Saúde Cardiovascular

[DrFraser]

The MRI is done with no contrast.

[Agetron]

Agreed, a bummer. And to think I should have a score of 3 by now and have zero - checked twice.

I have mentioned before on here that I have been on finasteride since I was about 32 years old (that is 33 to 34 years with no negative effects - all positive) - again like with rapamycin an early adopter. Finasteride is cheap and can be taken every day - or every 2-3 days.

Thanks to finasteride – I still have my hair. My urologist goes on an annual hunt to locate my prostate - the size of a person in their mid-20’s. He thinks it is funny to tell me - I know it is in here - somewhere. Another great benefit is your prostate doesn’t grow or act up.

Recently a possible 3rd benefit. NIH Report Link: Commonly prescribed hair loss drug might lower risk of heart disease | NHLBI, NIH.
Analyzing data from the National Health and Nutrition Examination Survey between 2009 and 2016, researchers found a significant link between men who had taken finasteride and lower cholesterol levels – on average, 30 points less than men who were not on the medication.

In a follow up study, the researchers dosed finasteride to mice that were genetically predisposed to develop atherosclerosis along with a high-fat, high-cholesterol Western diet. They found that the highest dose led to reduced cholesterol, delayed development of atherosclerosis, and reduced liver inflammation.

According to the study authors, “our data unveil finasteride as a potential treatment to delay cardiovascular disease in people by improving the plasma lipid profile.”

Cheap medication - you might consider for cholesterol. There are those that say it can dampen their libido (but reports say that is bunk). Concerned … go ahead and do tadalafil with it. My urologist says its great for urinary health.

[LaraPo]

I just had 2 MRI scans on the same day, for chest and abdomen. They explained that if it’s done without contrast iit is insensitive to malignancies if they exist. To cover potential malignancies it has to be with contrast. The contrast they use is called Vieway.

[DrFraser]

It depends on a number of factors - including resolution of the machine and the familiarity of the Radiologists with reading high volume of such scans for this purpose. So we have 2 major groups Prenuvo and SimonMed doing these scans for this reason. Neither of them feel the need to use contrast.
I’m happy leaving it to the experts - as panels of Radiologists determined what they feel is sensible.

You can see Prenuvo’s answer to this issue under their FAQs … They feel pretty good about not using contrast and feel it has sensitivity and specificity for detecting tumors as part of general population screening.

[LaraPo]

This is what was in the findings they sent to me after the MRI scans: The lack of IV contrast renders this examination insensitive for evaluating for malignancy. So I want to understand why my scans required contrast for the complete picture and yours did not. Does it depend on the equipment used?

[DrFraser]

So Radiologists love to basically shield themselves from making any definitive statement. It is classic on all our abdominal CT’s we do without contrast - they’ll say it decreases their likelihood of finding inflammatory or infectious issues (which it does a tiny bit). However, there are some radiologist very happy reading for those things without contrast.
The MRI done in a standard facility with standard techniques is probably not exactly geared to do what these ones are, where they know in advance, all scans non-contrast, everything optimized for screening for things, including cancer. Radiologists who are focused on this, and doing high volume of scans on this same machine, same protocol and same reason.
I’d guess it is a combination of all those factors that has groups like Prenuvo and SimoneMed comfortable with their approach. No test is 100%.
I’m just looking at this as screening, and happy with the limitations.

[AgentSmith]

The co-founder of Prenuvo explains their technology in this Peter Attia episode: #61 - Rajpaul Attariwala, M.D., Ph.D.: Cancer screening with full-body MRI scans and a seminar on the field of radiology - Peter Attia

In a nutshell, he says it’s a custom MRI machine using custom processing software.

[jnorm]

Just ordered some goodies from India, including rosuvastatin and ezetimibe. I’m considering rosuvastatin 5mg and ezetimibe 10mg for cholesterol management, but I’m wondering if there’s any consensus on which to try first?

LDL was 95 when I tested it almost a year ago—Plan on retesting it again any day now to see where I stand. But I definitely want to bring it down. Figure the sooner the better. And I may play around with TRT and/or AAS in the future (probably bad for longevity, I know), so I really want to have my lipids on lock.

[RapAdmin]

I would start with the statin…

Some info from ChatGPT and Drug Interaction checker:

For the typical person, what percent decrease in LDL does 20mg daily of rosuvastatin provide, and what percent decrease in LDL does 180mg of bempadoic acid provide, and 10mg of ezetimibe?

ChatGPT:

For the typical person:

1. Rosuvastatin (20mg daily): Rosuvastatin is a potent statin medication. At a daily dose of 20mg, rosuvastatin can lower LDL cholesterol levels by approximately 50% to 60%.
2. Bempedoic acid (180mg daily): Bempedoic acid is a newer medication that reduces cholesterol synthesis in the liver. At a daily dose of 180mg, bempedoic acid can lower LDL cholesterol levels by approximately 18% to 28%.
3. Ezetimibe (10mg daily): Ezetimibe works by inhibiting cholesterol absorption in the intestine. At a daily dose of 10mg, ezetimibe can lower LDL cholesterol levels by approximately 15% to 20%.

To summarize:

• Rosuvastatin (20mg daily): Decreases LDL by approximately 50% to 60%.
• Bempedoic acid (180mg daily): Decreases LDL by approximately 18% to 28%.
• Ezetimibe (10mg daily): Decreases LDL by approximately 15% to 20%.

These percentages provide a general guideline and actual results may vary based on individual factors such as baseline cholesterol levels and overall health status. Always follow your healthcare provider’s recommendations regarding medication usage and monitoring.

Source: Drug Interaction Report: ezetimibe, rosuvastatin

[jnorm]

Thank you that’s very helpful, I need to start using Chat more. I figure with the 5mg dose there would be fewer risk of sides while still good LDL reduction.

Chat:

The degree of LDL reduction depends on the dose. Generally, a 5 mg dose of rosuvastatin can reduce LDL cholesterol levels by approximately 40-50%.

Was also wondering how rosuvastatin and ezetimibe might impact triglyceride levels, since that’s an independent risk factor.

Yes, statins can impact triglyceride levels. While statins are primarily used to lower low-density lipoprotein (LDL) cholesterol, they also have an effect on triglycerides. Statins work by inhibiting the enzyme HMG-CoA reductase in the liver, which plays a crucial role in the production of cholesterol. This inhibition not only reduces LDL cholesterol but also results in a moderate reduction in triglyceride levels.

The extent to which statins lower triglycerides can vary depending on the specific statin and the dose. Generally, statins can reduce triglyceride levels by 10% to 30%. For individuals with elevated triglycerides, this effect can contribute to the overall cardiovascular benefits of statin therapy.

And as for ezetimibe

Ezetimibe has a modest effect on triglyceride levels. Studies have shown that it can reduce triglycerides by around 5% to 10%. While this reduction is not as significant as the reduction in LDL cholesterol, it can still be beneficial for individuals who have elevated triglycerides in addition to high LDL cholesterol.

My triglyceride levels were very good at 58 last time, and Chat says having extremely low levels might not provide additional health benefits.

[Neo]

@DrFraser

Small vessel disease in the brain with stroke is often present without having significant cardiac hard calcifications, …. I’d feel more reassured that you can ignore - for the time being, the LDL, if you had an MRA brain and neck that looked clean, i

Does “normal” MRI for cancer and/or neuroquant have that info? Or is the his a specific MRI protocol that is needed?

[AnUser]

Why did you choose rosuvastatin over atorvastatin? Just curious.

[DrFraser]

The MRA neck and head will let you know both large and small vessel disease and any prior stroke. It is important to note that only a small% of the brain is motor or sensory strip …, there is a huge are of brain that can have stroke that don’t necessarily relate to symptoms like motor or sensory loss. Oftentimes an MRI is where this diagnosis is made.

[jnorm]

That’s what Dr Stanfield uses. It’s more potent at lowering LDL though, so perhaps there’s less chance of side effects.

[adssx]

I would first test ApoB to get your baseline. And test your HOMA-IR (using fasting insulin and fasting glucose) at the same time. If HOMA-IR > 1 or if you have diabetes or a family history of diabetes I would go with ezetimibe first (statins can cause diabetes in some people). If HOMA-IR is below 1 (or if ezetimibe alone is not enough to reach your desired ApoB target) then a statin (rosuvastatin or atorvastatin) will do the job perfectly well.

[DeStrider]

My father is using Bempedoic Acid, Ezetemibe and now Atorvastatin. By adding the statin we hope to drop his LDL and ApoB from 65 to 45. He has moderate heart disease and a CAC of 352 even though he is a vegetarian and a gym rat and not obese.

[Davin8r]

DeStrider I can’t remember if you mentioned if his Lp(a) was ever checked?

[ng0rge]

In my blood testing to get a baseline before starting Rapamycin, I added Lp(a), as recommended here, and discovered it to be high (195 nmol/L). So I delayed starting rapamycin and started Atorvastatin 10mg and Ezetimibe 5mg. After 9 weeks - my LDL dropped from 116 to 68, my HDL 58 to 50, my Triglycerides 58 to 61, my ApoB 87 to 63 and ApoA1 stayed the same at 148. So, it worked and my numbers are good.
My HbA1c went from 5.3 on 04/23/2024 to 5.1 on 07/02/24 and Homa-IR went from 1.8 to 1.09. I take metformin 850mg/day and will start Acarbose with the rapa. I’m charting a few other types of tests but basically ready to start rapamycin now.

[essexaid]

So did your Lp(a) change at all after starting the statin and Ezetimibe?

[ng0rge]

I didn’t recheck on my latest blood test since I didn’t expect it to get better ( maybe slightly worse) and the test is a little expensive. I will retest it at some point, maybe after 3 months of rapamycin. I’m kinda resigned to just having high Lp(a) until a new drug comes out. PCSK9i would help some but probably not enough to make a real difference.