Help understanding my lipid profile and statin choices?

Newcomer introductions, personal anecdotes, caregiver issues, lab results, and n=1 experimentation.
bladedmind
Senior Contributor
Senior Contributor
Posts: 70
Joined: Tue Jan 13, 2015 8:23 pm

Help understanding my lipid profile and statin choices?

Postby bladedmind » Sun Mar 17, 2019 3:04 pm

I’m looking for authoritative documentation of Dr. Bredesen’s advice not to lower total cholesterol below 150. I’ve read the wiki entry on lipids several times. I need evidence for my cardiologist.

I’m 69 year old male, APOE 4/4, controlled hypertension, controlled T2D (H1Bac always 5.7), eating low carb (not keto), moderate protein, high good-fat diet. No heart attacks among mother (died at 93 with full mental faculties), father (died at 89 after several years of congestive heart disease and alzheimer’s), nor in two living brothers 10 and 14 years older (no Alzheimer’s either).

I had acute pericarditis 12 months ago and they saw a small lesion - not sure what that means. I had a cardiac stress test six months later and passed with flying colors - better than age.

In 2002 I tried Lipitor for a few months and ended up confused, fatigued, and depressed. Slowly recovered after quitting. In late 2017 because of physician pressure I tried pravastatin every other day. One day a few months later I was wandering around in my house and was able to figure out that my short-term memory had vanished - persistently I could not remember what I was doing or compose complex, linked thoughts. So I quit again and it took about six weeks to get back to baseline. Now, despite this history, the heart doctor wants me to go on rosuvastatin every other day, and I am afraid because I do complex intellectual work.

I do have one blood reading from the pravastatin period:
130 TC, 22 HDL, 83 LDL, 125 TG
My TC was below 150 and a few months later my short-term memory did not function.

Since my most recent total cholesterol reading is 182 (and my 10-year average 186), I’m worried that the rosuvastatin will drive it below 150 against APOE 4/4 advice.

I’ve been doing most of the Bredesen protocol on my own, skipping remedies that I don’t tolerate well, and I think as a result my memory is great right now.

I am looking at eight blood tests for the last 10 years (and my vague memory is that I have always had high triglycerides - genetic?): Readings are consistently similar, through bad diet and good diet, no change with age. I have a terrible TG/HDL ratio.

Omitting the pravastatin outlier, so 7 tests
Cholesterol
Range 172-228, only one reading above 200.
Average 186

HDL
Range 22-38
Average 31

LDL
Range 93-109
Average 95

Trigylcerides
Range 181-400, all over 170
Average 299

Through nursing error I had a nonfasting blood test in June 3, 2018
155 TC, 34 HDL, 92 LDL, 144 TG
A fasting blood test on June 15, 2018 was quite different.
182 TC, 22 HDL, 109 LDL, 257 TG
Does that discrepancy mean anything?

Thanks in advance for your help.

User avatar
Julie G
Mod
Mod
Posts: 8315
Joined: Sat Oct 26, 2013 6:36 pm

Re: Help understanding my lipid profile and statin choices?

Postby Julie G » Sun Mar 17, 2019 4:51 pm

You're not alone with the cognitive issues on lipid lowering therapy, blade! A handful of other 4/4s on the site have reported the same. As you know, adverse cognitive events are also listed in the FDA safety warnings with all statins. Lipitor is a lipophilic statin whereas pravastatin is hydrophilic; meaning it supposedly can't cross the BBB and affect the CNS pool of cholesterol. Given that you had such a bad reaction to a hydrophilic statin with every other day dosing, I'd be very hesitant to try again. Were you on a particularly high dose?

That said, I understand why your physician is concerned. You have two risk factors (hypertension & T2D) that do increase your risk for heart disease and as you noted, your ratios aren't great. It's been broadly theorized that the beneficial mechanism of action for statins is primarily through an anti-inflammatory effect which makes me wonder how you can lower inflammation through lifestyle. An A1c of 5.7 is still pre-diabetic. Are you eating grains and starchy carbs? I ask as your TGs are also pretty elevated. I've seen multiple members knock them down from 1,000+ to below 100 with dietary changes. There are also so many foods that powerfully upregulate nitric oxide and help maintain a healthy BP: arugula, cilantro, butter leaf lettuce, mesclun greens, basil, beet greens, oak leaf lettuce, and swiss chard. You might consider switching out some of your starchy carbs for some nitric oxide boosting greens. How are you doing with exercise? That helps tremendously with blood pressure and stress and it raises HDL. Avocado helps there too and it decreases LDL-P.

Based on your past experience, I'm proud of you for pushing back on the statin suggestion, blade. I suspect that you could improve your risk factor with some lifestyle interventions. Let us know what you decide to do.

JudyH
Contributor
Contributor
Posts: 48
Joined: Thu Dec 27, 2018 4:30 pm

Re: Help understanding my lipid profile and statin choices?

Postby JudyH » Sun Mar 17, 2019 8:05 pm

I am no expert on any of this so take my thoughts with a grain of thought.

I am 58 and have used statins for 18 years (very early heart disease/death in my family at the age of 42 years). I have taken Lipitor, then Simvastatin for years and recently back to generic Lipitor.

I would not take statins if I had cognitive side effects. Although initially, as a 40 year old woman, I had a few weeks of muscle pain, that was my only issue with statins. I have no side effects now, almost 2 decades later.

Even on a statin, my triglycerides are high now and my A1C and fasting glucose have just crossed the upper limit and make me prediabetic. This is new for me in the last couple of years. In December I learned of my e3/e4 status and decided to start down the road of dietary changes to help mitigate my risks. Working on insulin resistance and trying to limit my added sugar has been my first step. I am due for blood work now and will probably get that in early April. Down about 6 lbs and 1.5" in the waist so I am curious to see if it has impacted my TG and glucose numbers.

Right now I am not dropping my statin, CAD is my greatest risk and I need to prioritize that over AD. But as I learn more and get more biomarkers that help me understand my risks of both, that might change.
e3/e4
No family history of AD, they drop dead of heart attacks in their early 40's!
Celiac and Hashimotos

NewRon
Senior Contributor
Senior Contributor
Posts: 322
Joined: Fri Nov 07, 2014 3:04 am

Re: Help understanding my lipid profile and statin choices?

Postby NewRon » Mon Mar 18, 2019 4:14 am

My doctor told me that statins can cause diabetes.
Apo E4/E4, Male, Age 56

Fiver
Senior Contributor
Senior Contributor
Posts: 526
Joined: Wed Feb 01, 2017 12:51 pm

Re: Help understanding my lipid profile and statin choices?

Postby Fiver » Mon Mar 18, 2019 9:41 am

Having gone through something similar I'd recommend finding a really good cardiologist who specializes ins lipids. It's a complex issue and it really helps to have a knowledgeble doctor who will spend time with you. There are options beyond statins, including dietary changes and other medications. I'd recommend asking around and finding someone who will take time with you and develop a plan that works for you. I've tolerated some side effect to stay on a statin but I wouldn't ever tolerate the side effects you mentioned. So sorry you went through those scary side effects. :?
Four relatives with AD. Concerned, but hopeful. Introverted, but will talk about science.

cflegal
Contributor
Contributor
Posts: 46
Joined: Sun Nov 18, 2018 11:08 am
Location: Santa Rosa, CA

Re: Help understanding my lipid profile and statin choices?

Postby cflegal » Mon Mar 18, 2019 10:50 am

Both my GP and cardiologist have recently suggested that I start rosuvastatin (Crestor) even though I do not present any problems in need of correction. I am intrigued by the suggestion that statins can delay dementia since I am 77 and have Alzheimer's. But I am put off by the suggestion that statins can impact memory. A 2018 review "The Role of Statins in Both Cognitive Impairment and Protection Against Dementia: a Tale of Two Mechanisms" is extremely on the fence. I will wait awhile to gather more input before deciding one way or the other.

mike
Senior Contributor
Senior Contributor
Posts: 588
Joined: Fri Mar 09, 2018 4:55 pm
Location: CA - Sonoma County

Re: Help understanding my lipid profile and statin choices?

Postby mike » Mon Mar 18, 2019 1:49 pm

I read a meta analysis a few years back, and they said that they could only find benefit in taking stains for a small subgroup - older men who had already had a cardio event and who had pattern B Cholesterol. I'll try to find the reference.
Sonoma Mike
4/4

Fiver
Senior Contributor
Senior Contributor
Posts: 526
Joined: Wed Feb 01, 2017 12:51 pm

Re: Help understanding my lipid profile and statin choices?

Postby Fiver » Mon Mar 18, 2019 2:24 pm

My readings have led me to the some conclusion - there is either no AD risk reduction from statins or a small risk reduction, in some subsets of patients, if taken for many years. cflegal, sending good thoughts your way. You're asking good questions.
Four relatives with AD. Concerned, but hopeful. Introverted, but will talk about science.

mike
Senior Contributor
Senior Contributor
Posts: 588
Joined: Fri Mar 09, 2018 4:55 pm
Location: CA - Sonoma County

Re: Help understanding my lipid profile and statin choices?

Postby mike » Mon Mar 18, 2019 2:54 pm

Just did another search, and the results seem to be all over the place. For AD, I've also seen both plus and negative. From a personal perspective, I've always been suspect of drugs that can improve test results, without going after the root problem.
Sonoma Mike
4/4

SoCalGuy
Senior Contributor
Senior Contributor
Posts: 62
Joined: Tue Sep 25, 2018 4:41 pm

Re: Help understanding my lipid profile and statin choices?

Postby SoCalGuy » Mon Mar 18, 2019 5:45 pm

bladedmind wrote:I’m looking for authoritative documentation of Dr. Bredesen’s advice not to lower total cholesterol below 150. I’ve read the wiki entry on lipids several times. I need evidence for my cardiologist.

I’m 69 year old male, APOE 4/4, controlled hypertension, controlled T2D (H1Bac always 5.7), eating low carb (not keto), moderate protein, high good-fat diet. No heart attacks among mother (died at 93 with full mental faculties), father (died at 89 after several years of congestive heart disease and alzheimer’s), nor in two living brothers 10 and 14 years older (no Alzheimer’s either).

I had acute pericarditis 12 months ago and they saw a small lesion - not sure what that means. I had a cardiac stress test six months later and passed with flying colors - better than age.

In 2002 I tried Lipitor for a few months and ended up confused, fatigued, and depressed. Slowly recovered after quitting. In late 2017 because of physician pressure I tried pravastatin every other day. One day a few months later I was wandering around in my house and was able to figure out that my short-term memory had vanished - persistently I could not remember what I was doing or compose complex, linked thoughts. So I quit again and it took about six weeks to get back to baseline. Now, despite this history, the heart doctor wants me to go on rosuvastatin every other day, and I am afraid because I do complex intellectual work.

I do have one blood reading from the pravastatin period:
130 TC, 22 HDL, 83 LDL, 125 TG
My TC was below 150 and a few months later my short-term memory did not function.

Since my most recent total cholesterol reading is 182 (and my 10-year average 186), I’m worried that the rosuvastatin will drive it below 150 against APOE 4/4 advice.

I’ve been doing most of the Bredesen protocol on my own, skipping remedies that I don’t tolerate well, and I think as a result my memory is great right now.

I am looking at eight blood tests for the last 10 years (and my vague memory is that I have always had high triglycerides - genetic?): Readings are consistently similar, through bad diet and good diet, no change with age. I have a terrible TG/HDL ratio.

Omitting the pravastatin outlier, so 7 tests
Cholesterol
Range 172-228, only one reading above 200.
Average 186

HDL
Range 22-38
Average 31

LDL
Range 93-109
Average 95

Trigylcerides
Range 181-400, all over 170
Average 299

Through nursing error I had a nonfasting blood test in June 3, 2018
155 TC, 34 HDL, 92 LDL, 144 TG
A fasting blood test on June 15, 2018 was quite different.
182 TC, 22 HDL, 109 LDL, 257 TG
Does that discrepancy mean anything?

Thanks in advance for your help.


Tom Dayspring is one of the leading lipidologists in the United States and he says that if you experience cognitive decline then you should not take the statin. If you are interested in delving further into this topic he has a 5 part podcast series with Peter Attia that I would highly recommend. Link: https://peterattiamd.com/tomdayspring1/

From my notes it looks like fenofibrates are good for people with low HDL and high triglycerides. So you may want to research that and discuss with your doctor. Also, for people who cannot use statins it seems like they are candidates for PCSK9 inhibitors. They are pricey but you may be able to get insurance to offset or cover the cost.

Good luck! The Peter Attia podcast is an investment of time but there are also show notes which may prove helpful as a starting point.


Return to “Our Stories”

Who is online

Users browsing this forum: No registered users and 6 guests