Chronic low HDL but good LDL (need advice)

[Photon]

I have confirmed no plaque

This is the most important aspect.
Most (not all) will not get side either way, on the lowest possible statin dose.

 

[Sicsemptyran]

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?

Also worth mentioning bempedoic acid reliably lowers hematocrit. Doesn't matter what the hell I throw at myself, haven't seen 50+ hematocrit since I started bempedoic acid. (Currently on quite a bit, 49 hematocrit).

Speak to it a little bit more here. Should update that thread soon.

 

[Sicsemptyran]

This is the most important aspect.
Most (not all) will not get side either way, on the lowest possible statin dose.

Totally agreed. Which is why I think broadly your advice as a whole is spot on, just wanted to call out there are certain edge cases where ez + ba would be the better option. In my case that tiny risk of sides from a statin over the next 40 years just isn't worth it when everything is controlled, obviously can't speak to the OP since I do not know his age/whether he's had a CAC/CT-angiogram.

 

[120nmol]

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?

Correct I have a thread where I track my progress with optimizing lipids you can look into it.

 

[BamaCrazy]

Raising HDL via medications doesn’t reduce risk or change outcomes. Best to focus on lowering LDL, total cholesterol and triglycerides while on cycle.

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

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

 

[AlexDavis43]

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.

Yeah that's the thing. It's clear that lowering LDL is beneficial but it's always been kind of a mystery if pharmacologically elevating HDL is beneficial (vs just having naturally high HDL)

Raising HDL via medications doesn’t reduce risk or change outcomes. Best to focus on lowering LDL, total cholesterol and triglycerides while on cycle.

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

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

 

[BP_6]

HDL they are finding doesn't really seem to matter in overall outcomes either negatively or positively unless it is very high in that case it actually has worse outcomes. As for choosing a statin, start at the lowest dose possible and see how you respond.

I now personally use ezetimbie which I responded very, very well to getting my LDL down to about 57. When I was at my peak blasting gear, it was over 170+. I then tried just 5mg dose of crestor "rosuvastatin" the lowest dose. I was worried about muscle sides but I got none and last bloodwork two weeks ago LDL was at 20. I talked to my cardiologist and he told me he has seen lower with Repatha added in going below 10 and on some less sensitive test it is ND "Not detected" and has never had anyone have any issues. I looked and the studies show this as well and it seems to concur with what he told me. I also haven't noticed any.

I don't need to go any lower obviously, so I will keep it here.

 

[RockyP]

HDL they are finding doesn't really seem to matter in overall outcomes either negatively or positively unless it is very high in that case it actually has worse outcomes. As for choosing a statin, start at the lowest dose possible and see how you respond.

I now personally use ezetimbie which I responded very, very well to getting my LDL down to about 57. When I was at my peak blasting gear, it was over 170+. I then tried just 5mg dose of crestor "rosuvastatin" the lowest dose. I was worried about muscle sides but I got none and last bloodwork two weeks ago LDL was at 20. I talked to my cardiologist and he told me he has seen lower with Repatha added in going below 10 and on some less sensitive test it is ND "Not detected" and has never had anyone have any issues. I looked and the studies show this as well and it seems to concur with what he told me. I also haven't noticed any.

I don't need to go any lower obviously, so I will keep it here.

Can you provide any references regarding that claim that high HDL is actually not a good thing? Not challenging or doubting you, just trying to learn as I also have genetically low HDL and go out of my way to keep LDL very low.

 

[Sicsemptyran]

Can you provide any references regarding that claim that high HDL is actually not a good thing? Not challenging or doubting you, just trying to learn as I also have genetically low HDL and go out of my way to keep LDL very low.

I admittedly just don’t care to spend the time to grab references but we’re talking about HIGH HDL, like 100+ type things.

Theory is that there is some dysfunction going on where your HDL isn’t working and therefore your body overproduces. Growing evidence that very high HDL is a bad sign à la something like lp(a).

 

[RockyP]

I admittedly just don’t care to spend the time to grab references but we’re talking about HIGH HDL, like 100+ type things.

Theory is that there is some dysfunction going on where your HDL isn’t working and therefore your body overproduces. Growing evidence that very high HDL is a bad sign à la something like lp(a).

I can see that would make sense. I do think that what we don't know about heart disease / plaque formation could fill a book, and we track the numbers because they are measurable, perhaps not because they are important. What we do seem to know is that statin's efficacy (if there is any) is secondary to their anti-inflammatory properties, not really having anything to do with LDL, HDL, etc.

 

[BP_6]

Can you provide any references regarding that claim that high HDL is actually not a good thing? Not challenging or doubting you, just trying to learn as I also have genetically low HDL and go out of my way to keep LDL very low.

We're talking about people who have certain mutations that have them get not just high, but very high HDL levels. Like 80's 90s, and more. Some even as high as the low-mid 100's.

 

[Sicsemptyran]

I can see that would make sense. I do think that what we don't know about heart disease / plaque formation could fill a book, and we track the numbers because they are measurable, perhaps not because they are important. What we do seem to know is that statin's efficacy (if there is any) is secondary to their anti-inflammatory properties, not really having anything to do with LDL, HDL, etc.

Eh, I’d disagree with you on that second point. They do absolutely have benefit from the anti-inflammatory property standpoint and are unique in that, but we now have mortality data on multiple different lipid lowering meds (bempedoic acid, ezetimibe, etc) that do not have the inflammation impact and still lower mortality purely by lowering LDL/ApoB.

 

[Sicsemptyran]

We're talking about people who have certain mutations that have them get not just high, but very high HDL levels. Like 80's 90s, and more. Some even as high as the low-mid 100's.

My wife has always had an HDL in the 110-115 range across years of different training/diet regimens.

Interestingly she started ezetimibe and it dropped to 78. Have no real explanation for that one, but take it as a welcomed sign.

 

[RockyP]

Eh, I’d disagree with you on that second point. They do absolutely have benefit from the anti-inflammatory property standpoint and are unique in that, but we now have mortality data on multiple different lipid lowering meds (bempedoic acid, ezetimibe, etc) that do not have the inflammation impact and still lower mortality purely by lowering LDL/ApoB.

I’m admittedly behind on my cardiology risk prevention reading. There is far more useful info on this board than at the American college of cardiology meeting. Thank you.

 

[NotHuman]

Raising HDL via medications doesn’t reduce risk or change outcomes. Best to focus on lowering LDL, total cholesterol and triglycerides while on cycle.

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

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

Yea it is quite possible that artificially raising HDL is just a matter of a number looking prettier on a piece of paper.

Personally, I’d rather have higher HDL just in case but I’m also not losing any sleep over something like anavar lowering it for 8 weeks.

As for Rosuvastatin vs Pitavastatin, I don’t have a strong preference one way or another. It Pitavastatin lowers LDL enough, then I certainly see a use case. It’s more of an individual choice.

 

[Bassman99]

Does anyone share the idea of low Trig, high HDL are they key, while LDL is of low importance when you have low hsCRP and other inflammatory markers with good Apob and LP(a) ?
An eating window and keto diet did this for me
HDL 71
Trig 42
LDL 195
hsCRP 0.2
BP 108/70
No meds taken
This is with just over 2000 T level

Before this diet switch 3 yrs ago
HDL 45
Trig 155
LDL 120
hsCRP 8.x
BP 135/85
Not using Testosterone at all yet

 

[Ghoul]

Does anyone share the idea of low Trig, high HDL are they key, while LDL is of low importance when you have low hsCRP and other inflammatory markers with good Apob and LP(a) ?
An eating window and keto diet did this for me
HDL 71
Trig 42
LDL 195
hsCRP 0.2
BP 108/70
No meds taken
This is with just over 2000 T level

Before this diet switch 3 yrs ago
HDL 45
Trig 155
LDL 120
hsCRP 8.x
BP 135/85
Not using Testosterone at all yet

There's a chance that LDL is not the usual very high risk that 196 would be, but you need an NMR test to know for sure,

 

[Bassman99]

There's a chance that LDL is not the usual very high risk that 196 would be, but you need an NMR test to know for sure,

Im trying to convince Dr to do anything to prove to me Im at risk like carotid artery Ultrasound CAC score etc.
He refused and told me I was going to die in 3 yrs if I didnt go vegan.
Its been 3.5 yrs, Ive changed to a new Dr and getting a physical and blood testing.
I will push for the test you recommended.;
He did get me a CPAP and its helping me with waking up feeling better.
Thanks for the NMR test recommendation!
Nothing is for sure in the medical system IMO.

 

[Ghoul]

Im trying to convince Dr to do anything to prove to me Im at risk like carotid artery Ultrasound CAC score etc.
He refused and told me I was going to die in 3 yrs if I didnt go vegan.
Its been 3.5 yrs, Ive changed to a new Dr and getting a physical and blood testing.
I will push for the test you recommended.;
He did get me a CPAP and its helping me with waking up feeling better.
Thanks for the NMR test recommendation!
Nothing is for sure in the medical system IMO.

Are you in the US?

 

[Bassman99]

Are you in the US?

Yeah California