Chronic low HDL but good LDL (need advice)

[Kralteramon]

Hi guys,

I've just finished a blast of 400mg test 300mg primo 200 deca a week, made some really good gains and felt good throughout until the lethargy crept in at week 16. Did my bloodwork and wasn't surprised to see that my lipid ratio's got worse vs cruise.

I need some insights in what you think regarding my numbers. My HDL as a natural has always been borderline low. However my LDL and trigs are low which is great? I want to understand my risk profile better but I fail to find good information on the impact of just low HDL.

Pre
LDL 103mg/dl
HDL 39mg/dl
Trigs 35mg/dl
Cholesterol 159 mg/dl
Chol/HDL risk 4.1
LDL/HDL risk 2.6

Lp(a) 8.5 mg/dl
ApoA1 41.8 mg/dl
ApoA2 10.2 mg/dl
ApoB 30.5 mg/dl

Blast
LDL 77mg/dl
HDL 21mg/dl
Trigs 52mg/dl
Cholesterol 123mg/dl
Chol/HDL risk 5.9
LDL/HDL risk 3.7

I did not remeasure LPA and apo's because I understand that they don't change much (because mostly genetic). + pretty expensive. Wrong assumption?

By the way my HC has increased from 48 to 54. Docter says it should be fine as long as my hemo doesn't go out of range and iron looks normal. What do you guys think?

 

[b6798045]

ApoB/ApoA1

Apolipoprotein B / Apolipoprotein A1 Ratio - Cleveland HeartLab, Inc.

Order Code: Calculation automatically triggers from ordering both ApoB and ApoA1 (C511) CPT Code: 82172 (x2) ABN Requirement: No Synonyms: ApoB/ApoA1 Ratio Specimen: Serum Volume: 1.0 mL Minimum Volume: 0.5 mL Container: Gel-barrier tube (SST, Tiger Top) Collection: Serum: Collect and label...

www.clevelandheartlab.com

 

[Kralteramon]

ApoB/ApoA1

Apolipoprotein B / Apolipoprotein A1 Ratio - Cleveland HeartLab, Inc.

Order Code: Calculation automatically triggers from ordering both ApoB and ApoA1 (C511) CPT Code: 82172 (x2) ABN Requirement: No Synonyms: ApoB/ApoA1 Ratio Specimen: Serum Volume: 1.0 mL Minimum Volume: 0.5 mL Container: Gel-barrier tube (SST, Tiger Top) Collection: Serum: Collect and label...

www.clevelandheartlab.com

0,72 so that would be low risk for me. However i measured ApoB and A1 on cruise.

 

[b6798045]

It's hard to know what it was on blast.
I would be happy that on cruise is OK.

You can also measure this ratio on next blast, or even the hardcore test:
Subfractions of HDL and LDL

Redirect Notice

 

[Kralteramon]

It's hard to know what it was on blast.
I would be happy that on cruise is OK.

You can also measure this ratio on next blast, or even the hardcore test:
Subfractions of HDL and LDL

Redirect Notice

Thanks bro.

 

[Ghoul]

LDL's not as good as you think it is.

<70 is target for those with risk factors for CV disease; which includes AAS use.

<55 is proven to be best for long term health.

You could get below 55, and boost HDL significantly with Pitavastatin. Unlike other statins this is the only one with an extremely low risk of sides, none in the vast majority, and instead of worsening insulin resistance like every other statin, actually improves it.

 

[Kralteramon]

LDL's not as good as you think it is.

<70 is target for those with risk factors for CV disease; which includes AAS use.

<55 is proven to be best for long term health.

You could get below 55, and boost HDL significantly with Pitavastatin. Unlike other statins this is the only one with an extremely low risk of sides, none in the vast majority, and instead of worsening insulin resistance like every other statin, actually improves it.

Thanks. Taking RYR right now with lovastatin. Will see if I can source Pita or check with my GP, but he probably won't put me on a statin with these numbers.

 

[Photon]

Thanks. Taking RYR right now with lovastatin. Will see if I can source Pita or check with my GP, but he probably won't put me on a statin with these numbers.

I wouldn't go on Pita with your current LDL.
Pita is weaker at lowering LDL.
Maybe looking into adding Ezetimibe and Bempedoic acid instead.

 

[Kralteramon]

I wouldn't go on Pita with your current LDL.
Pita is weaker at lowering LDL.
Maybe looking into adding Ezetimibe and Bempedoic acid instead.

Thank, appreciate it. I'm trying to follow your logic. My LDL went down on RYR which is one of the weaker statins. My HDL is especially low and skewing my HDL/LDL ratio. Wouldn't increasing my HDL with Pita be better in this case + managing my LDL further with Ezetimib? Or do you think that further lowering LDL has more benefits?

 

[Ghoul]

Thanks. Taking RYR right now with lovastatin. Will see if I can source Pita or check with my GP, but he probably won't put me on a statin with these numbers.

Just FYI, and dropping this here in case anyone stumbles on it, Lovastatin is worse by every measure, effectiveness, sides, doesn't boost HDL, etc than Pitavastatin.

The only reason it's ever used it's because it's dirt cheap.

Pita went from a very expensive brand name drug to generic only recently, and many docs aren't familiar with it. Do a comparison online and you'll see for yourself it's clearly superior, not even close.

I cannot find a good reason to use any other statin (other than some offer slightly more LDL reduction in exchange for high risk of sides and worsened insulin resistance - add ezetimebe if you need more reduction).

I have terrific coverage that'll pay for it (especially now that it's much cheaper), and my doc still wouldn't prescribe it because she's clearly unfamiliar.

"Clinician inertia" lol.

India pharma has it.

In the US it's still pricy even as a generic, ~$150 for 90, but I pay $35 from my source. Ironically Zydus is the same manufacturer of the generic I get at the pharmacy.

 

[Photon]

Just FYI, and dropping this here in case anyone stumbles on it, Lovastatin is worse by every measure, effectiveness, sides, doesn't boost HDL, etc than Pitavastatin.

The only reason it's ever used it's because it's dirt cheap.

Pita went from a very expensive brand name drug to generic only recently, and many docs aren't familiar with it. Do a comparison online and you'll see for yourself it's clearly superior, not even close.

I cannot find a good reason to use any other statin (other than some offer slightly more LDL reduction in exchange for high risk of sides and worsened insulin resistance - add ezetimebe if you need more reduction).

I have terrific coverage that'll pay for it (especially now that it's much cheaper), and my doc still wouldn't prescribe it because she's clearly unfamiliar.

"Clinician inertia" lol.

India pharma has it.

In the US it's still pricy even as a generic, ~$150 for 90, but I pay $35 from my source. Ironically Zydus is the same manufacturer of the generic I get at the pharmacy.

View attachment 331502

I just use a telemedicine provider, most insurance will cover the generic.
Without insurance, its $50 for 4mg/90tabs at CostPlus.

Thank, appreciate it. I'm trying to follow your logic. My LDL went down on RYR which is one of the weaker statins. My HDL is especially low and skewing my HDL/LDL ratio. Wouldn't increasing my HDL with Pita be better in this case + managing my LDL further with Ezetimib? Or do you think that further lowering LDL has more benefits?

The primary goal is LDL reduction, followed by HDL maximisation.
That being said, HDL isn't that important, at extremely low LDL values.
I switched from Rosu when my LDL dropped below 30.

Lowering LDL has better clinical benefits, vs increasing HDL.

 

[Kralteramon]

BG Pharma seems to have everything so I'll probably get it from there if my GP or the anabolics clinic (yes this is really a thing here) won't prescribe, seems really cheap. In The Netherlands healthcare providers cover healthcare costs above €400 per year (own risk) so I'd rather get it through my pharmacy and get my bills above €400 for this year so I don't have to pay for anything else on top. Anyway it's still cheap but if you add Telmisartan, Ezetimib, Amlodipine (on my wishlist) & Nebivolol on top it's still quite a substantial amount.

 

[Kralteramon]

I just use a telemedicine provider, most insurance will cover the generic.
Without insurance, its $50 for 4mg/90tabs at CostPlus.



The primary goal is LDL reduction, followed by HDL maximisation.
That being said, HDL isn't that important, at extremely low LDL values.
I switched from Rosu when my LDL dropped below 30.

Lowering LDL has better clinical benefits, vs increasing HDL.

Okay got it. Thanks.

 

[explodingHeart]

Just FYI, and dropping this here in case anyone stumbles on it, Lovastatin is worse by every measure, effectiveness, sides, doesn't boost HDL, etc than Pitavastatin.

The only reason it's ever used it's because it's dirt cheap.

Pita went from a very expensive brand name drug to generic only recently, and many docs aren't familiar with it. Do a comparison online and you'll see for yourself it's clearly superior, not even close.

I cannot find a good reason to use any other statin (other than some offer slightly more LDL reduction in exchange for high risk of sides and worsened insulin resistance - add ezetimebe if you need more reduction).

I have terrific coverage that'll pay for it (especially now that it's much cheaper), and my doc still wouldn't prescribe it because she's clearly unfamiliar.

"Clinician inertia" lol.

India pharma has it.

In the US it's still pricy even as a generic, ~$150 for 90, but I pay $35 from my source. Ironically Zydus is the same manufacturer of the generic I get at the pharmacy.

View attachment 331502

If my LDL is ultra low without even using a statin, should I bother trying to boost HDL? Usually I'm around 31 LDL 25 HDL on 5mg ezitmibe.

 

[Ghoul]

I just use a telemedicine provider, most insurance will cover the generic.
Without insurance, its $50 for 4mg/90tabs at CostPlus.



The primary goal is LDL reduction, followed by HDL maximisation.
That being said, HDL isn't that important, at extremely low LDL values.
I switched from Rosu when my LDL dropped below 30.

Lowering LDL has better clinical benefits, vs increasing HDL.

I agree LDL is the main thing to focus on, but since most won't get their LDL below 55 without a handful of pills and probably Repatha, a good HDL still offers benefits to limit, or even reverse plaque buildup of LDL over 55.

Without getting too deep into the weeds, the other thing about Pita that's a real benefit for us isn't just it's HDL-C boost, up to 15%, but its specific mechanism of action making that potentially much higher for AAS users. I saw a jump over 20%.

AAS crushes HDL because it lowers the expression of APOA-I, the building blocks of HDL. Pitavastatin directly counteracts this restoring the pool of these molecules.

Beyond that, HDL in AAS users is less functional because of steroids impairing HDL efflux, the capacity of HDL to pull cholesterol out of cells in arterial walls. So even a "good" HDL number is deceptive if you're using AAS, and Pita boosts efflux capacity. No studies on AAS users specifically, but in similar "efflux impaired HDL" conditions this benefit has been demonstrated.

Pitavastatin Increases HDL Particles Functionally Preserved with Cholesterol Efflux Capacity and Antioxidative Actions in Dyslipidemic Patients

Access full-text academic articles: J-STAGE is an online platform for Japanese academic journals.

www.jstage.jst.go.jp

 

[Photon]

If my LDL is ultra low without even using a statin, should I bother trying to boost HDL? Usually I'm around 31 LDL 25 HDL on 5mg ezitmibe.

It's common to have low HDL values when LDL is extremely low.
Statins are clinically proven to reduce/stabalise plague, but Eze isn't.
If anything, I would drop Eze and hop on Pita.
Eze 5mg is a weird dose, isn't that half a pill?

Repatha, a good HDL still offers benefits to limit, or even reverse plaque buildup of LDL over 55.

Do you have clinical studies on plague regression/reverse for Repatha, without statins?

 

[explodingHeart]

Eze 5mg is a weird dose, isn't that half a pill?

Cheap dose. Supposedly just as effective.

Statins are clinically proven to reduce/stabalise plague, but Eze isn't.
If anything, I would drop Eze and hop on Pita.

That's a good point. Would I have any plaque at ldl 31 though? But I also guess it reduces inflammation, protects arteries in general, etc.

 

[120nmol]

10mg ezetimbe
10mg rosuvastatin
10 whole eggs a day
5g high quality omega 3 fish oil
Cut any other fats and use butter for cooking

Run bloods after 1 month on this protocol
My hdl was sub 20 ldl towards 100+ (max was almost 500)
Now hdl towards 60 ldl low 30
Just make sure you cutout processed junk food

 

[explodingHeart]

10mg ezetimbe
10mg rosuvastatin
10 whole eggs a day
5g high quality omega 3 fish oil
Cut any other fats and use butter for cooking

Run bloods after 1 month on this protocol
My hdl was sub 20 ldl towards 100+ (max was almost 500)
Now hdl towards 60 ldl low 30
Just make sure you cutout processed junk food

I'm confused. Your LDL was 100+ before the eggs and statin?

Or all of that helped bring yuor HDL to 60 while I assume on roids?

 

[Sicsemptyran]

Statins are clinically proven to reduce/stabalise plague, but Eze isn't.
If anything, I would drop Eze and hop on Pita.

While this isn't wrong at a population level, more variables could change the equation.

Young age (no plaques) + longer expected lifetime exposure to drugs and the side effects would push towards using ezetimibe + bempedoic acid if it appropriately lowers LDL/ApoB.

In my case that brings LDL into the 60s, ApoB below 60, HDL in the 60s, ApoA1 in the low 100s, up to 400mg/test/wk. I have confirmed no plaque, fasting insulin between 2-3, CRP that has never touched 1. Would be a poor swap for me!

If I were a bit older and/or with any confirmed plaque, would absolutely layer in a statin.