My overall cholesterol has recently increased (9.2 mmol/L), although my HDL remains high at 2.88 mmol/L. The jury seems to be out on whether high HDL levels are of benefit in combatting high LDL levels. My GP wants me to go on statins. I had hoped to continue trying to mitigate the high overall and LDL levels through diet and exercise, but I get the feeling it might be time for statins.
I came acoss this article which seems to suggest that simvastatin in particular can enhance the effects of enzalutamide. Should I cheerfully now capitulate, show my GP the article, and ask to go on simvastatin?
Congrats ! It can be amazing when you can assist in your own health benefits. The first rule of medicine should be do no harm. My wife and brother in law had to get off statins due to complications Might add that was after being placed on several types over time. Now proper diet a few supplements and detox and managing good gut microbiome all good.
Tricky question. I signed up for the Care oncology clinic (COC) protocol which I pay for every 3-months. One of the repurposed drugs is Atorvastatin. I've been almost 3 years on Enzalutamide and over 2 years on a statin. No idea if it helps but I felt the need to throw a number of extra repurposed drugs and supplements into the mix and so far so good. Good luck.
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If you can read this and make sense of it you are much better than me. It still does not answer the number you need to treat to get a benefit. If you take 1,000 people and the heat attack rate without statins is 2 and with statins 1, then it wouldn't be wrong to say stains lessen heart attacks 50%.
Statins significantly reduced mortality by 8%, stroke by 22%, and myocardial infarction by 33%. If you don't find that convincing, nothing will convince you.
Data is data. There is no such thing as "old data." The journal articles you discredit were from sources like Lancet, JAMA, NEJM, Circulation, BMJ, Am. Heart J., etc.
Well, there have been updates since 2010. One in 2016, and the most recent last year. The USPSTF updates its own data, you should too. "To update its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a review of the evidence on the benefits and harms of statins for reducing CVD-related morbidity or mortality or all-cause mortality."
LDL and TC alone are not a good indication of cardiovascular risk. Ratios such as TC/HDL (<5) and TG/HDL (<2) and other markers such as APO-B and Lp(a) have stronger correlation to CVD than LDL and TC. To get a picture of your current CV health, get the CAC and CIMT tests. Before starting a statin, try diet and exercise. Don't rely on a GP for advice on statins, see a lipidologist.
Thanks, I know of those ratios and they're both favourable in my case because of my (very) high HDL level. In fact 3.2 and 0.52 respectively. However, I read somewhere that current thinking is that high HDL only works against CVD up to a certain level, i.e. below mine. My diet and exercise regimes are being improved, so I'm still reluctant to start statins just yet.
Then of course there are other things than CVD to consider, viz. the potential benefits of lowering cholesterol for helping to control PCa.
Im with you on that, CAC and CIMT test are what tou need, better than just LDL numbers, and high HDL helps to have a good ratio between HDL and LDL, its oxidised LDL which is the bad LDL,i agree with you timotur, don't reley GP advice
I would do further testing by checking your risk for a cardiac event with the CIMT and CAC tests. Your ratios are pretty good. TC/HDL = 230/65 = 3.5 (upper limit = 5), and HDL/TG = 90/65 = 1.4 (UL = 2). Also check your APO-B. What about diet and exercise?
Do you want to know the #1 killer of men with PCa? Heart disease. My system is to exercise daily and be sure to eat enough protein for muscle maintenance, take care of my bone density, take my Atorvastatin, etc. My cholesterol numbers are on the low side of normal, BP is great, blood sugar is great, I'm a little heavier with a gut that won't go away... I think that when we are on ADT for a long time, when things go wrong in our bodies they go wrong a lot faster and bouncing back is a very steep uphill proposition.
The best evidence now is that it is the number of atherosclerotic particles that determines CVD risk rather than absolute lipid levels-- this is measured by APO-B, a protein on all LDL particles from VLDL down to small size LDL. A good APO-B number is < 90 (or some say even less), so I would check that to corroborate your good cholesterol ratios. If your APO-B is within range, it just means your LDL particles are larger (and therefore fewer in number), which is a good sign. HDL is less of an indicator for CVD risk as long as it's within range.
Since several studies indicate statins may inhibit mTOR signaling, it may be worth considering.. cedars-sinai.edu/research/n...
I see statins as another possible tool in the toolbox. I guess it comes down to the SE's of statins vs the protective benefit against PCa. I'm choosing not to go on statins for now, and instead, concentrate on keeping insulin levels in check through diet/exercise to limit insulin signaling in the IGF-1 pathway. ncbi.nlm.nih.gov/pmc/articl...
What that cedar-sinai link indicates is impressive. A statin + ezitimibe lowers cholesterol greatly, with lowering of mTORC2 and enabling CD8+ immune cells to invade prostate cancer tumor cells and reduce their growth.Probably clinches the case to add ezitimibe to my statin.
Yes, I am seeing a lipidologist and will discuss using ezetimibe as I am an "under-absorber" of cholesterol, as opposed to an "over-producer", as shown by a test I did from Boston Health-- the "cholesterol-balance-test".
But am inclined to simply take ezetimibe and/or acarbose and see what happens to my APO-B. It´s 65 now down from 86 before statin therapy, but around 30 or less is thought to be the best. A bigger worry is my high lp(a) for which I believe CoQ10 and tocotrienols has the the best potential, besides the expensive PCSK9 inhibitor.
The Cholesterol Balance test was $100, and I had to do the blood draw at a local lab that packed it in ice and sent it to Boston (non-Quest/LabCorp). [Be sure to take your test requistion with you for the draw.] Here is some info about the test.
In my case, since I am not an over-producer of cholesterol, a statin likely would not be a benefit in reducing LDL.
My understanding of of Lp(a) is it's genetically determined and there's not much you can do about it, but is good to know as another factor that determines your CVD risk. APO-B on the other hand can be modified through diet/exercise as you've done, and it appears to be the best predictor of CVD (although there are some who say LDL particle size is more determinant). [APO-B is a marker on all LDL particles regardless of size.]
Lp(a) levels are ≈70% to ≥90% genetically determined. The KIV2 copy number variant is inversely related to the Lp(a) concentration and is estimated to associate with 19% to 69% of interindividual heterogeneity in Lp(a) concentrations.34 In addition, numerous single nucleotide polymorphisms (SNPs) in the LPA locus strongly associate with Lp(a) levels.16 Although some are in linkage disequilibrium with the KIV2 copy number variant, SNPs independently associated with both high and low levels of Lp(a) have been reported.
A HDL of 2.88mmol/L isn’t ‘very’ high, and the so called protective quality of a high ratio is old medicine anyway. Agree that other numbers give a more complete picture, but your total isn’t that high either.
Still, I am with those who recommend statins for every older man, especially those on ADT drugs, for whom death from CVD dwarfs all other causes.
Men diagnosed with high LDL tend to want to lower themselves through ‘improving’ their diet and exercise regimes’ as you stated. This usually only works if you more sedentary and carrying substantial extra fat, and it’s still quite challenging.
What is your cardiovascular fitness? Have you had a calcium scan of your heart? What is your VO2 max, your maximum heart rate, 1 minute heart rate recovery, resting pulse? Have you had a Dexa scan lately? Body composition matters.
Most guys are not nearly as fit as they think they are. The folklore around statin side effects far exceeds the reality, and they work.
Some time ago our GP asked if I woud consider taking statins...... though other than age, there seemed to be little other reason for such a prescription. Perhaps GP thought my several unexplained fainting episodes justified a prescription. Now you've piqued my interest...maybe I'll look for some stats on SEs.
I think that’s a good idea. Testimonials on drug SE’s are mostly negative, which is understandable but often misleading.
I can’t think of a better example of this than statins. Statistically something like 40 million take them, with 10% reporting side effects. Mostly muscle weakness and aching, which can be mitigated by switching statin drug, altering the dose etc.
A lot of loud warnings about statins are from proponents of ‘pseudoscience’ and their followers. Many complaints are from people who have never even taken them. Folklore of this kind abounds but isn’t helpful.
What we know for sure is that beyond any other benefits statins provide, they are an incredibly effective front line defense against the cause of mortality that dwarfs all others. Those on ADT drugs have an even higher risk of course.
Pca kills about 34,000 men year in the US, heart disease 385,000.
Thanks.....I spend wya too much time on Google, but I'll make a time-limited effort to find some studies on life expectancy enhancements for men who take statins for x years.....also some stats on the SEs. With the resources patients have at hand today, I try to practice " trust but verify" whwn it comes to Doc advice!! Of course, for many questions, there are no direct studies...then it is "trust or not' .
I've had no specialist scans or measurements (this is the UK and the NHS), and I don't have any CV issues I know of However, I do track my all my activities on my Garmin Forerunner (via chest strap monitor and Garmin Connect). Over the last six months my average resting HR is 52, average high 125, and I generally peak at around 165 during cardio workouts at the gym. My VO2 max is 39.
I also have a great ratio with high HDL but still have LDL a bit high and also family history of heart issues. Don’t be too concerned with statin side effects. I’m on a mild dose of pravastatin. 20 mg per day. Absolutely no side effects and cost is extremely low. Been on this maybe 2 years, starting before my cancer diagnosis. At most recent oncologist visit they said good possibility I will die of something else before PC gets me but I’m only 64 so don’t want that too soon …
I’ve been taking statins for 20+ years. Snuffy Myers was a proponent for using statins to keep LDL levels low. LDL is converted to DHT to fuel prostate cancer when testosterone is being suppressed by Lupron (per Snuffy). Rosuvastatin (Crestor) is the correct one per Snuffy, it doesn’t interfere with ADT drugs like some other statins do. He had me switch from Simvastatin when I started seeing him when I was first diagnosed. I’ve stayed with all of his protocols over the past 9+ years. I currently see Dr. Sartor as my PCa specialist since Snuffy’s retirement, he hasn’t had me change a thing Snuffy prescribed.
Suggest you read and take a copy of "The Great Cholesterol Myth" to your Cardiologist. You should also search out YouTube Cardiologist discussing Statins and how they are pushed by Big Pharma, doctors get kickbacks. Take a look at David Diamond's (USF) lectures to a group of cardiologist, impressive talk and research.
It's stated a better indication of your heart health is by diving HDL into triglycerides levels, 2 or under ratio is good. My level went from a high of 5-1 down to 2.1 to 1, it takes some small changes but feeling "Mucho" better without the leg pain Statins had caused.
Thank you very much for sending along that article. Very valuable information. I’ve been taking Rosuvastatin/Crestor for 15 years, 20mg per day. My GFR is stable at +/- 90 and my creatinine goes between 0.85 and 0.95, typically. So, no apparent kidney issues. I will, however, ask my cardiologist about this issue you’ve raised. I’ve tried other statins but Rosuvastatin is the only one that didn’t result in uncomfortable side effects.
You are not on the 40mg high dose so may not be as much an issue. My wife was on the 40mg and I was on 20mg. Docs don't (cant) keep up with latest so I always do. Since she was switching, I went ahead and switched also. Atorvastatin.
In my experience over the last 30 years or so they have really helped me. Started on 40 mg of Atorvastatin I am now down to 20 mg. Since my cancer diagnosis I have wondered if it had lowered my PSA overall those years and it never rose to height a problem. But who knows!
This may achieve some blowback but over the last15 years I have cut my 40 mg in half and saved money. Also I have improved my diet with more veggies and fruit and much less red meat.
as always I encourage everyone to read and educate themselves before making any decisions about your health
Along with the books Gatun suggested I mention a few others: the dark side of statins, the cholesterol con and what does cholesterol really do
If you decide to take a statin, side effects can be reduced or stopped by the addition of resveratrol,metformin, berberine, fish oil and vitamin D. I have seen a few clients that have a fear of statins when compared to what chemotherapy entails
As a nutritionist I still think combining nutrients with drugs is advantageous but as always it’s your body your choice 💜💜💜
I've avoided statins for years. Read a lot about sound arguments for and against statins. My LDL has always been a bit over the reference range, but HDL, chol/HDL ratio and triglycerides have always been good. Diet, exercise, and a strict 6 month protocol of intermittent fasting (6 hr "feeding" window) have not had any affect on LDL. Lots of cardio raises my HDL, but baseline is still within reference range. It seems pretty clear that LDL in my case is genetic.
During a recent PSMA scan calcification was incidentally noticed in of my main arteries. I easily went through a subsequent stress test with the cardiologist, with a perfectly normal ECG. Cardiologist said being a male and aging were the biggest culprits in calcification, but the extent (quantification) of the calcification was unknown. My cardio-respiratory subjectively (and doing physical activities) is great.
My father, in addition to having PCA had a heart attack (he was thin) and my older brother had a heart attack (he got fat over the years). Years ago while running I believe I felt a piece of plaque break off and rush through the bloodstream. Recent research indicates statins increase calcification, but in a good way in that plaques become more stable and less likely to break off and clog something that you don't want clogged like your heart.
Given all this info, I finally relented and recently started on the recommended low dose Rosuvastatin (5 mg). In my case I'm thinking that maybe statins help with PCA (hopefully!), but the plaque issue and genetics justifies its use. I'm getting my next lipids and liver tests next week to see what effects there are, but at least no side effects that I am aware of.
Don't fear the statin. Most people will not have notable side effects with a common statin, and if you do there is the Tall Allen path to pitavastatin.
I couldn't tolerate simvastatin. Had to switch to atorvastatin. I take omeprazole for GERD/heartburn. The simvastin effectively negated the effect of omeprazole.
Corect me if I am wrong, but as I remeber the study, beside 1000mg Metformin, it was 20 mg of statins daily? I use it that way for more than 2 years (along with Xtandi).
Vilifying cholesterol was necessary before statins or any other cholesterol blockers/reducers could be marketed. that job was performed by a study in the 50s by Ancel Keys. Total scientific fraud, selective use of data to goal-seek. This article may be of interest - beleanforlifecoach.com › the-truth-about-ancel-keys-weve-all-got-it-wrong
All this blather about possible statin SE's seems to miss the barreling semi in the room -- prostate cancer and our extra vulnerability to heart disease due to PCa treatments.
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