MESO-Rx
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Pitavastatin
- Thread starter keengkong
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Unless u show uve had a clot on a statin as i did.. then repatha is handed to u and thru insurance is cheap af…
Ghoul
Member
I mean basically what we're trying to accomplish here is "trick" the system into giving us the same level of protection they'd normally reserve until AFTER you survive a heart attack or stroke, lol.
If the meds were free, cost effectiveness and "resource conservation" no longer factors, the guidelines would have everyone with >130 LDL on PCSK9 / Statin / Ezetimibe triple therapy.
Funny story, if insurance companies agreed to loosen the preauthorization requirements to cover Repatha, Amgen offered them a a money back guarantee. If someone on Repatha for at least six months has a stroke or heart attack, insurance companies get a full refund for Repatha's cost
Amgen Offers Cholesterol Drug With First Refund Guarantee For Heart Attack Or Stroke Sufferers
Amid concerns about the cost of the drug Repatha, pharmaceutical company Amgen is pledging money back guarantees, making its first such deal with Harvard Pilgrim Health Care. "We want to stand behind the value of our products. We want to put skin in the game," said one of Amgen's senior officials.
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Yay for the insurance companies… again… not for those who actually get a stroke or heart attack while on their drugs…I mean basically what we're trying to accomplish here is "trick" the system into giving us the same level of protection they'd normally reserve until AFTER you survive a heart attack or stroke, lol.
If the meds were free, cost effectiveness and "resource conservation" no longer factors, the guidelines would have everyone with >130 LDL on PCSK9 / Statin / Ezetimibe triple therapy.
Funny story, if insurance companies agreed to loosen the preauthorization requirements to cover Repatha, Amgen offered them a a money back guarantee. If someone on Repatha for at least six months has a stroke or heart attack, insurance companies get a full refund for Repatha's cost
Amgen Offers Cholesterol Drug With First Refund Guarantee For Heart Attack Or Stroke Sufferers
Amid concerns about the cost of the drug Repatha, pharmaceutical company Amgen is pledging money back guarantees, making its first such deal with Harvard Pilgrim Health Care. "We want to stand behind the value of our products. We want to put skin in the game," said one of Amgen's senior officials.www.wbur.org
I mean ive had “high” cholesterol for 20 yrs… and yea it could happen and pray to GOD it doesnt but thats why im going to start ezeti and then work my way up to taking the repatha and the others…
Ghoul
Member
I'm also someone who's had decades of exposure to high LDL trying to stop, reverse, and stabilize risk.
Based on what I know, it may be helpful to think of it like this:
1. LDL below 60 - Plaque accumulation stops.
2. LDL below 50 - Soft plaques regress. First, "fresh" plaque is removed, widening the space within the blood vessel. Then "fatty" content in the old, somewhat stiffened plaque mass is sucked out, leaving "dry" plaque behind. This stops the plaque from being metabolically active, so it's no longer a source of inflammation. (old soft plaque is rotting, the "necrotic core" of the plaque body, pumping out inflammatory particles) After stopping plaque accumulation, inflammation reduction within the arteries is the most crucial factor for reducing long term risk. Inflammation within the plaque causes "pimples" to form between the arterial wall and the plaque, which can cause a piece of plaque to break off, leaving a wound (like a scab getting ripped off), then clotting factors come into heal it, blocking off blood flow, causing a heart attack or stroke.
3. As cholesterol is removed from the plaque, what's left behind is a tough layer (the "plaque cap") that's resistant to breaking up. Eventually it calcifies. Your CAC score will go up, but that's a good thing. Calcified plaque is the most stable form, and as long as you're not laying down any new plaque, you've reached the end stage where risk has been reduced to the maximum possible degree.
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Good to know! Cac is darn near 0… so that may scare people a bit to see it go up… but as long as nothing breaks off to cause issues then thats cool
egruberman
Member
Well I'm stoked to know that you'll be living longer as a result of my influence. Kinda gives me warm fuzzies thinking about all the guys I've convinced to take care of this stuff. I'm out there doing god's work, saving meatheads from an early death.
One good turn deserves another. I'll be giving Pitavastatin a whirl and see if I enjoy some of the same benefits, though I imagine all the joint pain I'm experiencing is likely just me overdoing it rather than inflammation.
I'll take the bump in HDL, but the literature that I've seen suggests that with LDL (a rough proxy of ApoB as we all should know) managed, increases in HDL yield no benefit in outcomes.
egruberman
Member
A CAC of 0 is unlikely to go up. It's possible, I suppose, but calcified plaque is an advanced form of ASCVD, as is the type of plaque that would be calcified once stabilized. One would have to get a CT-CAC at exactly the right moment in the development of soft plaque and prior to the develop of calcified plaque.
Ghoul
Member
Not sure I'm following you here.
Plaque calcification typically takes many years, while significant plaque has been found long before any calcification has taken place, even in people in their early 20s. A recent study found people with 0 CAC score and 90%+ blockage! Statins speed up the process of calcification. (this is considered risk reducing because it stabilizes plaque)
I started taking K2 / D3 in an effort to redirect calcium away from arteries to bones to delay that process so the regression made possible by very low LDL, <50, mine is 24, has a longer window of time to reduce plaque volume before it becomes calcified.
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Ghoul
Member
It does indirectly. In the context of plaque regression, reducing Major Adverse Cardiac Events (MACE) by around 25% for every 1% reduction in plaque volume in numerous studies.
LDL level accounts for ~90% of the regression achieved. HDL ~10. HDL function (efflux capacity) appears to be much more significant than HDL quantity, but understanding regression is still early science. Luckily, Pitavastatin uniquely boosts APO-I, improving HDL function and therefore its ability to "reverse transport" cholesterol out of the arteries.
egruberman
Member
On this, I'm speculating. Based on some of the data I'm looking at 10-15% of folks with a zero CAC might progress to having a postiive number. The rest likely lack the predisposition.
Could be wrong, grain of salt, and all that. No matter, if a statin causes the CAC score to go from zero to non-zero that's still a good thing. One should get a CTA if they're really worried.
I'll say. Most cardiologists lack an entire clue that this work is happening. Something that makes me mad as hell.
Ghoul
Member
By 40 35% of men have CAC above 0. By 50 it's 60%. By 70 >90%. I know that a study of
the autopsies of children who died in accidents showed plaque was well established in major arteries by 8 years.
Since calcification is mostly a matter of time, the above rates make sense, Plaques don't really accumulate *on* blood vessel walls, but *in* them. When they reach a certain concentration, cholesterol crystallizes, causing wounds like anything else sharp would. Calcification is the end stage of scarring, basically.
The good news is that starting with the Pcsk9 meds, regression is now a major part of major clinical studies involving LDL reduction.
The thing to keep in mind is that until PCSK9 inhibitors like Repatha, reaching the very low LDL needed to reverse plaque significantly was impossible for most people. The leading edge cardiology and pharmaceutical company chatter is all about regressing being the next frontier. For now, reducing risk by "locking it in" using a statin to accelerate calcification makes sense with what's commonly available,
Once regression starts, it looks like you only get a couple of years worth before what's left has fibrosed or calcified. That's why I'm trying to delay it with K2/D3. Pitavastatin also induces less calcification than any other statin, hopefully leaving the window of opportunity open longer.
If I had a heart attack already though, I'd prioritize stabilizing plaque and forget pursuing max regression,
egruberman
Member
Hello Preacher, meet Choir.
Do this for me, have that paragraph burned into a Louisville slugger. In fact, have it burned into two of them. Then, let's you and I fly to DC and meet at the American College of Cardiology for batting practice.
egruberman
Member
Likewise. Check the form, either MK-4 or MK-7, one of which is more beneficial.
Agreed 100%
Ghoul
Member
I believe it's MK-7 (I hope so it's what I've got lol).
Wish I knew about D3 / k2 calcium "partitioning" benefit earlier. Apparently it appears to prevent cavities too.
I'm the OP, the person who started this thread. Since Ghoul has kept stating reasons why pitavastatin is superior to the other statins, I wanted to check out what he says using Google Scholar. My very quick research shows Ghoul is correct. See https://pmc.ncbi.nlm.nih.gov/articles/PMC9100469/; https://www.actapharmsci.com/uploads/pdf/pdf_722.pdf; https://www.internationaljournalofcardiology.com/article/S0167-5273(19)34045-8/fulltext. Disclaimer: I'm not a scientist and have no background in health or medicine.
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