of what the doctor tries to tell them. Just like they want ivermectin, or hydroxychloroquine

If someone has a heart attack on low intensity therapy, do you think a courtroom is going to care that the doctor was looking at ARR when deciding not to maximize an individual's risk reduction? I guarantee you any lawyer worth his salt can get 100 expert witnesses to say that the patient was not on optimal medications for maximal risk reduction. The practice of medicine these days is becoming more and more on what is defensible in court.

springagg said:

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Statins from what I hear can have bad side effects. I would rather fix the issue natural if possible. There were.a couple doctors for a while though saying statins were some of the best meds on the market and that basically all of us should take a low dose one. Cleaning up your diet is the hardest part.. I mean who doesn't like queso, pasta, pizza, and some alcohol.

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I am 45 and I've been on one since I was in my 20s. I've had zero side effects and believe that they are largely overblown.

That said, I would absolutely do what you can with diet and lifestyle before you take any prescription

Metamucil daily can help too

I can only give you my anecdotal experience but I've had no issues with a low dose statin. Some people get elevated liver enzymes so probably best to further restrict alcohol. The other common complaint is muscle pain, which I never experienced. I'm about your age (44) and somewhat similar circumstances with being mildly overweight (5-11, 185-190) that is active but has a questionable diet. Statins or statin derived compounds can be found in foods like red rice yeast but I wouldn't recommend going that route because it's really hard to estimate exactly how much you are getting.

Look at my thread Deep Nutrition. Changed my whole 90s education of the lipid cycle and got me off meds in about a year.

Statins had no side effects for me until I started lifting then I noted the poor muscle recovery, gains, and pain significantly. The other potential concern is increased risk of dementia over time.

I would call your numbers very concerning if they were mine.

An LDL of 187 is too high. Take a statin but also modify diet, exercise , etc. It will lower your LDL but more importantly it is thought to stabilize plaque.

Cardiologists and Endocrinologists in my opinion understand cholesterol and LDL best. Everyone I know would put you on a statin plus lifestyle modifications.

I don't understand all the negativity toward statins.

Ag9701 said:

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An LDL of 187 is too high. Take a statin but also modify diet, exercise , etc. It will lower your LDL but more importantly it is thought to stabilize plaque.

Cardiologists and Endocrinologists in my opinion understand cholesterol and LDL best. Everyone I know would put you on a statin plus lifestyle modifications.

I don't understand all the negativity toward statins.

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I had significant muscle pain and lack of gains once I started lifting more. There is also potential impact on dementia development.

If you can get off any med you should. But if your diet and exercise don't correct the dyslipidemia then certainly worth the risk of statins.

I had no muscle pain until I started lifting but I've had large gains and no pain since stopping statins in December.

I've known 5-10 people that took them, and had severe issues with their legs. Whether that is a corollary effect, I don't know, but I never want to take them.

I agree with the last 2 posts. Never take a med unless you need it. The benefit needs to outweigh the risk. Of course if you have side effects, don't take them. I think most people tolerate them, however. I would always start with lifestyle modifications but this doesn't seem to work for most people who need to decrease their LDL by more than 50.

Two Cardiologists I know did tell me that the two biggest gains they have seen in reducing CV events in their career are statins and GLp-1s.