I'd encourage you to get a Bioelectrical Impedance scan done to get an estimate of your visceral fat. You should be able to find a facility that has an InBody. If you can't, waist circumference (in cm) and/or Waist-to-Height Ratio can act as surrogate markers.

A waist circumference >102 cm (in men) is associated with high VAT and cardiometabolic risk as is a Waist-to-Height Ratio > 0.5.

Visceral adipose tissue is a major disruptor of metabolic health.

bigtruckguy3500 said:

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OasisMan said:

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As pointed out, Statin clinical benefits are overblown.
A meta-analysis of 21 studies showed that taking a statin reduced the risk of all-cause mortality by 0.8% (not very impressive) - so <1 person in 100.

Another study, on primary prevention (which is what you would be taking it for), showed absolute risk reduction of all cause mortality by 0.7% (again, not very impressive).

---

So my question, when I hear this, is always what about morbidity benefits? What is the risk reduction for non fatal cardiac events? Stroke reduction? Peripheral vascular disease? Etc.

And I don't know the answer, or if that risk reduction is worth the potential risk of certain side effects.

---

good question (morbidity) -- def need to take this into consideration

Quote:

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...21 randomized clinical trials in primary and secondary prevention that examined the efficacy of statins in reducing total mortality and cardiovascular outcomes... the absolute risk of 0.8% for all-cause mortality, 1.3% for myocardial infarction, and 0.4% for stroke in those randomized to treatment with statins compared with control

---

another meta-analysis (8 trials, 65000 pts)

Quote:

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These findings suggest that treating 100 adults (aged 50-75 years) without known cardiovascular disease with a statin for 2.5 years prevented 1 MACE (major adverse cardiovascular event) in 1 adult.

---

100 adults, take a pill daily, for 2.5yrs, to prevent 1 event


im not saying there is not a role for statins,
but i do believe they are wildly over prescribed, and this shows in the limited efficacy noted these primary prevention meta-analyses,
and pts do like to use them as a crutch so they dont have to change diet/habits/activities/etc

Thanks for your input and the incredibly difficult work you do.

MaxPower said:

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My understanding is the reduction is based on the population and in comparison to not taking a statin. Meaning if 2 out of 100 without statin's had a heart attack and 1 out of 100 in the statin had a heart attack that only reduced your likelihood by 1%. However, if I can take something that's unlikely by high risk and reduce it in half with minimal side effects then fine I'm doing it.

The biggest risk seems to be late stage cognitive issues but I have a family history of few men making it past 70 due to heart disease. In other words, if I live long enough to get dementia or Alzheimer's then it's a W.

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Yep, That's the "relative" risk reduction.

In statistics, the "absolute" risk reduction is typically considered more important / useful than the "relative" risk reduction

Also IMO another important one to consider is the Number Needed to Treat (ie 100 pts for 2.5yrs).

And re. >70 -- haha well you are on here so you are at least somewhat proactive, that's a start. If you are gung-ho on pharmacological cholesterol lowering agents, I would look into PCSK9-inhibitors first (ie Repatha, Leqvio, etc) and they (especially Leqvio) seem to have some anti-Alzheimer's side benefits. If you opt for statins, dementia recs would be favor the hydrophilic statins over the lipophilic ones.

Do you have a fish oil brand you recommend? I've heard mixed things about them so I've just stayed away and try and eat fish once a week.

I get prescription Lovaza or Vascepa via costplusdrugs.com, the generic version. My thought is that the prescription stuff hopefully is the most regulated and least likely to be contaminated, and most likely to have the concentration of what it says in it.

Lovaza I'd DHA (good for brain) and EPA (good for heart and blood vessels). But too much DHA has been associated with increased risk of atrial fibrillation - though this is likely not causing it, but perhaps making it easier for people predisposed to it to get sooner. I take 1 of each daily.

Statins are the devil. I have gotten my usage to the bear minimum by also taking Niacin.

Cholesterol tracking is tricky due to lowered targets over time resulting in greater pharmaceutical sales. So just like everything else in medicine do your own homework.

I started going to an alternative wellness clinic about 5 years ago and it has really helped with natural and alternative preventative options. So less subscriptions to treat symptoms and more due diligence on preventative.

Not saying you are wrong but your experience proves nothing.

bam02 said:

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Not saying you are wrong but your experience proves nothing.

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dude I don't even know how to translate your comment.

Ok let me explain my thinking. You make a blanket statement that statins are the devil. Not sure what this is based on. Maybe side effects you experienced?

You then state you were able to reduce their usage by adding Niaspan. So how did you find this balance? This implies you were treating to try to achieve a lipid panel number and you weren't able to hit your goals with low dose statin so you added Niaspan. I get all that and don't see anything wrong with it.

Another question is (assuming I am right and you were treating to hit a target number) how do you know what goal is appropriate? You imply the goals are pushed down based on pressure from pharmaceutical industry (you're probably right), so how did you and your doctor arrive at your target numbers?

OasisMan said:

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I personally opted for Carlson's (I get off Amazon) because that's one that Rhonda Patrick vetted and likes

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I saw it promoted once to do Krill Oil vs Fish Oil.

Any opinion?

bam02 said:

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Ok let me explain my thinking. You make a blanket statement that statins are the devil. Not sure what this is based on. Maybe side effects you experienced?

You then state you were able to reduce their usage by adding Niaspan. So how did you find this balance? This implies you were treating to try to achieve a lipid panel number and you weren't able to hit your goals with low dose statin so you added Niaspan. I get all that and don't see anything wrong with it.

Another question is (assuming I am right and you were treating to hit a target number) how do you know what goal is appropriate? You imply the goals are pushed down based on pressure from pharmaceutical industry (you're probably right), so how did you and your doctor arrive at your target numbers?

---

Statins have short term and longer term side effects. There is plenty of info out there.

I added Niacin and was able to reduce my Statin intake to the min. - .5 - or what ever it is... and I take my Statin every other day vs daily

My points on goals isn't about my targets... it's about the industry lowering goals so more people are on their products to hit the new target numbers and drive revenue.

My point is why go all in with big pharma who isn't in the problem solving business. I'd much rather own their stock than have to take their product.

fulshearAg96 said:

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bam02 said:

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Ok let me explain my thinking. You make a blanket statement that statins are the devil. Not sure what this is based on. Maybe side effects you experienced?

You then state you were able to reduce their usage by adding Niaspan. So how did you find this balance? This implies you were treating to try to achieve a lipid panel number and you weren't able to hit your goals with low dose statin so you added Niaspan. I get all that and don't see anything wrong with it.

Another question is (assuming I am right and you were treating to hit a target number) how do you know what goal is appropriate? You imply the goals are pushed down based on pressure from pharmaceutical industry (you're probably right), so how did you and your doctor arrive at your target numbers?

---

Statins have short term and longer term side effects. There is plenty of info out there.

I added Niacin and was able to reduce my Statin intake to the min. - .5 - or what ever it is... and I take my Statin every other day vs daily

My points on goals isn't about my targets... it's about the industry lowering goals so more people are on their products to hit the new target numbers and drive revenue.

My point is why go all in with big pharma who isn't in the problem solving business. I'd much rather own their stock than have to take their product.

---

So, everything you're saying is a perfect example of why people need to actually understand evidence based medicine before making clinical decisions.

Niacin has been shown to have benefits to lipid profiles, especially in conjunction with statins. However all the studies, including cochrane reviews, have shown no significant effect on clinical outcomes such as stroke, cardiovascular moratlity, major cardiovascular events, or all cause mortality.

A few years ago they lowered the recommended target for treating high blood pressure. This wasn't because they wanted to sell more blood pressure medications (most of which are quite cheap), it's because evidence showed a benefit to lower blood pressure and tighter blood pressure control.

Likewise, I haven't seen the studies myself, but lower LDL targets are associated with improved outcomes.

It is totally possible that they data may continue to change and evolve as time goes on. We may find better drugs over time. Or we may find ways to better tailor therapy to an individual's specific risk based on their activity level, genetics, diet, age, blood pressure, A1C, etc. But for now, most recommendations are based on population level data. And while I'm sure pharma enjoys making extra money from increased use of their drugs, they do have a data behind the recommendations.

You can 100% choose to say that you don't want to maximize your risk reduction, and that is your choice. And it's totally reasonable to weight the pros and cons of side effects against the pros and cons of risk reduction. But until someone produces evidence to support some intervention, or against that intervention, you're really not going to see guidelines for therapy change.

bigtruckguy3500 said:

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fulshearAg96 said:

---

bam02 said:

---

Ok let me explain my thinking. You make a blanket statement that statins are the devil. Not sure what this is based on. Maybe side effects you experienced?

You then state you were able to reduce their usage by adding Niaspan. So how did you find this balance? This implies you were treating to try to achieve a lipid panel number and you weren't able to hit your goals with low dose statin so you added Niaspan. I get all that and don't see anything wrong with it.

Another question is (assuming I am right and you were treating to hit a target number) how do you know what goal is appropriate? You imply the goals are pushed down based on pressure from pharmaceutical industry (you're probably right), so how did you and your doctor arrive at your target numbers?

---

Statins have short term and longer term side effects. There is plenty of info out there.

I added Niacin and was able to reduce my Statin intake to the min. - .5 - or what ever it is... and I take my Statin every other day vs daily

My points on goals isn't about my targets... it's about the industry lowering goals so more people are on their products to hit the new target numbers and drive revenue.

My point is why go all in with big pharma who isn't in the problem solving business. I'd much rather own their stock than have to take their product.

---

So, everything you're saying is a perfect example of why people need to actually understand evidence based medicine before making clinical decisions.

Niacin has been shown to have benefits to lipid profiles, especially in conjunction with statins. However all the studies, including cochrane reviews, have shown no significant effect on clinical outcomes such as stroke, cardiovascular moratlity, major cardiovascular events, or all cause mortality.

A few years ago they lowered the recommended target for treating high blood pressure. This wasn't because they wanted to sell more blood pressure medications (most of which are quite cheap), it's because evidence showed a benefit to lower blood pressure and tighter blood pressure control.

Likewise, I haven't seen the studies myself, but lower LDL targets are associated with improved outcomes.

It is totally possible that they data may continue to change and evolve as time goes on. We may find better drugs over time. Or we may find ways to better tailor therapy to an individual's specific risk based on their activity level, genetics, diet, age, blood pressure, A1C, etc. But for now, most recommendations are based on population level data. And while I'm sure pharma enjoys making extra money from increased use of their drugs, they do have a data behind the recommendations.

You can 100% choose to say that you don't want to maximize your risk reduction, and that is your choice. And it's totally reasonable to weight the pros and cons of side effects against the pros and cons of risk reduction. But until someone produces evidence to support some intervention, or against that intervention, you're really not going to see guidelines for therapy change.

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Fellas I just simply posted to say you have options other than big pharma to solve problems. I wasn't advocating for therapy change and as intertwined as big pharma is with politics I don't expect to see it anytime soon. You did make my point though - "... they do have a data behind the recommendations." The clinical trials are generally funded by the pharma companies and the selective reporting is done by the pharma companies... so take it for what it is but you'd be foolish not to do your homework.

KidDoc said:

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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.

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Statins reduce the risk of dementia, not increase.
https://pubmed.ncbi.nlm.nih.gov/39822593/

Dietary sources of cholesterol only contribute to about 15% of cholesterol in the body, so while diet is important, you can only have a modest effect on your cholesterol via diet. Statins reduce cholesterol, but not as aggressively as PCSK9 inhibitors.

I just don't fully understand what doing your own homework entails. All the data out there is not funded by pharma. You can search through it and find what is and isn't. I just get the feeling that when most people say to do their own homework, or research, what they're really doing is selectively going through the data and picking and choosing what fits their narrative - usually it's whatever will sell their brand (the fitness influencers and such mostly).

What I often see is people watching a YouTube video, or listening to a podcast, by someone who is very convincing in arguing for or against something. And they will take that and run with it, and ignore potentially a mountain of data saying to do the opposite.

But, unless we resort to unethical human experimentation, it will be hard to get truly definitive answers in a short period of time. I think in 10-30 years we should see lots of data, assuming people are looking and others are honest about their habits, regarding certain diets, supplements, and lifestyles.

bigtruckguy3500 said:

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I just don't fully understand what doing your own homework entails. All the data out there is not funded by pharma. You can search through it and find what is and isn't. I just get the feeling that when most people say to do their own homework, or research, what they're really doing is selectively going through the data and picking and choosing what fits their narrative - usually it's whatever will sell their brand (the fitness influencers and such mostly).

What I often see is people watching a YouTube video, or listening to a podcast, by someone who is very convincing in arguing for or against something. And they will take that and run with it, and ignore potentially a mountain of data saying to do the opposite.

But, unless we resort to unethical human experimentation, it will be hard to get truly definitive answers in a short period of time. I think in 10-30 years we should see lots of data, assuming people are looking and others are honest about their habits, regarding certain diets, supplements, and lifestyles.

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the Framingham heart study has been ongoing since 1948 (grandkids of the original participants now taking part). The original associations between cholesterol and cardiovascular disease, as well as other risk factors, come from this study.

This was the point of my response to his original post earlier. He said statins were the devil and I'm guessing that's based on having side effects or just a distrust of the pharmaceutical industry or both. All of those are reasonable

But then he seemed to imply that lowering his statin and adding niacin accomplished some goal for him. Not sure what that goal could be other than cholesterol target number. If so, where did that number come from and why does he trust it is the right target?

gunan01 said:

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bigtruckguy3500 said:

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I just don't fully understand what doing your own homework entails. All the data out there is not funded by pharma. You can search through it and find what is and isn't. I just get the feeling that when most people say to do their own homework, or research, what they're really doing is selectively going through the data and picking and choosing what fits their narrative - usually it's whatever will sell their brand (the fitness influencers and such mostly).

What I often see is people watching a YouTube video, or listening to a podcast, by someone who is very convincing in arguing for or against something. And they will take that and run with it, and ignore potentially a mountain of data saying to do the opposite.

But, unless we resort to unethical human experimentation, it will be hard to get truly definitive answers in a short period of time. I think in 10-30 years we should see lots of data, assuming people are looking and others are honest about their habits, regarding certain diets, supplements, and lifestyles.

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the Framingham heart study has been ongoing since 1948 (grandkids of the original participants now taking part). The original associations between cholesterol and cardiovascular disease, as well as other risk factors, come from this study.

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Yeah. What I mean though is that carnivore diets and keto and such have been gaining popularity over the past 10-15 years. And keto really before that. Those people that started those diets early on, and those starting them recently, will likely either start having heart attacks and strokes in the next 10-30, or not have them when others their age do. Lots of cofounders on a retrospective analysis, but it'll give us better insight.

bam02 said:

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This was the point of my response to his original post earlier. He said statins were the devil and I'm guessing that's based on having side effects or just a distrust of the pharmaceutical industry or both. All of those are reasonable

But then he seemed to imply that lowering his statin and adding niacin accomplished some goal for him. Not sure what that goal could be other than cholesterol target number. If so, where did that number come from and why does he trust it is the right target?

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Dear lord... Niacin + a min dose of Statin lowered my cholesterol. I prefer that over a large dose of Statin stand alone. My numbers are in the good/ideal category...

I understand. I've been on a statin and Niaspan for 20 years. I do that to lower my cholesterol and specifically Lp(a).

But dear lord what was your goal in lowering your cholesterol??? How do you know it's low enough???

bam02 said:

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I understand. I've been on a statin and Niaspan for 20 years. I do that to lower my cholesterol and specifically Lp(a).

But dear lord what was your goal in lowering your cholesterol??? How do you know it's low enough???

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Dropped from total cholesterol of 300+ and now staying under 200. All my levels are in the 'good' per labs.

Great point. Will be interesting to see.

Nice!

My cholesterol results from my bloodwork last Thursday:

Cholesterol - 68 mg/dL
Triglicirides - 98 mg/dL
dHDL - 23 mg/dL
cLDL - 25 mg/dL

----

My Vitamin B-12 from last Thursday:

Vitamin B12 - < 159 pg/mL

He thinks that account for my loss of appetite.

So Wednesday after my first Vitamin B-12 shot

Vitamin B12 - > 1000 pg/ml

That's quite a change.

---

The most concerning from yesterdays blood test:

D-DIMER-QUANT - 5.00 mg/L

The report said that the more usual range is from 0.19 to 0.49. So I'm ten times higher. I'm going to have an ultrasound at 12:15 to look for blood clots and will very likely be prescribed blood thinners this afternoon.

eric76 said:

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My cholesterol results from my bloodwork last Thursday:

Cholesterol - 68 mg/dL
Triglicirides - 98 mg/dL
dHDL - 23 mg/dL
cLDL - 25 mg/dL

----

My Vitamin B-12 from last Thursday:

Vitamin B12 - < 159 pg/mL

He thinks that account for my loss of appetite.

So Wednesday after my first Vitamin B-12 shot

Vitamin B12 - > 1000 pg/ml

That's quite a change.

---

The most concerning from yesterdays blood test:

D-DIMER-QUANT - 5.00 mg/L

The report said that the more usual range is from 0.19 to 0.49. So I'm ten times higher. I'm going to have an ultrasound at 12:15 to look for blood clots and will very likely be prescribed blood thinners this afternoon.

---

That HDL is really low. Do you lift weights? I would add lifting and consider Niacin as well.

I agree that D-Dimer is concerning, best of luck on your scans.

KidDoc said:

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eric76 said:

---

My cholesterol results from my bloodwork last Thursday:

Cholesterol - 68 mg/dL
Triglicirides - 98 mg/dL
dHDL - 23 mg/dL
cLDL - 25 mg/dL

----

My Vitamin B-12 from last Thursday:

Vitamin B12 - < 159 pg/mL

He thinks that account for my loss of appetite.

So Wednesday after my first Vitamin B-12 shot

Vitamin B12 - > 1000 pg/ml

That's quite a change.

---

The most concerning from yesterdays blood test:

D-DIMER-QUANT - 5.00 mg/L

The report said that the more usual range is from 0.19 to 0.49. So I'm ten times higher. I'm going to have an ultrasound at 12:15 to look for blood clots and will very likely be prescribed blood thinners this afternoon.

---

That HDL is really low. Do you lift weights? I would add lifting and consider Niacin as well.

I agree that D-Dimer is concerning, best of luck on your scans.

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My HDL has always stayed low. That was lower than my previous measurement, though.

The results of the ultrasound are in. As I understand it, the clot goes from near my groin down to near my knee. I'm now on Eliquis 5 mg twice daily (just took the first one).

The doctor usually takes Thursday afternoons off. He did come back to the office to talk to me, though.

Here is the report:

Quote:

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==============================================================================
R A D I O L O G Y R E P O R T
===============================================================================
PROCEDURE:US LOWER EXTREMITY DUPLEX

COMPARISON:None.

INDICATIONS:PAIN

TECHNIQUE:The lower extremities were evaluated utilizing gray scale images
with segmental compression, color Doppler, and spectral Doppler with
respiratory variation and augmentation.

FINDINGS:
RIGHT
Common femoral vein:Patent
Posterior tibial vein:Patent
Anterior tibial vein:Patent
Greater saphenous vein:Patent

Waveforms: Within normal limits.

LEFT
Common femoral vein:Thrombus
Femoral vein:Thrombus
Popliteal vein:Thrombus
Posterior tibial vein:Patent
Peroneal vein: Thrombus
Anterior tibial vein:Patent
Greater saphenous vein:Patent

Waveforms: Within normal limits.

Twenty-nine images received.

Dr. <redacted> was informed of the results by the sonographer

CONCLUSION:Left lower extremity deep venous thrombus.

---

I'm going to have to look up some of those veins in Gray's Anatomy (book, not the tv show).

I guess I won't be shaving for a month or two.

By the way, I stopped at the old drug store lunch counter (no drugs available any more) for lunch and spent my time going through the package insert for the Eliquis.

Lucky they picked that up before it launched to your lungs! Hopefully it Will slowly melt away with your med.

Were you having leg swelling? Any recent trips, travel, periods of long immobility? It's not common to order a d dimer without an indication since it's a very non specific test. And if you have nothing that provoked it, you need a workup for why you developed it.

bigtruckguy3500 said:

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Were you having leg swelling? Any recent trips, travel, periods of long immobility? It's not common to order a d dimer without an indication since it's a very non specific test. And if you have nothing that provoked it, you need a workup for why you developed it.

---

I started having some discomfort in the leg on Sunday afternoon and made it out to customer sites on Sunday evening, Monday afternoon, and Tuesday afternoon. I came real close to climbing a relatively short radio tower on Monday but didn't because of the leg.

I went to the doctor on Wednesday. My primary concern was that it was leg pain associated with taking lipids so I wasn't real worried even though it didn't feel like the leg plain associated with taking lipids felt a couple of years ago -- the pain was much sharper then.

I had considered the idea that it might be a blood clot, but with no redness,, warming, swelling, and only mild to moderate pain, I didn't think that likely. The main reason I was concerned about it and brought it up was that it was affecting one or more muscles in both the lower left leg and the upper left leg.

The doctor had ordered a number of blood tests the previous Thursday after I went to him about my loss of appetite. Over time, many foods have not been tasting right. About the only things that hasn't changed is things like cake and ice cream. Also, eating vegetables is mostly unchanged.

Most affected is beef -- I haven't seemed to be able to taste beef much at all for several months and had quit eating hamburgers, chicken fried steak, tacos, and spaghetti meat sauce. Chicken still has some taste. Fish and shrimp offer some taste, but less.

The doctor thinks that this loss of appetite issue may be due to the very low Vitamin B-12 levels (< 159 pg/mL) showing up in my blood tests last Thursday.

The blood tests last Thursday were for Vitamin B-12, H Pylori IgG, PSA, TSH and T4Free, CBC with Diff, Brain Natriuretic Peptide, Vitamin D 25 OH, Magnesium, Glycohemoglobin A1C, CPK, Lipid Profile, and Complete Metabolic Profile. They also did a urine analysis and took a number of x-rays.

I was particularly interested in the VItamin D results since I had been taking 5,000 IU of Vitamin D daily for more than twenty years and in the A1C which was 5.2% which was down slightly from 5.3% the one previous time they measured it.