I guess I'll be taking a statin

[PSu82537%a6r_dnz]

The trouble is I can't see myself walking in to my doctor's office and acting like I know more about this than he does. I can't see how it would come across any other way.

WhatNext

It could very well be literally true that you do know more about this than your doctor. Not that it will do you any good to point it out, but facts are facts. I had an experience where my designated primary care provider doubled my statins, from 40 mg to 80 mg as a knee-jerk reaction to a very mildly elevated cholesterol number. Even my cardiologist sort of shrugged at that, seeming to suggest that he would not have done that, but he went along with the PCP because it is very important to him (the cardiologist) to make the point that PCPs are responsible for monitoring and controlling cholesterol, not him (the cardiologist). I also went along with it, for awhile, but it bothered me, so I consulted with a nurse practitioner who was happy to listen to my concerns and worked with me to lower the statins to 20 mg and review lab results that show this is a good level for me. Many medical practices include a nurse practitioner, and I have always found that they are much better listeners than MDs, are more open to patient input into decisions, and generally just better doctors. Clearly there are exceptions, but that has been my experience. If you have that option in your medical care situation, you might want to check it out.


Best of Luck to you.

[Julie G]

Hi Julie, thanks for responding. It turns out the test results did include 2 additional numbers. On the most recent test vldl was 11 and triglycerides were 54. I don't know what they were on the previous test. I'd need to order a test from LabCorps and pay out of pocket to get any other results, which I'm seriously considering doing. The last time I did was October 2017. My fasting glucose was 77. My test didn't include hbA1c unless it's called something else. My insulin Resistance score, LP-IR was <25. My diet hasn't changed.

No signs of insulin resistance and your TG:HDL ratio at 0.7 is optimal. I think having a coronary calcium scan done would be very instructive. Do you have a strong family history of heart disease?

[MarcR]

I think if I have ANY side effects from the Zetia I'll print this out and take it to my doctor.

How will you know in time? Some side effects are not felt until they cause irreparable damage. For example, the side effects of glyphosate (Roundup) exposure may include non-Hodgkin lymphoma.

Nutritional guidelines favoring processed foods (especially seed oils) and a medical standard of care favoring everyday consumption of pharmaceutical products (e.g. statins and ezetimibe, antidepressants, proton pump inhibitors) have coincided with an explosion of chronic disease. In a world gone mad, profoundly corrupted by profit-seeking corporations, the sane response might be to do the opposite of what your doctor recommends.

Your numbers look great to me - no sign of insulin resistance, which I believe to be the root cause of most chronic disease. I recommend that you trust your amazing and unfathomably subtle and complex body to continue to operate itself.

For a deeper dive into the inverse relationship between LDL and mortality, I recommend this post.

[donbob]

I agree with the "coronary artery calcium scan" posters. I was pressed by my doctor to start a statin. My CAC scan was 19 at age 70. Like you, my TRI/HDL was less than 1.

[chrissyr]

I actually had a positive impression about Zetia when compared to a statin-- that for many of us it may be better to block absorption rather than impeding production. I'll have to do some more reading or listening about the potential negatives.

[slacker]

I don't think that there is consistent evidence that Zetia saves lives. Here is a 2018 meta-analysis from Cochrane Database on the subject. The abstract summary concludes:

Moderate- to high-quality evidence suggests that ezetimibe has modest beneficial effects on the risk of CVD endpoints, primarily driven by a reduction in non-fatal MI and non-fatal stroke, but it has little or no effect on clinical fatal endpoints. The cardiovascular benefit of ezetimibe might involve the reduction of LDL-C, total cholesterol and triglycerides. There is insufficient evidence to determine whether ezetimibe increases the risk of adverse events due to the low and very low quality of the evidence. The evidence for beneficial effects was mainly obtained from individuals with established atherosclerotic cardiovascular disease (ASCVD, predominantly with acute coronary syndrome) administered ezetimibe plus statins. However, there is limited evidence regarding the role of ezetimibe in primary prevention and the effects of ezetimibe monotherapy in the prevention of CVD, and these topics thus requires further investigation.

[WhatNext]

How will you know in time? Some side effects are not felt until they cause irreparable damage. For example, the side effects of glyphosate (Roundup) exposure may include non-Hodgkin lymphoma.

...

Your numbers look great to me - no sign of insulin resistance, which I believe to be the root cause of most chronic disease. I recommend that you trust your amazing and unfathomably subtle and complex body to continue to operate itself.

For a deeper dive into the inverse relationship between LDL and mortality, I recommend this post.

Good question!! Day 1, so far no side-effects, haha (think very weak laughter).

Thank you for the link. Maybe I'll take this with me when I go back for a follow-up appointment in 2 months. I expect an argument though and it's one I can't win. I think I'll also have more complete blood-work done than he prescribed and take that with me too. He doesn't prescribe anything that insurance won't pay for.

[WhatNext]

Hi Donbob, thanks for the response.

I agree with the "coronary artery calcium scan" posters. I was pressed by my doctor to start a statin. My CAC scan was 19 at age 70. Like you, my TRI/HDL was less than 1.

If my doctor doesn't accept more complete blood-work as sufficient evidence that I don't have heart disease I'll suggest this. I know he won't suggest it himself because based on a quick Google search today most insurance companies won't pay for it.

WhatNext

[donbob]

My insurance doesn’t pay. However, it is the best $150 I have spent lately. The peace of mind and factual “brick and mortar” aspect make it very valuable. The ability to repeat the scan in a few years to see if lifestyle is holding the line on artery health has utility. Best wishes.

[WhatNext]

I actually had a positive impression about Zetia when compared to a statin-- that for many of us it may be better to block absorption rather than impeding production. I'll have to do some more reading or listening about the potential negatives.

Hi Chrissy,
It does sound like a better approach although I'd like to know how it works. I'm leery of anything that affects digestion because I have something like 20 genetic markers for Crohn's disease. I don't have it but I'm worried about something getting tripped that would set off a downward spiral.
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