I've deep dived on the subject of statins in the past and am reviewing information more recently. There seems to be conflicting evidence depending on the study you look at on whether lypholic (fat soluble: Simvastatin / Atorvastatin) or hydrophilic statins (Rosuvastatin) had the highest potential for lowering the Hazard Ratio for PCa metastases and mortality. There seems to be a larger (but older) body of evidence giving the lyophilic statins the edge (especially in-vitro) yet more recent studies give hydrophilic (specifically Rosuvastatin) the edge.
It's important to note, many of the studies looked at overall mortality for PCa patients which makes it difficult to amass a large body of evidence regarding PCa specific mortality comparisons. As most patients taking stating were probably pre-disposed to cardiac issues and weren't taking statins for PCa benefits. So the newer evidence showing the edge to the newer hydrophilic statins may be showing more of a benefit in cardiac-related death prevention than death related to PCa (in my opinion)
I'm wondering if anyone has discussed the subject with their Oncologist in recent years in deciding which form of statins to take? I would guess a lot of people base their decision primarily on minimizing side effects for achieving a target blood lipid profile as opposed to which statin may lower the PCa mortality Hazard Ratio the most:?
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Personally I am only worried about PCSS. Given my good health and aggressive PCa I'm more concerned with reducing the chance of recurrence and metastatis.
Even with the uncertainty of any effect if the side effects were ok (and hydrophilic seems to have less adverse effects), I'd consider it.
I have an appointment with my onco cardiologist in May and will discuss it then. My LDL is slightly above target range although ratios are good. I doubt most oncologists are even aware of these studies and if they were the evidence is so weak they would not prescribe statins on that basis.
I'd be interested to see the evidence you found in favour of hydrophilic...
We discussed this with Patrick some years ago. IMO Patrick has been the most reliable source of information in this forum. His reasoning is in line with the well known saying: " Black cat - white cat doesn't mater, as long as they catch mice". In our case "mouse catching" is bringing down Triglycerides below 100, 80 being a good value.
Yes, mg/dl as per the Friedewald formula. As you probably already know, total Cholesterol, HDL, LDL, and 3glycerides are interrelated such that if you know the first 3 of them the 4th can be calculated. Mentioned formula gives good results for normal Cholesterol ranges, but there is also a table form that caters for extremities.
Just for your information, statins have no effect what so ever on your triglyceride profile. If you are suffering with high triglyceride's then the advice would be to increase physical activity and supplement with Omega 3 and B3 ( Niacin). Not niacinamide, niacin!
I'm talking a supplement who contains lovastatin ,this is the red yeast rice .Red yeast rice was investigated and it contains moncolin k. Which is structurally the same as lovastatin.
Side effects are lower than taking statins and the supplement does its job lowering cholesterol and his fatty gang.
Due to Lipitor side effects I chose to go with Simvastatin. All done through PCP, not MO. Just talked about importance of taking statin and how it may help with PC. I also read somewhere, back then, that simvastatin worked well with Xtandi.
I recently started Rosuvastatin on a very low dosage. Interestingly it from an Abdominal CT Scan that a bit of calcium was detected on my Coronary artery. My cholesterol and triglyceride levels are and have been fine. My LPa is extremely low. However, I do have a Mitral Prolapse/Regurgitation and my father developed congestive heart failure in his later years. As for PCa, Gleason 9, RP, Salvage Radiation, and off ADT for a bit over 10 months, cancer and PSA undetectable for almost 2 3/4 years. -- My doctors are all in contact with each other and the discussion was to pull cholesterol even lower and to benefit my continued positive outcome regarding PCa. Some studies actually don't show one or the other as better. The evidence shows that it upsets the mevalonate pathway and that is the important part. As with many things, we're all a little different and react differently. Finding the best one for you, with little side effects/impact and effective in the process should be the discussion.
My urologic oncologist and my cardiologist both agree that rosuvastatin is the one for me. I've been on it since 2008 with no side effects and only good results. There is no one size fits all, however, I know men who've had significant side effects from rosuvastatin and others, like me, who are doing fine on it.
I take daily 180mg bempedoic acid, brand name Nilemdo, because the statin I used before was causing muscle pain in my legs.
drugs.com says:
What is bempedoic acid?
Bempedoic acid (brand name Nexletol) is an oral, non-statin, LDL cholesterol-lowering treatment that may be used in adults to:
lower the risk of heart attack and heart procedures (for example stent placement or bypass surgery), in those unable to take recommended statin treatment (a cholesterol-lowering medicine), or are not taking a statin, who:
have known heart disease, or
are at high risk for heart disease but without known heart disease.
reduce low-density lipoprotein (LDL, or bad cholesterol) in those with high blood cholesterol levels (called primary hyperlipidemia), including a type of high blood cholesterol called heterozygous familial hypercholesterolemia (HeFH).
Bempedoic acid should be used along with diet and other cholesterol-lowering medicines, or alone if use with other cholesterol-lowering medicines is not possible.
Bempedoic acid lowers LDL-C levels in the blood and works by blocking an enzyme called adenosine triphosphate-citrate lyase (ACL) that is involved in the production of cholesterol by the liver.
Bempedoic acid was first FDA-approved on February 21, 2020, under the brand name, Nexletol. There is no Nexletol generic.
My wife & I just had a conversation with MO this past Wednesday regarding statins. He advised Atorvastatin or Zetia. For those of you taking Nubeqa, most statins cause problems. It's important to check with pharmacy. Zetia is not a statin & causes NO muscle pain.
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