mccoy
#949
I would agree with your suggestions, although, since berberine has been a part of the traditional chinese and Ayurvedic medicine, it’s maybe obvious that the Chinese and the Indians tend to study more this plant-derived principle.
I’m not able to judge if the substance of the article is reliable enough, although formally it would appear pretty good. I also concur that it would be best if there were more articles on this subject. I also read the literature on the IMPROVE-IT study and relative comments. I’m not 100% convinced, but a choice must be done.
At the end, this choice may turn out to be conservative on the side of safety although less effective on the side of results.
Last, and I did not mention it before, the issue is not just berberine. My GP won’t give me a prescription because these preventional strategies are not contemplated in the guidelines.
The specialist I know, a friend of mine, will give a prescription but has suggested Vytorin (with simvastatin) instead of Rosumibe (with rosuvastatin) because he’s taking this combo without problems after consulting with a cardiologist.
So, in this specific and personal situation, the easiest way now would appear to settle on Vytorin and potentiate it with berberine. I can always change if results are not as desired.
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adssx
#950
The lack of good research on non patented compounds is indeed very sad. But as you mentioned you were risk averse and because well studied and affordable alternatives exist (namely statins, ezetimibe and bempedoic acid), I see no reasons to use berberine. The availability is a good point: you can buy anything from IndiaMart and you can get a prescription for anything with EU Doctor (or any other doctor in Europe actually).
Coming back to the general topic of cardiovascular health, a new paper comparing statin + ezetimibe vs high intensity statin alone: Safety and efficacy of moderate-intensity statin plus ezetimibe versus high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease: A meta-analysis
The combo is better for LDL reduction and achieving target. For MACE, not statistically significant, but only 3 studies looked at that and the OR might still be in favor of the combo: “Lastly, MACE were evaluated by three studies, encompassing 4568 patients, and a non-significant difference in occurrence was found, with an OR of 0.54 (95 % CI [0.14; 2.11]; p = 0.373; I² = 53 %)” And: “Also, no difference was observed with respect to drug intolerance (OR 0.75; 95 % CI [0.32; 1.78]; p = 0.515; I² = 38 %) (Fig. 3C) or drug related adverse events (OR 1.20; 95 % CI [0.78; 1.84]; p = 0.404; I² = 0 %) (FIg 3D).”
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mccoy
#951
The average OR looks good, were it not for the vast variability in the 95% CI…
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adssx
#952
Yes but check Fig 2 F: the wide OR is due to Choi 2023: a small study that found no difference (1 MACE in each group). If you remove it, the OR might become statistically significant in favor of the combo. This is cherry picking but it’s just to say that the trend looks good. We need more studies looking at combo vs single statin therapy to conclude definitely on this though.
mccoy
#953
adssx, I think the cherry picking (discarding outliers or suspicious values), is acceptable when attempting to reach an objective conclusion and not just pushing an agenda.
2 Likes
adssx
#954
I agree. I just wanted to be clear for those reading us that for now there’s no definite answer as to whether ezetimibe + low or medium dose statin is better than high intensity statin alone in terms of outcome.
Thankfully, several ongoing trials are looking at this question: ClinicalTrials.gov
We’ll have to wait a few years to get the results though… In the meantime we have to rely on the above…
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AnUser
#955
Effect on LDL up to 40 mg ezetimibe:
https://x.com/Drlipid/status/1823755001422078178
Atorvastatin is generally considered the first choice.
4 Likes
mccoy
#956
Yes, I’m just reading the details now and unfortunately the improvements in the combo with respect to simple statins are statistically significant but not that glamorous in average
LDL-C reduction (Mean Difference (MD) -5.05 mg/dL; 95 % CI [-9.02;-1.07]
Also, ApoB seems unaffected by the combo with respect to the control…
I wonder if there are in commerce reliable devices to check lipids with a finger prick and reactive strip, this would be the best strategy to ascertain on an individual basis the results.
adssx
#957
Yes tiny LDL difference but big difference in % of people who reached the 70 mg/dL target.
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Davin8r
#958
Note: thread title is “2019” but the study discussed below is brand new, published in Circulation 8/21/24
I thought this is worth cross posting. Attaching CVD through anti-inflammatory pathways using low dose colchicine appears to be a great option to decrease risk after maximally lowering ApoB. I’ve been on the fence, but this new study pushed me to go ahead and ask my PCP for colchicine Rx.
There is danger in extrapolating an effect of a medication in disease to individuals without disease. Trivial example: two patients with a life threatening bacterial infection - one of them is given a powerful antibiotic and survives, the other one dies. So a paper is written: survival advantage of Powerful Antibiotic. And then longevity fans all start taking Powerful Antibiotic and disaster results.
Drug extends life, has good effect in people with a given disease? I don’t have that disease, should I take it for my health/longevity? That’s the question. Why do I like ITP trials? Because they’re in healthy mice. Not like those studies where they use genetically messed up mice give them “SPECIAL DRUG” to compensate for that particular mess, then declare “life extending benefits of special drug” and we all immediately take it even though we don’t have the mess condition. Here’s my longevity recommendation: pillow taped around the body - my proof, in my experiment, I smashed mice with a hammer, but the ones wrapped in pillows had a survival advantage. Ergo, we should all wrap ourselves in pillows. But ITP studies are still in mice - people, who knows.
Does this drug advantage healthy people, based on studies in sick people?
2 Likes
Davin8r
#960
Are you talking about colchicine? I doubt such a study will ever be done in humans, but for those of us at high risk due to genetics (Lp(a), FH, etc) this approach could be a real breakthrough. I’m not suggesting they put colchicine in the water supply.
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mccoy
#961
I really find it hard to believe… at 1 mg, 1/10th the minimum commercial dosage, the effect is just about the same than at 10 mg. I wish there were a way to split the pill in tenths.
Why?
adssx
#962
The half life is 22h so you can split in two and take it every other day. It might be doable to split in 3, but the ezetimibe 10 mg pill is already so small…
1 Like
mccoy
#963
I’m thinking about something similar with one pill of Rosumibe 5/10 and one pill of Rosuvastatin which has a half life of 19 hrs.
-Day one: 1/4 pill of rosumibe 5/10; Provides Ezetimibe= 2.5 mg, Rosuvastatin 1.25 mg
-Day two: 1/4 pill of Rosuvastatin, provides 1.25 mg
-Day three: 1/4 pill of rosumibe 5/10; Provides Ezetimibe= 2.5 mg, Rosuvastatin 1.25 mg
-Day four: 1/4 pill of Rosuvastatin, provides 1.25 mg
-…same as above
In such a way, I could have an average daily dose of 1.25 mg Ezetimibe and 1.25 mg Rosuvastatin, which sounds pretty optimal.
The drawback would be the pill splitting and conservation.
I would be open to alternatives.
FYI, here’s my results before and after taking BA (140 mg) + Ezetemibe (10 mg) + Atorvastatin (5 mg)
You can see LDL went from 122 to 48 and ApoB went from 102 to 48.
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mccoy
#965
The results are impressive, back to the panel of a 10-years boy perhaps and without even using PCSK9-inhibitors.
What governed your choice of Atorvastatin?
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I tried Rosuvastatin first, but I was intolerant. Atorvastatin worked for me. Without Atorvastatin,my LDL and ApoB were 68. Atorvastatin makes a significant difference.
Although my LDL was 67 before Rapamycin, it’s nice to see that this combination therapy reduced my cholesterol below pre-Rapamycin levels.
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adssx
#967
I think atorvastatin and rosuvastatin are the most potent statins and the only ones to have shown all-cause mortality reduction in populations with “normal” cholesterol (JUPITER and ASCOT trials?). (@AnUser is that correct?) So they’re considered the best choices to start. Some people are intolerant to one but not the other. And rosuvastatin has a higher risk of new onset diabetes vs atorvastatin. See also this discussion: Rosuvastatin versus atorvastatin treatment in adults with coronary artery disease: secondary analysis of the randomised LODESTAR trial (2023)
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adssx
#968
You could just start with 1/4 of the combo pill every other day and see if well tolerated but not enough to reach your target after 3 months then you could move to 1/4 every day. It’s more manageable than alternating every other day between two pills. (If 1/4 every day still not enough you can add double to 1/2 every day or add bempedoic acid.)
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