Ezetimibe & High ApoB & Cholesterol

[V_afp]

Hello. I'm 44 year old vegetarian woman.

Lipidologist has prescribed ezetimibe due to high ApoB & because I can't take statins.

Why have I got high Apob? It not FHC genes.

My family can't tolerate statins and I'm v v sensitive to medications.

I'm nervous of starting the ezetimibe and the effects and consequencesof lowering cholesterol in my body and brain.

Was fit & healthy up to 2020 but always had borderline high cholesterol since my 20s & hypothyroid and low vit D until 2013.My cholesterol has crept up gradually - even after having to cut out eggs and dairy due to allergy & eating a really clean healthy diet. No coconut/ palm / seed oil. Only olive oil. No hydrogenated fats. No avocado as intolerance.

The last few years after alot of stress & illness cholesterol jumped to 8. With high ldl & low hdl ( hdl used to be sky high).

Having seen a fab lipidologist we've ruled out genetic famial hypercholesterimia. My apob is v high as is LDL low ApoA. I've had the ct scan & calcium test and amazingly heart & arteries look clean of plaques.

He said diet / thyroid meds / exercise won't change the high Apob and I'm at risk of cvd given its in my close family and both grandparents died of heart attack in their 60s.

Why have I got high Apob and if its not genetic why the high chol esp after clean diet & fitness most of my life?

Will exercise help at all?

Can I get the apob down naturally with things like garlic and artichoke capsules?

Has anybody got any stories of taking ezetimibe??

Being 44 now I don't really want to be on a drug for what could be decades ahead if I'm lucky if I can avoid it.

Are there any examples of people having high chol and apob and being OK with no cvd?

What about this injection to lower cholesterol?

Thank you xxxx

[sandandkev]

Ezetimibe is not a statin! It is god to reduce cholesterol,I took it but found it makes me tired,but you could try it but keep in mind that if you feel really tired it's probably that

[V_afp in reply to sandandkev]

Yes correct - he's prescribed it because I can't take statins. I'm still nervous of it as I'm chronically ill and have m.e. too. Xx

[sandandkev in reply to V_afp]

And that alone gives you fatigue,all you can do is try it,but if makes you feel worse then stop

[fatbarry]

Hmmm, intriguing. I guess the lipidologist went through your diet thoroughly in relation to saturated fats (coconut oil etc)? I can only give my personal experience that since using only olive oil for cooking rather than sunflower and eating ground linseed and whole chia seeds 3 or 4 times a week (20-40g each time) my LDL has fallen and HDL risen considerably. How much do you exercise? That seems the easiest place to start, as you've hinted - walking (especially in the daylight outdoors if you can), simple bodyweight exercises, yoga.

Let us know how it goes xx

[V_afp in reply to fatbarry]

The only oil I consume is olive oil - no seed oils or saturated fats. No coconut oil - no hydrogenated fats - no palm oil - can't tolerate avocado etc xx

I'm allergic to linseed and chia.

I've been sedentary for 4 years as chronically ill but had high cholesterol for 20 years xx

[David-66]

I had a heart attack 7 weeks ago, due to a blocked artery. Cholesterol was just over 5 and BP high. After having a stent fitted I was put on a cocktail of drugs, including Ezetimibe, after 5 weeks my Cholesterol levels were great. All I can say is give the Ezetimibe a go for a while then have bloods checked again. You might feel tired, but it’s a little sacrifice to get you Cholesterol down.

[V_afp in reply to David-66]

Thank you so much and wish you a speedy & long recovery xx

[Pepperthedog]

Hi - Ezetimibe is more expensive than statins, so it's not given as a first line medication on the NHS. I too react badly to many medications: unable to tolerate statins for high cholesterol - they caused severe muscle meltdown and proteinuria - I've been taking Ezetimibe for decades; it's lowered the cholesterol and hasn't caused any obvious side effects. I do get tired but at the age of 80, that's not too surprising!

[V_afp in reply to Pepperthedog]

Ah that's fantastic to read - thank you xxx

[Lowerfield_no_more]

I have very high cholesterol and have taken a statin for 25 years and am now on the max dose. Last year I added ezetimibe to the statin since the statin alone was not quite up to the job on its own, and the ezetimibe has made a noticeable improvement and I now have a lipid profile I am happy with. Statins and ezetimibe work in different ways in modifying the lipid profile so their effect is cumulative. Anyway I am fortunate in that I do not apparently suffer any side effects from either the statin or ezetimibe nor indeed any of the other meds I take. I certainly do not get any more tired than I expect to be at my age, considering what I do in life, and I didn't notice any change when I started on ezetimibe. My position on adding new medication to what you already take, should the need arise, is you won't know how it will affect you in terms of side effects until you try it. Think glass half full rather than glass half empty. I recommend you trial ezetimibe if you are recommended to take it and if it works as intended you will have then reduced your heart health risk, but if you suffer side effects which affect your quality of life and have to stop, then you can then say that at least you tried.

Otherwise, medication aside, you can reduce your heart health risk by reviewing the 'lifestyle' measures recommended on the BHF webpages, covering diet, exercise, alcohol, smoking and body weight management , which at your relatively young age, will stand you in good stead for the rest of your life.

Finally as far as an Inclisiran injection is concerned, this is only offered to some people (due to cost and necessity) and you have to meet certain criteria before you are offered it.

[V_afp]

Thank you so much. Sounds like great advice. Some of my close relatives have the injection due to statin allergy. I know my cholesterol / Ldl and Apob can't stay high so will ponder a bit more xxxx thank you xxx

[Tiggs876]

hello, your situation sounds very similar to mine. 2 close relatives with heart attacks. My mother died at 48 from hers. High cholesterol since my 20s. It was 8 overall & high LDL when I was referred to hospital lipid clinic. Also high ApoB. Although genetic testing did not confirm FH, I was told that they do not yet know all of the gene markers for FH & that I fit the criteria for FH. I have very mild plaque in one artery on scan. Statin intolerant. I’ve always had a good diet (cooking from scratch/avoid junk food); kept myself fit. I’m now in my late 60s & menopause hasn’t helped my cholesterol numbers.

I can’t take ezetimibe due to gut issues (ezetimibe works in the colon). The lipid clinic prescribed me a newish one a day drug called Bempedoic Acid (Nilemdo) 2 years ago. It’s worked really well for me and my cholesterol numbers are now close to normal, although the clinic want my ldl down to 2.5 due to the family heart attack risk. I have had no side effects and will happily take it for the rest of my life as it’s doing a good job.

The NHS have a protocol, if a statin is not suitable for you; next in line is ezetimibe; if that doesn’t suit you Bempedoic Acid can be prescribed (not sure if you need to be sent to a Lipid Clinic for this). Bempedoic Acid can also be combined with ezetimibe in one tablet (Nustendi).

Inclisiran is injected it’s a PCSK9 inhibitor & my understanding is that it’s prescribed in specific limited circumstances one being that you have had a heart attack.

There are clinical trials taking place for a gene editing drug to reduce high cholesterol which I’m told involves a one off infusion. I’ve recently agreed to being put forward to take part in the trial. That doesn’t mean I’ll be accepted or that if I am I get the drug as they randomly select who gets it and who gets a placebo.

Good luck in finding a treatment that suits you and don’t despair 😊

[JaneBrown55]

I can’t take statins and was given exetimbe but had a severe reaction to it so had to wait for my liver to recover , I’m now on inclisan injections and fine

[Fynndog]

hi V_afp. Sorry if I come across not very savvy. You mentioned effects and consequences of lowered cholesterol in your body and brain.

Being one of the few that have suffered rhabmyolosis brought in by statins , I can no longer take them. I am taking esetimibe but it is not lowering cholesterol sufficiently.

Now I am wondering just what those effects to body and brain might be. I have not heard if any really nasty side effects from exetimibe unless I’m not keeping myself well enough informed.

Its very difficult to know how to deal with this cholesterol problem , having changed my diet and on the whole really trying to keep to it.