WhatNext wrote:I had a follow-up appt with my GP yesterday, having been on Zetia for two months. He’d ordered a follow-up cholesterol test and at the same time I had a test for apolipoproteins B and A-1, which I’d bought on Walk-in-Lab. I’d read that the ratio of those two numbers is a better indicator of risk of CVD than LDL cholesterol. My ApoB was “borderline high” at 94: the desirable range is below 90. But my ApoA1 was also high and the ratio was .5, which is lower than the average risk for a woman, which is .6.
I was thinking ApoB correlated with LDL cholesterol and I expected my LDL to still be over 100 -- those results were just sent to the doctor’s office. I figured the doctor would want me to either increase the dose of Zetia or switch to a statin. I’d brought quite a bit of information with me to bolster my case for worrying more about my brain than my heart and not wanting to take a statin, which can interfere with sleep (that would be the side-effect I’d have, if any). I’d decided to tell him I was APOE3/4 and I’d brought a screen-clip of my Promethease report. I’d also brought a few paragraphs from the FoundMyFitness report regarding the reduced activity in the melatonin receptors. I’d also printed the Scandinavian study that found that people my age with no history of diabetes or heart disease did better with higher cholesterol. I’d entered my numbers from the previous visit into a Framingham Heart Risk test and found I have a 1.6% risk of having a heart attack during the next ten years.
As it turned out my LDL cholesterol had dropped from 121 to 88 and he was happy: he said “The Zetia is working.” My HDL was 89: VLDL was 10, TC 187. So the decision I had to make was whether to just keep taking it or try to convince him I didn’t need to worry about cholesterol. I showed him everything I’d brought and he said “I can understand why you’re confused.” I didn’t want him to think I was confused: I wanted him to think I was well-informed. He left it up to me to decide whether to stay on the Zetia or not. I told him the only way I could be sure I have no history of heart disease would be to have a coronary artery calcium scan, but he said the trouble with the scan is that you can’t tell if the calcium is on the interior of the artery or on the outside. He said the only way to know is to have a cardiac catheterization which he would “strongly advise against.” There’s no way I’d do that: it’s an invasive procedure.
So, taking my APOE3/4 status into account and not knowing how that would confound the Scandinavian mortality results, taking my father’s history of quintuple-bypass surgery into account, and the fact that I haven’t always eaten healthy food and I haven’t always exercised, and just not wanting to try to argue with him, which is impossible, I decided to stay on the Zetia. I said “Now I can start eating eggs again: eggs contain choline, which is good for the brain” to which he responded “Too much information.”
I agree with what fiver just said re the calcium score. Yes, you've made bad choices in the past and the CAC test will let you know how consequential those mistakes have been.
But, please take into consideration that for an over 65 woman, with only borderlijne high apoB, there is absolutely no data showing better outcomes for cholesterol lowering. There may instead be data that higher cholesterol might be a little better. Look at this 2019 study of 12 million people (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367420/
According to that, the cholesterol sweet spot at your age is closing in on 230. Your cholesterol looks just fine to me -- without any Zetia.
But not only is the best cholesterol level for not dying controversial, you have below ave risk considering apoA, apoB. And your 10-year Framingham risk is only 1.6%. I think your doctor is at worst, borderline malpractice, and at best, just simply wrong. To top it off, his dismissive TMI response to you was completely uncalled for. In your shoes, I would get another GP.