Wizbang
Member
Yeah was trying to see if something else was pulling down the HDL just to rule out other factors
MESO-Rx
Anabolic Steroids
Cholesterol numbers on no med, then on statin then on statin + Repatha
- Thread starter jtmarlin
- Start date
Yeah was trying to see if something else was pulling down the HDL just to rule out other factors
I have to say that I have not noticed my E2 levels affecting my HDL as is commonly claimed to happen by some people whether they have actually proved it or not. I've had bloods done with e2 at 8 and E2 at 70 and the HDL didn't budge. This was either with low dose primo or adex.
egruberman
Member
The technology to do so is actually commonplace in China.... Well, maybe not commonplace, but it's being used at scale.
It doesn't matter. If there's low/no atherogenic burden from elevated ApoB there's no benefit to HDL to help clear it.
egruberman
Member
Don't do this. It won't improve health outcomes.
Is this known or is this best guess? Bc I am torn between continuing Repatha or boosting my statin dose slightly bc having tried multiple combos, it is clear to me that Repatha and Repatha + statin lowers my HDL by 15 points whereas statin monotherapy does not do this.
So if I'm running ApoB 40-45 I can have HDL of 10 and be totally ok?
Wizbang
Member
Great to know! Always learning
You’re right on dosage and right on the studies - which are accurate as I use niacin. The use of niacin “immediate flush” is the mechanism of action for its use in reducing cholesterol and increasing HDL. Within 3-5 weeks of continuous use the flush is almost nonexistent. The only drawback to niacin is excessive intake. Studies show an increase risk of cardiovascular disease if niacin is used in excess due to the metabolite 4PY and 2PY. Does Niacin work as you mentioned? Absolutely. Is the study on excess use reliable? I don’t know, pharmaceutical companies fund those studies and niacin and statins are cheap compared to what they are coming out with now.
egruberman
Member
Please revisit the literature on niacin. Yes, it doesn't improve biomarkers, but no, it does not improve outcomes, and in some cases makes them worse.
Who’s going to trust an underground lab biologic with no way to test it? Do you want xenomorphs bursting out of your chest? Because that’s how you get xenomorphs.
Ghoul
Member
Statin intolerance can develop spontaneously. The most common symptom, muscle pain, simply from cumulative exposure even if you were fine for years.
Start complaining to your doc of muscle pain, and ask "could the statin be causing this?". If they suggest a trial dose reduction or switch agree to it (you can keep using your treatment as before ofc).. "It definately lessened a bit but still there.".
Typically after 6-12 weeks of intolerance symptoms on paper, repatha will be authorized.
Just say to your doctor after a couple of months of trying whatever they recommend: "I can't put up with this much longer. Maybe we could resubmit a preauthorization for repatha so I can keep my LDL down without the discomfort. of the muscle side effects".
If you name the company I can tell you exactly what you need, otherwise look up "repatha preauthorization for xxx insurance" to find the requirements..
You may not even need to go through this if your attempt to get authorization was last year or earlier.
Most insurance companies have dropped preauthorization requirements for Repatha this year. Amgen has been offering huge discounts to insurance companies agreeing to loosen or eliminate preauthorization requirements for patients with documented high cholesterol.
Wizbang
Member
I pay a whopping $5 copayment. (Doc just switched me from Praluent to Repatha this month because he knows most of the insurances are preferring Repatha)
Ghoul
Member
When my prescription was entered into the system my shocked provider, prepared with all the docs and arguments to get an exception to the requirements the insurance co lists online, was informed no preauthorization or annual reauthorization was required. My copay is $15/mo with the Amgen copay card they offer online saving me $5/mo lol. 6 pens at a time are overnighted to me in a cooler.
I spent about 6 weeks on the "muscle pain train" to get the prescription and meet the preauthorization requirements, that turned out to not be necessary.
Wizbang
Member
Unfortunately I lived the muscle pain train and limited results on statins, not fun. Doc has also placed me on Icosapent Ethyl, I had been on EPA only fish oil and asked him to consider putting me on it for the pleiotropic effects and my lack of trust that supplement companies actually provide what they say, so we will see if it has any impact on my numbers going forward (I do not currently have hypertriglyceridemia but perhaps it will have some benefit)
Ghoul
Member
You need Pitavastatin.
Most primary care docs are unfamiliar with it, because it was $500/mo until recently (vs $5 for generics of other statins), and was very difficult to get coverage for.
It's now a generic at -$50/mo, most insurance will cover it, or buy from India pharmacy for $40/100 x 4mg tabs. Only one brand of generic available in the US or India so far, Zydus.
It's been the preferred statin for professional athletes, for good reason.
I planned to do a write up on this little known statin, so this is a little sloppy, but TLDR it provides 90% of the LDL lowering of the most potent "conventional" statins, along with unique characteristics like boosting HDL numbers (and improving HDL function, ie HDL's 'reverse cholesterol transport', the capacity to suck lipids out of your arteries, making it a great candidate for plaque regression, not just stopping further accumulation).
Uniquely, it doesn't increase insulin resistance like other statins, and often improves it(!).
It doesn't harm muscle mitochondrial function, the common issue with every other statin. Muscle related sides are very rare as a result.
It has an enhancing effect on fat lipolysis, and inhibits fat deposition, allowing for increased fat burn and recomposition, unlike the negative impact other statins have on fat metabolism.
It has no interactions with Test or GH because it's not metabolized by CYP3A4 like other statins, preventing accumulation that often leads to sides.
This was a quick and dirty summary, but aside from slightly less LDL lowering ability, and cost, this is clearly the best statin by a mile for prevention (outside of a few edge cases requiring rapid calcification of plaque due to imminent risk).
With Repatha, Ezetimebe, Pitavastatin 4mg you're looking at a 85-90% drop in LDL 10-15%. boost in HDL, and minimal, or more likely no sides.
Even just Pita 4mg and Ezetimebe it's approx 60% drop in LDL, 50% APOb, 30% triglycerides, and 10-15% boost in HDL with an excellent shot at not experiencing any sides.
The statin for statin haters like me.
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I’ve seen a couple of studies mentioned indicating that medical interventions to raise HDL do not change the outcomes that would be associated with the unaltered lower HDL. Is there reason to believe that would be different for pitavastatin-induced increases in HDL?
Photon
Member
Its 50$, 4mg for 3months without insurance at costplus.
With insurance, as good as free.
He has a low LDL, which is the key difference.
If yours is still high even with Rosu + Eze and you have no access to PSCK9, then you should not be switching.
I switched from Rosu too in April when my LDL hit single digits.
Pita is alot more common in Asia.
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Ghoul
Member
The difference is the level of function of the HDL produced.
Other interventions, including other statins that raise HDL typically either produce a low quality form of HDL that actually increases risk, a "bad" HDL, or improves it only slightly compared to Pitavastatin.
PH index measures the relative capacity of HDL to remove plaque from arteries per 1% increase in HDL-C. Negative numbers mean regression of plaque, positive contributes to it,
Pitavastatin: -1.8
Rosuvastatin: -.03
Other statins: -.01 to +1.4
Pitavastatin's much stronger ability to regress plaque vs other statins has been demonstrated in trials.
And while plaque regression still hasn't been validated by the necessary gold standard, long term, very large clinical trials necessary to establish it as a definitive improver of outcomes, there's a lot of evidence and clinical observation (and frankly some common sense imo) that less plaque means fewer heart attacks and bypasses.
One "small" 2 year study involving ~600 high risk cardiac subjects comparing Pitavastatin to Lipitor showed a 63% lower rate of major cardiac events (heart attack/bypass surgery) in the Pitavastatin group at the same level of LDL reduction.
Pitavastatin isn't inferior to any other statin in effectiveness. It's the most tolerable of all statins, which is why it existed despite commanding a premium price. High dose high intensity statins lower LDL somewhat more, but that comes at a cost to health that increases over time.
Pita 4 & Rosu 10 reduce LDL by 45%
Rosu 40 reduces LDL by 55%
Rosu:
-Raises insulin resistance increasing the risk of diabetes by 12%. Nothing a GH user would want to pile on.
-Raises liver enzymes
-Causes mild to (rare) severe muscle problems.
-Intermittant Kidney proteinuria
Setting aside the question of HDL and regression related improved outcomes (and if removal of plaque is "proven" to improve outcomes, Pita blows away Rosu), if someone's using 10mg Rosuvastatin, there's no question Pita 4 is better by every measure, and keeps getting better over the long term because of its very low risk of sides, neutral or positive effect on insulin sensitivity, and other metabolic improvements.
If someone needs every point of LDL reduction they can get, max dose Rosuvastatin is better, but comes at a cost to other aspects of health.
I think Pitavastatin is a great way for those who are statin averse to significantly improve lipids beyond the ezetimebe/bempodoic acid that's been the go to in the PED using community, with very little potential downside.
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There is not enough evidience confirming the improvement in insulin resistance, just because it doesnt increase homa in studies =/= it doesnt improve it. For Diabetics or Pre-Diabetic or people who use a ton of GH still a better choice but i would be careful with that claim
Feel free to link me the study you used as reference but the last time i checked this is not confirmed
Also the claim with the fat burning enhancement should be taken with a grain of salt, it is suggested because of the lipid metabolism but not proven or confirmed to my understanding, this is like the carnitine claim for the upregulation of androgen receptors. Suggested and assumed but not confirmed or explained in medical papers
The plague regression sounds really nice although i this is also just a suggestion made based on the HDL increase but if i recall it right there is no scientific benefit of increasing your HDL (feel free to correct me here, no lipid expert)
While i think the risk of cardiac event stat of 63% is interesting i would also take this with a grain of salt considering its done in high risk subjects with metabolic disorders, i believe the most recent one was just at around 40% similar to the SLGT2 one
Ghoul
Member
I'm not suggesting it be used as a treatment for insulin sensitivity or anything other than hyperlipidemia. Simply that those potential benefits, however modest, or even just a neutral effect (we know at the least Pita induces no insulin resistance), are advantages over other statins,
I'll share links to the relevant studies,
Can you point to any downside to Pitavastatin as a means of improving lipids compared to the others?
Ezetimebe became the go to for PED users because of it's "free" lipid improvement, since there's really almost no chance of sides. Bempedoic acid's been added to the repertoire despite the collagen suppressing effect. I think Pita fits the bill here in terms of being "low impact", while other statins are avoided for good reason.
Are there any areas in which other statins provide advantages that make them an overall better choice? Beyond the small additional reduction in LDL at the highest doses of high intensity stains, which come with accompanying hazards, I can't find a good argument, outside of needing that extra bit of LDL reduction so badly that accepting an increase in insulin resistance and the significantly higher muscle related side effect risk is a worthwhile tradeoff.
Outside of cost, for instance, I can't see any good reason to use Rosu 10mg (the most common dose of the most common statin) vs Pita 4mg .
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I agree with the neutral effect, just referring to your claim of "Uniquely, it doesn't increase insulin resistance like other statins, and often improves it(!)."
A Statin that improves Homa got my immediate curiosity so i wanted to follow up on that and learn more!
I think the LDL reduction could be interesting for some people but generally speaking i would always try and stay away from Statins as much as possible. I did not have the intentions to look for downsides of Pitavastatin, the only one i could think of is the cost and availability given that they only come in 30 Pills boxes within Europe and cost nearly 80-90€. For an insurance to cover it most of the time a extended period of "testing and trialing" is needed, so you might need to complain a lot to your doc to approve the switch
I think Pitavastatin great, just alone for the Insulin resistance part which seems to be untouched and the stronger effect of plaque reduction plus the different way it gets metabolized in the liver
