Who here is on a statin?

[Ghoul]

You’re right, I should be using some protection…
Since it’s been more than 6 weeks since my last bloodwork, I repeated the tests yesterday while taking omega-3s, cutting calories quite a bit, and eating as clean as possible.
Considering that I haven’t done a blast in a while, and I’m not even sure if I’ll do one again, I feel fine at 200 mg of testosterone per week.

Would you take ezetimibe year-round without stopping, and maybe just add a statin during blasts? Or would you only use these drugs during periods when doses go up a bit?

Basically, I’d like to understand if these meds are something to keep in all year long… also, if they’re used for a few months and then stopped, is there any kind of rebound effect on blood lipids?

I would take eze and a statin year round. There is no rebound, but you should stay on them if your baseline LDL is over 100. Consider them just another daily vitamin or supplement like the Omega 3 and others you're taking.

As long as you have no sides, which is most likely the case, there's no downside and only benefits your long term health.

The risks of high cholesterol have become much clearer in recent years. The European Society of Cardiology just released their latest cholesterol guidelines, which reinforce a couple of very easy to understand points.

1. LDL is the primary risk for arteriosclerosis, and it begins to develop as soon as it rises over 60. Other markers are useful, but nothing matters nearly as much as LDL. There's no doubt.

2. Current treatment is overly conservative, mostly guided by cost, not health outcomes, and starts far too late in life.

Most gear users fall into the "High risk" category. At 100+ LDL lifestyle (diet and exercise), AND meds to lower LDL are advised to be started immediately.




If money were no object to the medical / insurance establishment, whatever it took to get LDL below 55 would be done. Right now, PCSK9 inhibitors, which most would need to accomplish that, are too expensive at $7,000/yr. Statistically they know people will suffer heart attacks and strokes that could be avoided with it, but not enough to make it worth the money to give to more people.

"NNT" means "Number Needing Treatment" to save a single life over 10 years of that treatment. "Triple" is Statin+Eze+PCSK9. It's more cost effective to save a life among the high risk group, which is why expensive triple therapy lipid lowering is reserved for the higher risk groups. Too bad for the ones who'll needlessly die in the lower risk groups.




LDL over 60 means you're laying down plaque in your arteries.

After a total of 5000 "LDL years" cumulative exposure, you'll have arteriosclerosis, So 50 years of average 100 LDL and you're at high risk of being on the operating table if you're lucky, or having a heart attack if you're not.

The sooner you stop using up those 5000 LDL "hit points", the better off you'll be.

https://www.escardio.org/static-file/Escardio/Guidelines/Products/Slide%20sets/2025/2025%20official%20slides_Dyslipidaemias.pdf

 

[ganciodestro]

I would take eze and a statin year round. There is no rebound, but you should stay on them if your baseline LDL is over 100z

As long as you have no sides, which is most likely the case, there's no downside and only benefits your long term health.

The risks of high cholesterol have become much clearer in recent years. The European Society of Cardiology just released their latest cholesterol guidelines, which reinforce a couple of very easy to understand points.

1. LDL is the primary risk for arteriosclerosis, and it begins to develop as soon as it rises over 60. Other markers are useful, but nothing matters as nearly as much as LDL. There's no doubt.

2. Current treatment is overly conservative, mostly guided by cost, not health outcomes, and starts far too late in life.

Most gear users fall into the "High risk" category. At 100+ LDL lifestyle (diet and exercise), AND meds to lower LDL are advised to be started immediately.

View attachment 346645


If money were no object to the medical / insurance establishment, whatever it took to get LDL below 55 would be done. Right now, PCSK9 inhibitors, which most would need to accomplish that, are too expensive at $7,000/yr. Statistically they know people will suffer heart attacks and strokes that could be avoided with it, but not enough to make it worth the money to give to more people.

"NNT" means "Number Needing Treatment" to save a single life over 10 years of that treatment. "Triple" is Statin+Eze+PCSK9. It's more cost effective to save a life among the high risk group, which is why expensive triple therapy lipid lowering is reserved for the higher risk groups. Too bad for the ones who'll needlessly die in the lower risk groups.

View attachment 346643


LDL over 60 means you're laying down plaque in your arteries.

After a total of 5000 "LDL years" cumulative exposure, you'll have arteriosclerosis, So 50 years of average 100 LDL and you're at high risk of being on the operating table if you're lucky, or having a heart attack if you're not.

The sooner you stop using up those 5000 LDL "hit points", the better off you'll be.

https://www.escardio.org/static-file/Escardio/Guidelines/Products/Slide%20sets/2025/2025%20official%20slides_Dyslipidaemias.pdf

Thank you so much for your availability and for this free information!! You’ve really given me a much clearer picture!





Since I’m not taking anything right now, would it be better to maybe start with just Eze at 10 mg/day and see how it goes before adding a statin?


Or is it better to start with Pita without Eze and add it later if needed?


Or would it be best to start directly with Eze + Pita?





Thanks a lot!

 

[Ghoul]

Thank you so much for your availability and for this free information!! You’ve really given me a much clearer picture!





Since I’m not taking anything right now, would it be better to maybe start with just Eze at 10 mg/day and see how it goes before adding a statin?


Or is it better to start with Pita without Eze and add it later if needed?


Or would it be best to start directly with Eze + Pita?





Thanks a lot!

The risk of sides with eze or pita are extremely low, but it's sensible to start with one, then the other a week later, just in case you are the .001% that has some allergic reaction, you'll know which med is causing it. If you have both on hand I'd start with Pita simply because it's going to provide most of the benefit. If cost is an issue 2mg Pita is 80% as effective as 4mg, so you can split tabs. They can be taken any time of day, with or without food. So use whatever schedule makes it most likely that you'll stick with it.

Long term consistency is where most of the benefits are.

 

[ganciodestro]

The risk of sides with eze or pita are extremely low, but it's sensible to start with one, then the other a week later, just in case you are the .001% that has some allergic reaction, you'll know which med is causing it. If you have both on hand I'd start with Pita simply because it's going to provide most of the benefit. If cost is an issue 2mg Pita is 80% as effective as 4mg, so you can split tabs. They can be taken any time of day, with or without food. So use whatever schedule makes it most likely that you'll stick with it.

Long term consistency is where most of the benefits are.

If just Pita alone brings me to an optimal value, could I skip adding Eze?
Also, if I stop taking it, has any LDL rebound ever been observed (a sudden increase after stopping)?

Not sure if it matters to mention, but I’m 30 years old and my 200 mg testo weekly dose will be for a life so even this add of statin will be.

 

[Ghoul]

If just Pita alone brings me to an optimal value, could I skip adding Eze?
Also, if I stop taking it, has any LDL rebound ever been observed (a sudden increase after stopping)?

Not sure if it matters to mention, but I’m 30 years old and my 200 mg testo weekly dose will be for a life so even this add of statin will be.

There's no rebound. You'll just return to where you were.

If Pita brings you below 55 you could skip the eze, And one less pill is always a noble goal.

However, there is no lower limit of LDL below which risk doesn't continue to decline. "Lower is better" is the unofficial motto of preventative cardiology.

And one other benefit to eze. Ezetimibe blocks cholesterol absorption in the intestines. Now most of what's being blocked, 80%+ is cholesterol produced in the liver, which dumps it into the intestines, then it's absorbed in the bloodstream (sounds weird I know, but that's how it works).

But the other 20% being blocked is dietary cholesterol. This gives you a little more "dietary flexibility", and the ability to eat saturated fats without them raising cholesterol as much as they otherwise would. So you could eat more red meat for instance without affecting your lipids as much.

 

[ganciodestro]

There's no rebound. You'll just return to where you were.

If Pita brings you below 55 you could skip the eze, And one less pill is always a noble goal.

However, there is no lower limit of LDL below which risk doesn't continue to decline. "Lower is better" is the unofficial motto of preventative cardiology.

And one other benefit to eze. Ezetimibe blocks cholesterol absorption in the intestines. Now most of what's being blocked, 80%+ is cholesterol produced in the liver, which dumps it into the intestines, then it's absorbed in the bloodstream (sounds weird I know, but that's how it works).

But the other 20% being blocked is dietary cholesterol. This gives you a little more "dietary flexibility", and the ability to eat saturated fats without them raising cholesterol as much as they otherwise would. So you could eat more red meat for instance without affecting your lipids as much.

Ok, thank you so much. I saw that in the pharmacy in my town, Pita costs really a lot: 28 tablets of 1 mg are 21 euros…

What would be another option with minimal side effects like Pita? Apparently, all the others are cheaper, except that one lol

 

[Sampei]

Ok, thank you so much. I saw that in the pharmacy in my town, Pita costs really a lot: 28 tablets of 1 mg are 21 euros…

What would be another option with minimal side effects like Pita? Apparently, all the others are cheaper, except that one lol

Simvastatin or go with rosu 5mg EOD + ezetimibe

 

[Ghoul]

Ok, thank you so much. I saw that in the pharmacy in my town, Pita costs really a lot: 28 tablets of 1 mg are 21 euros…

What would be another option with minimal side effects like Pita? Apparently, all the others are cheaper, except that one lol

Pravastatin 40mg is the next safest.

Rosuvastatin, at a low dose, 10mg, has a very low risk of side effects, and is likely the very cheapest statin on the market. Most people use that dose for many years with no issues. Higher doses, 20-40mg increase the chance of (temporary) side effects. This is the statin most doctors prescribe first. If someone has a problem on it, they switch them to prava or pitavastatin.

 

[ganciodestro]

Pravastatin 40mg is the next safest.

Rosuvastatin, at a low dose, 10mg, has a very low risk of side effects, and is likely the very cheapest statin on the market. Most people use that dose for many years with no issues. Higher doses, 20-40mg increase the chance of (temporary) side effects. This is the statin most doctors prescribe first. If someone has a problem on it, they switch them to prava or pitavastatin.

Ok, pravastatina seems to be a much cheaper option. In terms of potency in lowering LDL, how does it compare to 4 mg of Pita?





I found out that my father takes atorvastatin and it costs really little… now I’m not sure about the side effects.

 

[Sampei]

Pravastatin 40mg is the next safest.

Rosuvastatin, at a low dose, 10mg, has a very low risk of side effects, and is likely the very cheapest statin on the market. Most people use that dose for many years with no issues. Higher doses, 20-40mg increase the chance of (temporary) side effects. This is the statin most doctors prescribe first. If someone has a problem on it, they switch them to prava or pitavastatin.

Difference of benefit between 10mg and 5mg is negligible and the possibilities of insulin resistance and side effect is almost double for what I remember. 5mg is the best risk/benefit ratio for rosu. Even 5mg EOD gives great LDL reduction especially paired with ezetimibe

 

[Ghoul]

Ok, pravastatina seems to be a much cheaper option. In terms of potency in lowering LDL, how does it compare to 4 mg of Pita?





I found out that my father takes atorvastatin and it costs really little… now I’m not sure about the side effects.

Pita 2-4
Prava 40
Rosu 5 daily

All reduce LDL by approx ~40%

Pita has the lowest risks, insulin and muscle sides.

Prava the next lowest.

Rosu is low but higher than Prava.

Rosu 5mg eod only reduces LDL by about 20%.

Eze (10mg is the only dose) will drop LDL another 15-25%.

 

[ganciodestro]

Pita 2-4
Prava 40
Rosu 5 daily

All reduce LDL by approx ~40%

Pita has the lowest risks, insulin and muscle sides.

Prava the next lowest.

Rosu is low but higher than Prava.

Rosu 5mg eod only reduces LDL by about 20%.

Eze (10mg is the only dose) will drop LDL another 15-25%.

Wow thank you so much!!
Atrovastatine what about ?

 

[Ghoul]

Wow thank you so much!!
Atrovastatine what about ?

It's older, with much higher risk for insulin resistance and muscle pain. The older the statin, the worse risks and side effects are, which is where the bad reputation comes from. Rosu, Prava and most recently Pita are the "new generation" statins. If someone has been on an older statin with no problems, doctors won't change it, but no cardiologist would prescribe atorvastatin to new patients anymore,

Rosy is very cheap, effective, and much safer than older statins. It's the #1 statin for new prescriptions. Prava and especially Pita are usually reserved for those who have a problem on Rosu, because of cost. Pita used to cost $300/mo before it became generic, and it was hard to get insurance to cover it,

 

[ganciodestro]

It's older, with much higher risk for insulin resistance and muscle pain. The older the statin, the worse risks and side effects are, which is where the bad reputation comes from. Rosu, Prava and most recently Pita are the "new generation" statins. If someone has been on an older statin with no problems, doctors won't change it, but no cardiologist would prescribe atorvastatin to new patients anymore,

Welcome to italy here everything is possible ahahahahah
Jokes aside, in terms of healthcare we are very behind and closed-minded.

 

[Sampei]

Welcome to italy here everything is possible ahahahahah
Jokes aside, in terms of healthcare we are very behind and closed-minded.

You should be thankful to be in Italy, you can walk in a pharmacy and buy most of the meds you need for peanuts unlike USA.

And you just need to request to you GP rosuvastatin and he will prescribe it to you and will cost you 0 euro.

So no you are deadly wrong

 

[Duke309]

Pita 2-4
Prava 40
Rosu 5 daily

All reduce LDL by approx ~40%

Pita has the lowest risks, insulin and muscle sides.

Prava the next lowest.

Rosu is low but higher than Prava.

Rosu 5mg eod only reduces LDL by about 20%.

Eze (10mg is the only dose) will drop LDL another 15-25%.

Split your ezetimibe 10mg pills and take 5mg per day and save money for approximately the same reduction in LDL (26.1% vs 25.8%).

Source:

Ezetimibe 5 and 10 mg for lowering LDL-C: potential billion-dollar savings with improved tolerability - PubMed

These data strongly suggest that ezetimibe 5 mg and ezetimibe 10 mg are clinically equivalent with respect to LDL-C reduction and achievement of ATP III LDL-C goals. Widespread adoption of this low-dose strategy could result in a potential cost savings of more than a billion dollars annually...

pubmed.ncbi.nlm.nih.gov

 

[ganciodestro]

You should be thankful to be in Italy, you can walk in a pharmacy and buy most of the meds you need for peanuts unlike USA.

And you just need to request to you GP rosuvastatin and he will prescribe it to you and will cost you 0 euro.

So no you are deadly wrong

Maybe I didn’t express myself clearly. Here, people are closed-minded. Sure, the healthcare system works differently economically and bureaucratically compared to the USA, but in terms of mentality we are very behind.
For example, here they don’t prescribe TRT even to men who are hypogonadal, and when they do prescribe it, they give a dose of just one vial of testosterone per month.

 

[OldGHGuy]

Pita 2-4
Prava 40
Rosu 5 daily

All reduce LDL by approx ~40%

Pita has the lowest risks, insulin and muscle sides.

Prava the next lowest.

Rosu is low but higher than Prava.

Rosu 5mg eod only reduces LDL by about 20%.

Eze (10mg is the only dose) will drop LDL another 15-25%.

Thanks alot Ghoul. Had to get Eze on order to add to my Atorvastatin and 2)contact doc to see about updating statin to Pita (if its avaialble in the US). My numbers are good on the statin alone but would adding Eze just on blast make sense?

 

[Ghoul]

Thanks alot Ghoul. Had to get Eze on order to add to my Atorvastatin and 2)contact doc to see about updating statin to Pita (if its avaialble in the US). My numbers are good on the statin alone but would adding Eze just on blast make sense?

Define "Good" numbers and I can give you a better answer.

Pitavastatin is 100% available in the US and insurers no longer require preauthorization. If you're over 40 it's free (no copay, by law) otherwise you just pay the usual deductible. If you have to pay cash for whatever reason, it $30/mo.

Now whether your primary care provider knows about it is another matter, lol. Buddy of mine got a prescription via telehealth. And while it only took five minutes (Sesame Health), the woman who wrote him the 90 day prescription said "I've been a cardiac nurse for 10 years and never heard of it, I looked it up and it sounds great, I can't believe this isn't prescribed more often".

 

[Ghoul]

Split your ezetimibe 10mg pills and take 5mg per day and save money for approximately the same reduction in LDL (26.1% vs 25.8%).

Source:

Ezetimibe 5 and 10 mg for lowering LDL-C: potential billion-dollar savings with improved tolerability - PubMed

These data strongly suggest that ezetimibe 5 mg and ezetimibe 10 mg are clinically equivalent with respect to LDL-C reduction and achievement of ATP III LDL-C goals. Widespread adoption of this low-dose strategy could result in a potential cost savings of more than a billion dollars annually...

pubmed.ncbi.nlm.nih.gov

It's a reasonable option if ezetimibe is hard to get or costly, but that was a very small (240 patients) , short study done by the Veterans Administration looking to save money when it was expensive (90 tabs $1500 !!) and they didn't end up splitting.

The FDA looked at much larger group, testing doses from .25mg to 40mg. They found that the benefit, in the vast majority, plateaued at 10mg.

Between 5 and 10mg LDL reduction on average was 16% and 19%, or 20% more reduction with 10mg. Bigger doses didn't lower LDL much more so they settled on 10mg as the standard.

Now as a generic it's only $14 for 90 x 10mg tablets in the US.