General Research - Ancillaries

[Sicsemptyran]

Anyway, assume mid-range for the values that matter in the context of this thread thus far, what's the first thing I should try adding (and then measure)? The one with the least potential for negative side effects, I'm assuming. Ezetimibe? And, what dose?

It comes always as a single 10mg dose, and yes it's basically zero risk though similarly fairly low reward for most people, just lowers LDL/ApoB a small amount. Very small amount of people have gastrointestinal issues with it but most don't notice anything at all.

 

[Ghoul]

Thank you for the responses.

I'm interested in the long-term. Both health span and life span.

I'm already on semaglutide (1mg/week) purely for the non-weightloss benefits that I've learned about from this great forum (again–much appreciation to those of you doing the time-consuming research and sharing your findings in an objective manner!).

Anyway, assume mid-range for the values that matter in the context of this thread thus far, what's the first thing I should try adding (and then measure)? The one with the least potential for negative side effects, I'm assuming. Ezetimibe? And, what dose?

The first thing you should address is BP.

That's the main risk factor for the leading cause of death and disability. Start by getting a blood pressure monitor.

Telmisartan is the better of the two as a mono medication. Start at 20, a very low
dose. Wait 2 weeks, if all is well but you're still not at target BP increase to 40. Again, two more weeks to stabilize. While 80 is the max (and common dose), if still not at target, it's better to add low dose Cilnidipine than increasing Telm. It relaxes a different set of blood vessels for more balance than simply opening the same ones even further. 5mg to start, again, two weeks to evaluate for tolerance and effectiveness, Then you can titrate to 10mg if necessary.

A side effect common to all BP meds can be a little fatigue, initially. The reason, obviously, is blood flow is slowed to everything. Expect and endure this. What will happen is the body will respond by constricting certain vessels to, for instance, increase blood flow to the brain. This natural equalizing system is very effective and will resolve any fatigue (if you even experience that, only a minority do). It's just a little slow to adjust, and it's in this first week or two most who quit do so, mistakenly thinking it's permanent.

For lowering lipids, Ezetimibe is the most benign, always the same dose. Some people get minor GI issues initially but they almost always resolve quickly after your digestive system adjusts to the extra fat that's no longer absorbed. It's a modest LDL reduction, around 15%.. If you decide to preemptively get pitavastatin, plan for 2mg (a microdose in the world of statins), as 80% of the benefits are there vs the 4mg "full dose". This lowers the already rock bottom risk of sides even lower. Initial sides of Pita should be, none. You most likely will feel nothing whatsoever.

Because of the long lead times, if you're ordering from India, IMO, the shopping list for maximum flexibility should be 90 day supply of each of these:

Telmisartan 40
Cilnidipine 10
Ezetimebe (it's always 10mg)
Pitavastain 2mg (or 4 and split if that's a better value)

These doses will give you the ability to split, and slowly titrate as needed.

Get yourself a pill cutter and tablet organizer box.

Once everything is dialed in, which may take 2 months, you can switch to combo tablets in the future. IE Telm 40/Cilnidipine 10 and Pita 2/Ezetimibe

Personally I find combo pills to be both easier to deal with, cheaper, and more pleasant from a psychological standpoint.

 

[Ateam2023]

The first thing you should address is BP.

That's the main risk factor for the leading cause of death and disability. Start by getting a blood pressure monitor.

Telmisartan is the better of the two as a mono medication. Start at 20, a very low
dose. Wait 2 weeks, if all is well but you're still not at target BP increase to 40. Again, two more weeks to stabilize. While 80 is the max (and common dose), if still not at target, it's better to add low dose Cilnidipine than increasing Telm. It relaxes a different set of blood vessels for more balance than simply opening the same ones even further. 5mg to start, again, two weeks to evaluate for tolerance and effectiveness, Then you can titrate to 10mg if necessary.

A side effect common to all BP meds can be a little fatigue, initially. The reason, obviously, is blood flow is slowed to everything. Expect and endure this. What will happen is the body will respond by constricting certain vessels to, for instance, increase blood flow to the brain. This natural equalizing system is very effective and will resolve any fatigue (if you even experience that, only a minority do). It's just a little slow to adjust, and it's in this first week or two most who quit do so, mistakenly thinking it's permanent.

For lowering lipids, Ezetimibe is the most benign, always the same dose. Some people get minor GI issues initially but they almost always resolve quickly after your digestive system adjusts to the extra fat that's no longer absorbed. It's a modest LDL reduction, around 15%.. If you decide to preemptively get pitavastatin, plan for 2mg (a microdose in the world of statins), as 80% of the benefits are there vs the 4mg "full dose". This lowers the already rock bottom risk of sides even lower. Initial sides of Pita should be, none. You most likely will feel nothing whatsoever.

Because of the long lead times, if you're ordering from India, IMO, the shopping list for maximum flexibility should be 90 day supply of each of these:

Telmisartan 40
Cilnidipine 10
Ezetimebe (it's always 10mg)
Pitavastain 2mg (or 4 and split if that's a better value)

These doses will give you the ability to split, and slowly titrate as needed.

Get yourself a pill cutter and tablet organizer box.

Once everything is dialed in, which may take 2 months, you can switch to combo tablets in the future. IE Telm 40/Cilnidipine 10 and Pita 2/Ezetimibe

Personally I find combo pills to be both easier to deal with, cheaper, and more pleasant from a psychological standpoint.

Why not just start the combo drugs to start?

 

[Ghoul]

Why not just start the combo drugs to start?

You've got to know what dosage you need first. If you mean why not start with 20 Telm and 5 Cilnidipine, it'd probably be fine, but in the very unlikely event there are sides you wouldn't know which is causing them. Once you have it dialed in you can just order a year+ supply.

 

[Photon]

Once everything is dialed in, which may take 2 months, you can switch to combo tablets in the future. IE Telm 40/Cilnidipine 10 and Pita 2/Ezetimibe

Personally I find combo pills to be both easier to deal with, cheaper, and more pleasant from a psychological standpoint.

Nebivolol too for those who need it.
Telm 40/Cilnidipine 10 + Neb 5/Cilnidipine 10

 

[Ghoul]

Nebivolol too for those who need it.
Telm 40/Cilnidipine 10 + Neb 5/Cilnidipine 10

Everything is just better with a little cilnidipine sprinkled on...

 

[egruberman]

obscure tests or biomarkers you would be curious to see tested on someone

I got a full genome from nebula genomics.

 

[egruberman]

very little additional benefit going below 30

I don't think the data support this. Best I can tell, there's a linear improvement in outcomes the lower one goes.

 

[masonstoner]

The first thing you should address is BP.

That's the main risk factor for the leading cause of death and disability. Start by getting a blood pressure monitor.

Telmisartan is the better of the two as a mono medication. Start at 20, a very low
dose. Wait 2 weeks, if all is well but you're still not at target BP increase to 40. Again, two more weeks to stabilize. While 80 is the max (and common dose), if still not at target, it's better to add low dose Cilnidipine than increasing Telm. It relaxes a different set of blood vessels for more balance than simply opening the same ones even further. 5mg to start, again, two weeks to evaluate for tolerance and effectiveness, Then you can titrate to 10mg if necessary.

A side effect common to all BP meds can be a little fatigue, initially. The reason, obviously, is blood flow is slowed to everything. Expect and endure this. What will happen is the body will respond by constricting certain vessels to, for instance, increase blood flow to the brain. This natural equalizing system is very effective and will resolve any fatigue (if you even experience that, only a minority do). It's just a little slow to adjust, and it's in this first week or two most who quit do so, mistakenly thinking it's permanent.

For lowering lipids, Ezetimibe is the most benign, always the same dose. Some people get minor GI issues initially but they almost always resolve quickly after your digestive system adjusts to the extra fat that's no longer absorbed. It's a modest LDL reduction, around 15%.. If you decide to preemptively get pitavastatin, plan for 2mg (a microdose in the world of statins), as 80% of the benefits are there vs the 4mg "full dose". This lowers the already rock bottom risk of sides even lower. Initial sides of Pita should be, none. You most likely will feel nothing whatsoever.

Because of the long lead times, if you're ordering from India, IMO, the shopping list for maximum flexibility should be 90 day supply of each of these:

Telmisartan 40
Cilnidipine 10
Ezetimebe (it's always 10mg)
Pitavastain 2mg (or 4 and split if that's a better value)

These doses will give you the ability to split, and slowly titrate as needed.

Get yourself a pill cutter and tablet organizer box.

Once everything is dialed in, which may take 2 months, you can switch to combo tablets in the future. IE Telm 40/Cilnidipine 10 and Pita 2/Ezetimibe

Personally I find combo pills to be both easier to deal with, cheaper, and more pleasant from a psychological standpoint.

First of all, thank you Ghoul, for this post, and all other great posts and topics you have shared here on Meso on bloods/lipids/meds.
I'm digging up this old post because I was searching for myself, and right now I'm gonna go the Pita/Ezetimbe route.

My bloods:
HDL - 56
LDL - 132
Apo A1 - 128
Apo B - 92
Lp A - 5.7
CRP - 0.05

This is with a great diet, no gear, weight in check. It's 100% genetic (all family with high values). I'm in my 40's, so this is not gonna get better with time, so I'm going to be pro-active about it.

Starting with:
2mg Pita
10mg Ezetimibe

Gonna closely monitor my BP as well, as I'm gonna start TRT soon.

 

[Ghoul]

First of all, thank you Ghoul, for this post, and all other great posts and topics you have shared here on Meso on bloods/lipids/meds.
I'm digging up this old post because I was searching for myself, and right now I'm gonna go the Pita/Ezetimbe route.

My bloods:
HDL - 56
LDL - 132
Apo A1 - 128
Apo B - 92
Lp A - 5.7
CRP - 0.05

This is with a great diet, no gear, weight in check. It's 100% genetic (all family with high values). I'm in my 40's, so this is not gonna get better with time, so I'm going to be pro-active about it.

Starting with:
2mg Pita
10mg Ezetimibe

Gonna closely monitor my BP as well, as I'm gonna start TRT soon.

Glad to hear it brother.

From keeping my nose in stacks of research, the material that will become the guidelines 20 years from now, I can tell you there’s a shift on what the experts think the approach to BP and Lipids should be.

Unless they’re only slightly elevated, a “pharma first”,approach is being recognized at the most sensible.

Why? Because as noble as “change your diet and exercise” is, and they do have benefits, 90% of factors driving BP and lipids are genetic, and letting damage continue for another year, or more, with those lifestyle changes only having a minimal effect at best is not wise.

Also, we finally have meds for these conditions that aren’t half cure half poison like older generations of pharma, which is what drove the “avoid at all costs” mentality.

Many people take a handful of supplements without thinking twice. Dial in the meds and doses you need for what we know are the ideal ranges for long term health (BP <120/80, LDL <70 but the lower the better), make it part of your daily routine, and then forget about them. The right meds at the right doses won’t be “reminding you” of their presence via side effects.

I just heard a heart surgeon say he’s never seen a patient, in 3+ decades, whose LDL was brought below 55, for at least a year, have a first heart attack.

Anecdotal I know, but it puts the risk reduction stats, impressive as they are when you crush LDL, into some real world context.

 

[masonstoner]

Glad to hear it brother.

From keeping my nose in stacks of research, the material that will become the guidelines 20 years from now, I can tell you there’s a shift on what the experts think the approach to BP and Lipids should be.

Unless they’re only slightly elevated, a “pharma first”,approach is being recognized at the most sensible.

Why? Because as noble as “change your diet and exercise” is, and they do have benefits, 90% of factors driving BP and lipids are genetic, and letting damage continue for another year, or more, with those lifestyle changes only having a minimal effect at best is not wise.

Also, we finally have meds for these conditions that aren’t half cure half poison like older generations of pharma, which is what drove the “avoid at all costs” mentality.

Many people take a handful of supplements without thinking twice. Dial incthe meds and doses you need for what we know are the ideal ranges for long term health (BP <120/80, LDL <70 but the lower the better), make it part of your daily routine, and then forget about them. The right meds at the right doses won’t be “reminding you” of their presence via side effects.

I just heard a heart surgeon say he’s never seen a patient, in 3+ decades, whose LDL was brought below 55, for at least a year, have a first heart attack.

Anecdotal I know, but it puts the risk reduction stats, impressive as they are when you crush LDL, into some real world context.

Yeah, I completely agree with you. I'm a prime example that this is 100% genetic, and there is no excuse to let this get out off control and then try to solve this 5 years from now, when values are gonna be way worse and have a higher risk for a hearth attack.

 

[Ghoul]

Yeah, I completely agree with you. I'm a prime example that this is 100% genetic, and there is no excuse to let this get out off control and then try to solve this 5 years from now, when values are gonna be way worse and have a higher risk for a hearth attack.

Get a CAC score if you need some motivation (assuming you’re north of 40).

And keep us updated with your markers gonna forward. Nothing as inspirational as seeing the potential of numbers similar to what you have moving in the eighth direction.

 

[masonstoner]

Get a CAC score if you need some motivation (assuming you’re north of 40).

And keep us updated with your markers gonna forward. Nothing as inspirational as seeing the potential of numbers similar to what you have moving in the eighth direction.

Will do and I will.

I'm going to start TRT asap, and I will do bloods 7-8 weeks after the start, so I'll share the results here.