Cholesterol numbers on no med, then on statin then on statin + Repatha

[Ghoul]

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

I sincerely appreciate your thoughtful response.

I found it easier to get my doctor to prescribe Repatha than Pitavastatin. I thought I must be missing something negative about it, but concluded it was clinical inertia.

When I finally met with a Preventative Cardiologist, who treats a pro sports team in his practice outside the University health system I use, he confirmed my conclusions about Pita. Despite the massive drop in cost in the US, he thinks it'll be a decade or more before its use becomes common,

Same with plaque regression. Clearly this is a primary focus of cardiology now that "stabilizing" plaque has conclusively been proven to offer massive benefits, regression is the next logical step.

Pita leaves that regression window open longer than other statins, which induce rapid calcification. That's great for quick risk reduction by stabilizing plaque so it can't break off causing a clot, but where there's no imminent danger, reducing the narrowing of arteries as much as possible before sealing it by accelerating the formation of an arterial "rock tube" is my personal target. I'm not waiting for another decade of trials, and am willing to roll the dice on that one.

Sometimes when choosing a drug, there really aren't any tradeoffs between them. Cilnidipine is clearly superior to Amlodipine, with no (medical) reason to ever pick the latter. It seems to me Pita vs every other statin is another example.

 

[Nidus]

I sincerely appreciate your thoughtful response.

I found it easier to get my doctor to prescribe Repatha than Pitavastatin. I thought I must be missing something negative about it, but concluded it was clinical inertia.

When I finally met with a Preventative Cardiologist, who treats a pro sports team in his practice outside the University health system I use, he confirmed my conclusions about Pita. Despite the massive drop in cost in the US, he thinks it'll be a decade or more before its use becomes common,

Same with plaque regression. Clearly this is a primary focus of cardiology now that "stabilizing" plaque has conclusively been proven to offer massive benefits, regression is the next logical step.

Pita leaves that regression window open longer than other statins, which induce rapid calcification. That's great for quick risk reduction by stabilizing plaque so it can't break off causing a clot, but where there's no imminent danger, reducing the narrowing of arteries as much as possible before sealing it by accelerating the formation of an arterial "rock tube" is my personal target. I'm not waiting for another decade of trials, and am willing to roll the dice on that one.

Sometimes when choosing a drug, there really aren't any tradeoffs between them. Cilnidipine is clearly superior to Amlodipine, with no (medical) reason to ever pick the latter. It seems to me Pita vs every other statin is another example.

You'd be surprised with Amlodipine in Germany, its basically the first and 2nd line of treatment for BP. Candesartan first, 2nd in line Amlo.

Nebivol or Telmisartarn or even HCTZ comes lower after that

 

[Ghoul]

You'd be surprised with Amlodipine in Germany, its basically the first and 2nd line of treatment for BP. Candesartan first, 2nd in line Amlo.

Nebivol or Telmisartarn or even HCTZ comes lower after that

Same in the US. It's the most prescribed, first line CCB. 20 milllion on it. This will likely rise when docs finally catch up to the most up to date treatment standards that advise initiating pharma intervention earlier, and using a low dose dual class med, ARB/CCB being preferred, rather than monotherapy.

But I still have no doubt Amlodipine would disappear if Cilnidipine were available and an equal price.

I recently went down the rabbit hole of Amlo's increased risk of edema, especially the way that risk rises over time.

I thought it was because the patient becomes more vulnerable to edema with age, which is true. But it's also because Amlodipine induces cumulative DAMAGE that makes it more likely! TLDR the high flow from relaxed arterioles into capillaries that sympathetically constrict in response to relaxed arteries, raises pressure within them, stretching and over time damaging the walls causing leakage of water into surrounding tissue, ie edema.

Cilnidipine's addition of calcium N channel blocking stops sympathetic reactions so capillaries stay relaxed avoiding the stretching and damage.

This is also at the heart of Ciln's kidney protective properties.

Apparently dooming patients to compression socks in later life is accepted as a minor downside vs the benefits, but it's completely avoidable!!

 

[Photon]

Looks like there's quite a number of Pita brands in India, not just Zydus.
Pita + Eze combo pills are also present.

Ive switched alot of my India Pharma medications to US Pharma (Mostly from India still lol but I feel like the quality is probably better) but I might just get the India Pharma combo pill just to cut down on storage space.

 

[Ghoul]

Looks like there's quite a number of Pita brands in India, not just Zydus.
Pita + Eze combo pills are also present.

Ive switched alot of my India Pharma medications to US Pharma (Mostly from India still lol but I feel like the quality is probably better) but I might just get the India Pharma combo pill just to cut down on storage space.

Can you point me in the direction of pita / eze combo? What's it called?

 

[Photon]

Can you point me in the direction of pita / eze combo? What's it called?

4/10 mg dosing
Ptvs Duo
Livastat-EZ

Same cost as your Zydus 4 probably.

 

[Ghoul]

Can you point me in the direction of pita / eze combo? What's it called?

4/10 mg dosing
Ptvs Duo
Livastat-EZ

Same cost as your Zydus 4 probably.

Nevermind, I remember after checking on cheaper brands (and especially combos) once I was quoted what sounded like an excessive price for an Indian sourced med.

Nissan Chemicals Japan, the Pitavastatin patent holder, sued every generic maker of Pita in India. 1mg(dotcom) shows every variant "unavailable" except for Zydus (aka Cadilla), who struck a deal for a license to make it,

Cadila settles patent litigation related to Livalo tabs - Express Pharma

Under the terms of the agreement, Kowa and Nissan grant Zydus a licence to market Zydus’ generic version of Livalo beginning on May 2, 2023, or earlier under certain circumstances

www.expresspharma.in

But if you ever find a combo with ezetimebe (or just a cheaper alternative), please let me know, I really prefer to lower pill count.

So for now, unless I'm missing something, Zydus is it.

 

[Photon]

Nevermind, I remember after checking on other brands (especially combos).

Nissan Chemicals Japan, the Pitavastatin patent holder, sued every generic maker of Pita in India. 1mg(dotcom) shows every variant "unavailable" except for Zydus (aka Cadilla), who struck a deal for a license to make it,

Cadila settles patent litigation related to Livalo tabs - Express Pharma

Under the terms of the agreement, Kowa and Nissan grant Zydus a licence to market Zydus’ generic version of Livalo beginning on May 2, 2023, or earlier under certain circumstances

www.expresspharma.in

But if you ever find a combo with ezetimebe, please let me know, I really prefer to lower pill count.

Ptvs Duo is in stock on 1mg.
Not 100% sure but I guess Pct24x will probably charge $4 for a strip of 10 for it.

 

[Ghoul]

Ptvs Duo is in stock on 1mg.
Not 100% sure but I guess Pct24x will probably charge $4 for a strip of 10 for it.

Fingers crossed that it's available!

 

[verylargeshoes]

Ive switched alot of my India Pharma medications to US Pharma (Mostly from India still lol but I feel like the quality is probably better) but I might just get the India Pharma combo pill just to cut down on storage space.

I can't seem to find pitavastatin from any of the usual pharma sources here and on SST. Mind sharing a pointer?

 

[Photon]

I can't seem to find pitavastatin from any of the usual pharma sources here and on SST. Mind sharing a pointer?

The 2 india pct vendors can get it.
Its not on their pricelist cause it's not that common
1/2/4 mg

Pivasta 1
Pivasta 2
Pivasta 4

You can request for pctzone to add to their website.

 

[Nidus]

Same in the US. It's the most prescribed, first line CCB. 20 milllion on it. This will likely rise when docs finally catch up to the most up to date treatment standards that advise initiating pharma intervention earlier, and using a low dose dual class med, ARB/CCB being preferred, rather than monotherapy.

But I still have no doubt Amlodipine would disappear if Cilnidipine were available and an equal price.

I recently went down the rabbit hole of Amlo's increased risk of edema, especially the way that risk rises over time.

I thought it was because the patient becomes more vulnerable to edema with age, which is true. But it's also because Amlodipine induces cumulative DAMAGE that makes it more likely! TLDR the high flow from relaxed arterioles into capillaries that sympathetically constrict in response to relaxed arteries, raises pressure within them, stretching and over time damaging the walls causing leakage of water into surrounding tissue, ie edema.

Cilnidipine's addition of calcium N channel blocking stops sympathetic reactions so capillaries stay relaxed avoiding the stretching and damage.

This is also at the heart of Ciln's kidney protective properties.

Apparently dooming patients to compression socks in later life is accepted as a minor downside vs the benefits, but it's completely avoidable!!

Yeah, the edema issue and crazy amount of water retention is what put me off right away. Apparently its also very common to induce hairloss in females, my pharmacy guy told me about it, have not looked into it but also another reason to stay away from it.

Unfortunately, every doctor here will throw Amlodipine at you and other older generation of BP meds at you instead of the new, better researched and medically proven stuff. Very frustrating.

Same with Statins here, they just put you on 40-50mg of Simvastatin. Most dont even know about Ezemtibe and Bempoic Acid is extremely unknown.

But hey, at least they prescribe you X amount of Painkillers right away

 

[Nidus]

Looks like there's quite a number of Pita brands in India, not just Zydus.
Pita + Eze combo pills are also present.

Ive switched alot of my India Pharma medications to US Pharma (Mostly from India still lol but I feel like the quality is probably better) but I might just get the India Pharma combo pill just to cut down on storage space.

I always try and had good luck so far to get everything covered through my insurance. So i get the big boxes of nustendi (98x 10mg ezemtibe/180mg of bempoic acid) which are about 260€ every 2.5 months.

Same for Jardiance, i also have a lot of Rosuvastin left but will definitely try and add some Pita and try to switch fully although only small boxes are available which is annoying and insurances will annoy you why you ask for 3 boxes right away

 

[Wizbang]

I've recently started Icosapent Ethyl capsules, @Nidus and @Ghoul what are your thoughts on this stuff?

I read a couple studies on potential plaque stabilization/regression, anti-inflammatory properties and cell strengthening and a couple other pleiotropic effects and since I was already taking EPA only fish oil my cardio was more than happy to switch me to the tested stuff.

 

[Ghoul]

I've recently started Icosapent Ethyl capsules, @Nidus and @Ghoul what are your thoughts on this stuff?

I read a couple studies on potential plaque stabilization/regression, anti-inflammatory properties and cell strengthening and a couple other pleiotropic effects and since I was already taking EPA only fish oil my cardio was more than happy to switch me to the tested stuff.

A great addition to the anti-CVD, plaque regression stack. The only minuscule downside is 2x / day dosing.

The EVAPORATE trial showed a 17% reduction in Low Attenuation Plaque, the type most likely to break off and form clots.

The combo of this, a statin, ezetimebe, K2, a GLP, and a PCSK9 inhibitor and we're pretty much as far into heart disease reversing territory as current medicine can get us.

 

[Photon]

A great addition to the anti-CVD, plaque regression stack. The only minuscule downside is 2x / day dosing.

The EVAPORATE trial showed a 17% reduction in Low Attenuation Plaque, the type most likely to break off and form clots.

The combo of this, a statin, ezetimebe, K2, a GLP, and a PCSK9 inhibitor and we're pretty much as far into heart disease reversing territory as current medicine can get us.

Isn't the main target for this to lower high fasting trigs?

 

[Ghoul]

Isn't the main target for this to lower high fasting trigs?

It's used off label for triglycerides. but its main indication is to lower overall risk of cardiovascular events by 25%, which isn't primarily explained by the TG reduction, but a combination of its very strong hsCRP anti-inflammatory effect, anti-oxidant properties, endothelial function improvement and plaque stabilization.

Usually prescribed to people post stroke or heart attack....as usual, after the fact.

It should be OTC like any other Omega 3 supplement.

 

[Wizbang]

It's used off label for triglycerides. but its main indication is to lower overall risk of cardiovascular events by 25%, which isn't primarily explained by the TG reduction, but a combination of its very strong hsCRP anti-inflammatory effect, anti-oxidant properties, endothelial function improvement and plaque stabilization.

Usually prescribed to people post stroke or heart attack....as usual, after the fact.

It should be OTC like any other Omega 3 supplement.

I had a MI in 2020, so thus my interest.

 

[Ghoul]

I had a MI in 2020, so thus my interest.

That explains it. It's usually difficult to get insurance to cover it. Really solid evidence of its benefits so it's great you're on it, since regular fish oil doesn't come close.

Self pay is $100/mo for a generic with GoodRx, $40 / mo from India pharma.

 

[Wizbang]

That explains it. It's usually difficult to get insurance to cover it. Really solid evidence of its benefits so it's great you're on it, since regular fish oil doesn't come close.

Self pay is $100/mo for a generic with GoodRx, $40 / mo from India pharma.

Even less from Costplus