Chronic low HDL but good LDL (need advice)

[Ghoul]

Do you think this risk mitigates with concurrent GLP-1 therapy? I know that’s not the point but just curious if we are stuck with non Pita prescribers

It's an issue of worsened insulin sensitivity, so GLP would offset that risk to some degree by improving insulin sensitivity.

I’m sorry if I missed it in any of your prior posts but can you share the data on Pita showing that it improves HDL? That would be the main selling point for me.

Effects of pitavastatin (LIVALO Tablet) on high density lipoprotein cholesterol (HDL-C) in hypercholesterolemia - PubMed

Pitavastatin had stable clinical effects on LDL-C, TG, and HDL-C for 104 weeks. It was noteworthy that HDL-C in patients with low HDL-C was continuously increased by this agent during the period tested.

pubmed.ncbi.nlm.nih.gov

 

[Nidus]

It's not even on the list of insurance covered meds here. My anabolic steroid clinic that I go to never even heard of Pita.. They can only give me Rosuva

Same here, i wish they would prescribe Pita or at least have more generics.

 

[Ghoul]

Same here, i wish they would prescribe Pita or at least have more generics.

If you're in the US a telemedicine provider will prescribe it in 5 minutes, and 99% of insurance policies cover it (with zero deductible if you're over 40).

 

[Nidus]

If you're in the US a telemedicine provider will prescribe it in 5 minutes, and 99% of insurance policies cover it (with zero deductible if you're over 40).

European peasant here. I can get it prescribed but a pack of 4mg costs about 77€, insurance would only give me a 10€ discount on it for a pack of 30 pills
Rosuvastin i get a pack of 100 pills 20mg, which can be split into 5mg for free

 

[RockyP]

https://www.jacc.org/doi/10.1016/S0735-1097%2813%2962033-1

Conclusion​

Besides decreasing serum LDL–C levels, pitavastatin elevates serum HDL–C levels and modulates the size, composition and levels of HDL–associated enzymes, but as a whole, increases HDL particles with preserved anti–atherosclerotic properties.”

This is great thank you so much. Will show it to my cardiologist. I can hear him scoffing at the N of 23 already but he honestly doesn’t seem to know anything about it.

 

[Enjoythements]

Not to hijack the thread, but I'm dealing with something similar. About a month after finishing a steroid blast (~1.5g/week of injectables and had orals on top), I had bloodwork done. Everything came back in range, but I noticed my HDL is very low. My doctor didn't even mention it, I only caught it while reviewing the results myself.

Should I be concerned? Is there anything I can do to improve it?

Here are the relevant numbers:
Total cholesterol: 44 mg/dL (ref <190)
HDL: 12 mg/dL (ref >35)
LDL: 23 mg/dL (ref <100)
Cholesterol/HDL ratio: 3.7 (ref <5)
Non-HDL cholesterol: 32 mg/dL (ref <130)
Triglycerides: 45 mg/dL (ref <150)

I also checked liver markers since I saw GPT mention low HDL could be linked to liver issues, but those came back fine:
ALT: 30 (ref <41)
GGT: 10 (ref <60)

Diet:
My diet is extremely low in fat. I don't include any direct fat sources because I'm eating a high amount of carbs and protein. Whenever I try to add fats, I end up not digesting well. After seeing my bloodwork, I started taking 5g of fish oil daily.

 

[Ghoul]

Not to hijack the thread, but I'm dealing with something similar. About a month after finishing a steroid blast (~1.5g/week of injectables and had orals on top), I had bloodwork done. Everything came back in range, but I noticed my HDL is very low. My doctor didn't even mention it, I only caught it while reviewing the results myself.

Should I be concerned? Is there anything I can do to improve it?

Here are the relevant numbers:
Total cholesterol: 44 mg/dL (ref <190)
HDL: 12 mg/dL (ref >35)
LDL: 23 mg/dL (ref <100)
Cholesterol/HDL ratio: 3.7 (ref <5)
Non-HDL cholesterol: 32 mg/dL (ref <130)
Triglycerides: 45 mg/dL (ref <150)

I also checked liver markers since I saw GPT mention low HDL could be linked to liver issues, but those came back fine:
ALT: 30 (ref <41)
GGT: 10 (ref <60)

Diet:
My diet is extremely low in fat. I don't include any direct fat sources because I'm eating a high amount of carbs and protein. Whenever I try to add fats, I end up not digesting well. After seeing my bloodwork, I started taking 5g of fish oil daily.

This is another one of those odd situations that could be very bad, or very good, but it needs advanced testing to determine which.

You need to see ApoA-I and HDL-P.

If both are high, it means you have many tiny, but well functioning HDL particles and the low HDL-C number is no concern. In fact it's an extremely good position to be in with that rock bottom LDL-C.

If ApoA-I and HDL-P are low, you're at high risk and steps will have to be taken to protect your endothelium from the damaging effects of oxidative HDL.

Suggest you get the Lipomap test I posted about earlier.

 

[BamaCrazy]

Not to hijack the thread, but I'm dealing with something similar. About a month after finishing a steroid blast (~1.5g/week of injectables and had orals on top), I had bloodwork done. Everything came back in range, but I noticed my HDL is very low. My doctor didn't even mention it, I only caught it while reviewing the results myself.

Should I be concerned? Is there anything I can do to improve it?

Here are the relevant numbers:
Total cholesterol: 44 mg/dL (ref <190)
HDL: 12 mg/dL (ref >35)
LDL: 23 mg/dL (ref <100)
Cholesterol/HDL ratio: 3.7 (ref <5)
Non-HDL cholesterol: 32 mg/dL (ref <130)
Triglycerides: 45 mg/dL (ref <150)

I also checked liver markers since I saw GPT mention low HDL could be linked to liver issues, but those came back fine:
ALT: 30 (ref <41)
GGT: 10 (ref <60)

Diet:
My diet is extremely low in fat. I don't include any direct fat sources because I'm eating a high amount of carbs and protein. Whenever I try to add fats, I end up not digesting well. After seeing my bloodwork, I started taking 5g of fish oil daily.

My HDL always bounces back after I end my cycle and do a reset. I concentrate on keeping total cholesterol, LDL and triglycerides low because I know I’m going to crush my HDL on cycle every time. After a 2 month break of only TRT my HDL returns to baseline.

 

[RockyP]

My HDL always bounces back after I end my cycle and do a reset. I concentrate on keeping total cholesterol, LDL and triglycerides low because I know I’m going to crush my HDL on cycle every time. After a 2 month break of only TRT my HDL returns to baseline.

Still a good idea to be very aggressive managing HDL on cycle. Even if the values are low briefly, damage is being done.

 

[Ghoul]

Still a good idea to be very aggressive managing HDL on cycle. Even if the values are low briefly, damage is being done.

One of the things being suggested by recent research looking at why AAS users seemingly have permanent high cardiovascular risk, despite good looking markers, calcium scores, etc, often years after stopping, is that the very bad short term lipid conditions may not be around long enough to damage large vessels in any noticeable way, but are wrecking microvessels in heart muscle and elsewhere, which is virtually impossible to see, even in an autopsy, unless the tissue is specifically examined for that type
of damage. And when they've looked for it, more often then not, in AAS users they find it.

 

[BamaCrazy]

Still a good idea to be very aggressive managing HDL on cycle. Even if the values are low briefly, damage is being done.

Nothing can be done to raise HDL when on cycle. Studies show that increasing HDL via pharmaceuticals is not helpful. So how do you propose to aggressively manage HDL on cycle? That’s why a reset is necessary and focusing on keeping total cholesterol, LDL and triglycerides as low as possible on cycle.

Effect of HDL-Raising Drugs on Cardiovascular Outcomes: A Systematic Review and Meta-Regression - PMC

Substantial residual cardiovascular risk remains after optimal LDL lowering in patients of established coronary artery disease. A number of therapeutic agents that raise HDL-C have been tested in clinical trials to cover this risk. However, the ...

pmc.ncbi.nlm.nih.gov

“Increasing HDL levels via pharmacological manipulation beyond optimal lipid lowering therapy for secondary prevention is not beneficial.”

 

[RockyP]

Nothing can be done to raise HDL when on cycle. Studies show that increasing HDL via pharmaceuticals is not helpful. So how do you propose to aggressively manage HDL on cycle? That’s why a reset is necessary and focusing on keeping total cholesterol, LDL and triglycerides as low as possible on cycle.

Effect of HDL-Raising Drugs on Cardiovascular Outcomes: A Systematic Review and Meta-Regression - PMC

Substantial residual cardiovascular risk remains after optimal LDL lowering in patients of established coronary artery disease. A number of therapeutic agents that raise HDL-C have been tested in clinical trials to cover this risk. However, the ...

pmc.ncbi.nlm.nih.gov

“Increasing HDL levels via pharmacological manipulation beyond optimal lipid lowering therapy for secondary prevention is not beneficial.”

would this data not then negate the main argument for using Pita (HDL increase), assuming you can tolerate another statin?

 

[BamaCrazy]

would this data not then negate the main argument for using Pita (HDL increase), assuming you can tolerate another statin?

If the only reason you are going to switch from Rosuvastatin to Pita is to increase HDL, then it’s a waste of time. But Pita is more tolerable in most with less side effects. It’s cholesterol lowing effects are pretty close to Rosuvastatin plus the insulin sensitivity benefits mentioned above.

Knowing what I know now, if I wasn’t already taking Rosuvastatin, I’d ask my Doc for Pita.

 

[RockyP]

If the only reason you are going to switch from Rosuvastatin to Pita is to increase HDL, then it’s a waste of time. But Pita is more tolerable in most with less side effects. It’s cholesterol lowing effects are pretty close to Rosuvastatin plus the insulin sensitivity benefits mentioned above.

Knowing what I know now, if I wasn’t already taking Rosuvastatin, I’d ask my Doc for Pita.

Me too. I’m still just very thankful to have all this information available to bounce off each other. My Ivy League cardiologist just says “I’ve never prescribed it.”

One thing I do wonder is if the insulin resistance shown with the other statins is mitigated / eliminated in our population eating clean, lots of muscle mass, and (most of us) on a GLP-1.

 

[BamaCrazy]

Me too. I’m still just very thankful to have all this information available to bounce off each other. My Ivy League cardiologist just says “I’ve never prescribed it.”

I’m seriously considering getting a Concierge Doctor just so I can breakout of the same medical groupthink you are referring to. $100-200 a month is worth getting the level of care I’m seeking.

 

[Ghoul]

If the only reason you are going to switch from Rosuvastatin to Pita is to increase HDL, then it’s a waste of time. But Pita is more tolerable in most with less side effects. It’s cholesterol lowing effects are pretty close to Rosuvastatin plus the insulin sensitivity benefits mentioned above.

Knowing what I know now, if I wasn’t already taking Rosuvastatin, I’d ask my Doc for Pita.

No.

Hundreds of studies after that 2014 paper went on to establish that cardiovascular risk is lowered by quality, not only quantity of HDL. HDL's ability to remove cholesterol, measured by CEC (cholesterol efflux capacity) and anti-inflammatory properties are what matters most.

Increasing poor quality HDL-C doesn't help, Worse, since it's inflammatory it damages blood vessels.

The interventions used in that study increase low quality HDL.

Pitavastatin, uniquely, generates high quality HDL with high CEC function.

High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease - PMC

Several prospective epidemiological studies have shown that there is a clear inverse relationship between serum high-density lipoprotein-cholesterol (HDL-C) concentrations and risk for coronary heart disease (CHD), even at low-density ...

pmc.ncbi.nlm.nih.gov

Increased HDL quantity and quality:

Pitavastatin increases HDL particles functionally preserved with cholesterol efflux capacity and antioxidative actions in dyslipidemic patients - PubMed

In addition to its LDL-C-lowering effects, pitavastatin elevates the HDL-C level and enhances the cholesterol efflux capacity and antioxidative properties of HDL. Pitavastatin therefore increases the amount of functional HDL without attenuating HDL quality.

pubmed.ncbi.nlm.nih.gov

Even improving the quality of existing HDL and making it less inflammatory:

Pitavastatin in cardiometabolic disease: therapeutic profile - Cardiovascular Diabetology

Statins effectively lower low-density lipoprotein-cholesterol (LDL-C) and reduce cardiovascular risk in people with dyslipidemia and cardiometabolic diseases such as Metabolic syndrome (MetS) or type 2 diabetes (T2D). In addition to elevated levels of LDL-C, people with these conditions often...

cardiab.biomedcentral.com

https://www.sciencedirect.com/science/article/pii/S1567568817300430

 

[Almoister]

Damn dude thats interesting stuff Thanks

 

[RockyP]

No.

Hundreds of studies after that 2014 paper went on to establish that cardiovascular risk is lowered by quality, not only quantity of HDL. HDL's ability to remove cholesterol, measured by CEC (cholesterol efflux capacity) and anti-inflammatory properties are what matters most.

Increasing poor quality HDL-C doesn't help, Worse, since it's inflammatory it damages blood vessels.

The interventions used in that study increase low quality HDL.

Pitavastatin, uniquely, generates high quality HDL with high CEC function.

View attachment 339091

High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease - PMC

Several prospective epidemiological studies have shown that there is a clear inverse relationship between serum high-density lipoprotein-cholesterol (HDL-C) concentrations and risk for coronary heart disease (CHD), even at low-density ...

pmc.ncbi.nlm.nih.gov

Increased HDL quantity and quality:

View attachment 339102

Pitavastatin increases HDL particles functionally preserved with cholesterol efflux capacity and antioxidative actions in dyslipidemic patients - PubMed

In addition to its LDL-C-lowering effects, pitavastatin elevates the HDL-C level and enhances the cholesterol efflux capacity and antioxidative properties of HDL. Pitavastatin therefore increases the amount of functional HDL without attenuating HDL quality.

pubmed.ncbi.nlm.nih.gov

Even improving the quality of existing HDL and making it less inflammatory:

View attachment 339101

Pitavastatin in cardiometabolic disease: therapeutic profile - Cardiovascular Diabetology

Statins effectively lower low-density lipoprotein-cholesterol (LDL-C) and reduce cardiovascular risk in people with dyslipidemia and cardiometabolic diseases such as Metabolic syndrome (MetS) or type 2 diabetes (T2D). In addition to elevated levels of LDL-C, people with these conditions often...

cardiab.biomedcentral.com

View attachment 339100

https://www.sciencedirect.com/science/article/pii/S1567568817300430

Bookmarked. Incredible content. Thank you!

 

[BamaCrazy]

No.

Hundreds of studies after that 2014 paper went on to establish that cardiovascular risk is lowered by quality, not only quantity of HDL. HDL's ability to remove cholesterol, measured by CEC (cholesterol efflux capacity) and anti-inflammatory properties are what matters most.

Increasing poor quality HDL-C doesn't help, Worse, since it's inflammatory it damages blood vessels.

The interventions used in that study increase low quality HDL.

Pitavastatin, uniquely, generates high quality HDL with high CEC function.

View attachment 339091

High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease - PMC

Several prospective epidemiological studies have shown that there is a clear inverse relationship between serum high-density lipoprotein-cholesterol (HDL-C) concentrations and risk for coronary heart disease (CHD), even at low-density ...

pmc.ncbi.nlm.nih.gov

Increased HDL quantity and quality:

View attachment 339102

Pitavastatin increases HDL particles functionally preserved with cholesterol efflux capacity and antioxidative actions in dyslipidemic patients - PubMed

In addition to its LDL-C-lowering effects, pitavastatin elevates the HDL-C level and enhances the cholesterol efflux capacity and antioxidative properties of HDL. Pitavastatin therefore increases the amount of functional HDL without attenuating HDL quality.

pubmed.ncbi.nlm.nih.gov

Even improving the quality of existing HDL and making it less inflammatory:

View attachment 339101

Pitavastatin in cardiometabolic disease: therapeutic profile - Cardiovascular Diabetology

Statins effectively lower low-density lipoprotein-cholesterol (LDL-C) and reduce cardiovascular risk in people with dyslipidemia and cardiometabolic diseases such as Metabolic syndrome (MetS) or type 2 diabetes (T2D). In addition to elevated levels of LDL-C, people with these conditions often...

cardiab.biomedcentral.com

View attachment 339100

https://www.sciencedirect.com/science/article/pii/S1567568817300430

Hmmm. Might make the switch after all.

 

[Photon]

No.

Hundreds of studies after that 2014 paper went on to establish that cardiovascular risk is lowered by quality, not only quantity of HDL. HDL's ability to remove cholesterol, measured by CEC (cholesterol efflux capacity) and anti-inflammatory properties are what matters most.

The 2014 studies looks at the following, all of which i believe improve CEC, with CETP providing the strongest improvements.







In a different post i believe you ranked Niacin and Fibrates as well, right after Pita, both of which were also evaluated in the 2014 study as not being beneficial.
Edit, found it

Post in thread 'Cholesterol numbers on no med, then on statin then on statin + Repatha'

Jul 16, 2025

Yea, they are discovering more and more that HDL doesn't seem to affect outcomes either way. With the exception being if it is very high tending to lead to worse outcomes actually.

In part that's because there's "good HDL" and "bad HDL", which is determined by its RCT (reverse cholesterol transport) function.

Raising quantity of low quality HDL contributes to inflammation and doesn't remove cholesterol from arteries.

The main biomarkers to check HDL quality are CEC (cholesterol efflux capacity, this one is enough if you have access to it) and/or APOA-I.

In order of...

• Ghoul

•