L_H
#2738
And there may be risks to targeting extremely low ldl-c. I think it’s important to note that the Odyssey trial thought: “It is important to note that, although adverse consequences of very low LDL-C were not identified in these trials, the long-term effects of very low levels of LDL-C induced by PCSK9 inhibitors are unknown.”
I think this gives a good overview of the state of the science re brain effects of targeting very low ldl-c (as at Sept 2023.)
https://www.ahajournals.org/doi/10.1161/ATV.0000000000000164
The mendelian randomization studies also detect a negative re diabetes:
“In conclusion, genetic variants in PCSK9 that associate with lower concentrations of LDL cholesterol are also associated with a modestly higher risk of type 2 diabetes and with associated differences in measures of glycaemia and bodyweight”
1 Like
LaraPo
#2739
My LDL dropped from 152 to 95 within 7 months on rosuvastatin 5mg, ezetimibe 10 mg + supplements. For the first time my cholesterol is normal, but CAC is elevated (almost 300 for coronary artery).
4 Likes
L_H
#2740
Hi Lara, i know you’re taking (thinkjng of taking?) Nattokinase. But i found the links from this interesting
“Supplementation with vitamin K2 and D3 has been suggested to have a protective role in the progression of CAC.” Protocol: Effects of vitamins K2 and D3 supplementation in patients with severe coronary artery calcification: a study protocol for a randomised controlled trial - PMC.
They’re trying dose: 720 µg/day of MK-7 and 25 µg/day of vitamin D3
2 Likes
aaa21usa
#2741
So as in my case, with a positive CAC, low dose statin is advisable to reduce risk. Hope you’re taking K2 and CoQ10 as well to minimize side effects. BTW - I’ve read that water soluble statins (like rosuvastatin) are less risky than fat soluble ones. Also consider taking Kyolic Aged Garlic and Nattokinase as well (look up the studies on PubMed).
One interesting study on CAC showed that if we can reduce the growth of CAC to less than 15% year then our risk of an MI drops significantly, and approaches that of someone with a CAC=0. That’s a worthwhile target (though obviously you don’t want to be get tested every year because the radiation has its own risks). I plan to get a follow up test 3-4 years from now. Crossing my fingers! LOL
5 Likes
LaraPo
#2742
D3/K2 - yes, I’m taking both, as well as CoQ10.
3 Likes
L_H
#2744
2 Likes
It may be true that the rate of progression varies and hence it is possible that it can be static. However, the underlying difficulty is having a system for measuring CAC that enables someone to track it without harm (or massive cost).
It may be possible to pick this sort of thing up from complex measurements of blood flow.
However, in the end I think there probably is a point where the absolute levels indicate more frequent measurement.
L_H
#2746
Yes, you’re right it may be more predictive without being useful for practical reasons.
I was also thinking that it would be helpful psychologically for people to know that, despite high CAC, if they could achieve low apo B / ldl-c then their risk is potentially much lower than most would believe. There’s nothing like a bit of hope!
1 Like
It would be nice if we could have better systems of measurement. We would then be able to tell if a mixture of menaquinones, vitamin D and citrate can reverse it.
1 Like
L_H
#2748
I just wanted to go back to this topic. Ezetimibe negatively impacts absorption of some omega 3 ,(ALA). And the benefit of ezetimibe is affected by EPA status - suggesting that it’s benefit might be negated by it’s negative impact on EPA absorption.
Does anyone have a view on this?
Given that omega 3 has benefits beyond atherosclerosis, blocking absorption is quite a cost.
2 Likes
CTStan
#2749
Almost all of my omega-3 is in the form of DHA EPA supplements, krill oil, sardines and other fish products.
So I dont think that my Ezetimibe has any significant impact on my omega 3.
L_H
#2751
Do you know if there is direct evidence on ezetimibe and DHA/EPA absorption? Either positive or negative?
The study i quoted relates to EPA. It suggests that if your EPA levels are good, then then the ldl-c benefit of ezetimibe is offset - suggesting that EPA absorption may be blocked.
Virilius
#2752
High EPA => ezetimibe has no effect in patients in the study
Low EPA => ezetimibe reduces events in patients in the study
Nowhere does it say that ezetimibe blocks EPA absorption in the study.
L_H
#2753
You’re right, I’m just saying it would be one possible explanation. There may be other explanations - but nothing jumps out.
scta123
#2754
Have you checked this study? It is small sample and statistically insignificant but there are some indications that ezetimibe affects absorption of omega 3.
blackwood2015.pdf (431.7 KB)
1 Like
L_H
#2755
Thank you, it is small, but persuasive for ALA. And I can’t quite see how ezetimibe would block ALA and not the other omega 3s (Dha and EPA).
I’m planning to experiment with micro dose ezetimibe - but the thought of effectively rendering my high fish diet useless is off-putting to say the least!
1 Like
Neo
#2756
You can test the your omegas - have you done that?
Could be good to do a before and after
This is the test I use. Heard that it is better than normal blood testing labs because it looks at what’s in the cell membrane and hence gives you an average over time that is more stable/reliable (kind of like HbA1c vs just one blood glucose reading). Learned that it is what Peter Attia’s team uses after looking at different options.
They also have a cheaper one for $49.
1 Like
scta123
#2757
Looking at plasma fatty acid concentrations EPA (20:5) and DHA (22:6) were lower with Ezetimibe though.
2 Likes
