I always get an Advanced Lipid profile done when I get my semi-annual blood work. I have struggled with my keeping all my lipid numbers ( large and small particle sizes of both good and bad ) for years, I exercise 4 days a week and can’t even get my HDL above 38, but heat when I have my AVR done last year they did checked my arteries and said no signs of issues and not likely going to see any issues for another 30 years. So while my numbers and not good there is something to say for eating decent and exercising to help overcome genetic predispositions. Not to say it is an excuse, but we can only do the best we can with the hand we are dealt.
There was a good show on PBS like 5-10 years ago about Heat Disease by Gary Null, excellent watch. It takes about how statins have adverse side effects and when you take statins you need to be taking CoQ10.
Keith, to follow up on your comment about statins. I do believe that statins help many people, which is supported by many clinical trials. However, I do also believe that many docs are too quick to prescribe statins. If one has had a CVE or if they have heart disease, statins have been shown to reduce events (reduce HR). However, if a person has no heart disease, which would be reflected in a 0 calcium score on a CAC, then it has been shown that statins have no benefit- see study linked here:
https://www.tctmd.com/news/statins-...y Calcium Is Zero, Study Shows,-The study was
Generally, a physician is going to prescribe statins if they detect an elevated LDL. But, if they are following the clinical evidence, the next question should be whether the patient has heart disease. So, get a CAC or a CIMT to determine. CIMT is a little harder to find and measures carotid plaque, but this almost always tracks with coronary plaque.
No heart disease would indicate that the endothelium is still doing its job regardless of the LDL level, so perhaps no need for statins yet, provided the endothelium keeps doing its job.
If heart disease has been detected, or if the patient has had an event, I would argue that it is still not automatic to prescribe statins. They should first check Lp(a) level. If LDL and Lp(a) are both elevated, your doc should consider putting you on a PCSK9-I which lowers both and probably has a better side effect profile than statins. If a person has very high Lp(a) and elevated LDL, it is possible that the reduced HR from statins reducing LDL could be offset by the increased HR from statins increasing Lp(a) and it is even possible, if Lp(a) is high enough, that the hazard ratio is being increased by the statin above the non-treatment level. And it gets a little more complicated than that, because one statin may raise Lp(a) 25% for someone, while another statin might not raise it at all and the dose of the statin can affect how much Lp(a) moves also. So, it really comes down to what I call n=1 medicine or individualized medicine.
In an ideal world, for what it's worth, here is my take on what should be considered by your doctor before statin is prescribed.
1. Confirm there is heart disease or prior event before prescribing statin. This can be done with a CAC or CIMT. We should also add that perhaps one should consider lifestyle changes first before statin, so see if that can get LDL into target range.
2. Confirm Lp(a) is not elevated before statin- it is elevated for 20% of the population.
3. If Lp(a) is also elevated, practice individualized medicine to obtain the lowest hazard ratio by finding the treatment option that lowers LDL to target, but does not impact Lp(a) significantly.
4. If no statin can be found that brings LDL to target and leaves Lp(a) alone, then consider PCSK9-I.
5. Prepare for a battle with your insurance company who will not want to cover the PCSK9-I- they are expensive.
