My LDL-C averages 100-125 with a low of 87 in 2019.
ApoB was measured once at 99
Lp(a) was. measured twice (70 and 77)
43 - 190lbs at 5’10” and no family history of heart attacks. I don’t smoke, blood pressure is 100-110/70.
The website: https://www.lpaclinicalguidance.com - referenced by BBM gives me a 10-11% of heart attack by 80. That seems fairly low. I’ve yet to employ a consistent cardio program year-round and will be starting that. I’m also in the process of removing Chick-Fil A, periods of nightly cookies/ice cream binges etc from my diet and will retest in 2-3 months.
That said, I corresponded with Dr. Spencer Nadolsky and we’re around the same size/age and he said he takes a low dose statin and ezetimibe. Unless I’m unaware of his family history etc., he and his brother are jacked too, it makes me wonder if I should be taking one too. I know Layne takes them but his parents are obese from what I remember so maybe more genetic risk factors.
Questions:
Based on my numbers and risk - will I be able to see an appreciable reduction in those numbers with added cardio and cleaning up diet?
At what percent risk should people begin to discuss statins with their doctor?
1- This is not something we can confidently predict in advance, but the fact that you had that LDL-c measurement of 87 in 2019 does suggest to me that you’ll likely have some responsiveness to lifestyle. Regardless, the only way to find out is to try it. Significant increases in physical activity, as well as significant dietary changes can all be helpful for those who are not dealing with significant genetic predisposition to high blood lipid levels. The dietary changes can include
-increasing soluble fiber from dietary sources (oats, berries, vegetables), and/or supplemental fiber sources such as psyllium
-substituting animal-derived saturated fat sources with unsaturated sources
-incorporating things like mixed nuts/seeds (walnuts, chia/flax, etc.)
-increasing plant-derived protein sources in the diet (tofu, edamame, legumes, etc)
2- Current clinical guidelines suggest that when 10-year cardiovascular risk is estimated at 7.5% or greater, that statins can be considered. However, there are a number of issues with this advice, particularly when it comes to younger individuals who are less concerned with 10-year risk and more with lifetime risk – which may be better captured by 30-year estimates, as in the PREVENT calculator (… although this does not currently account for Lp(a)). Regardless of these calculators, though, it’s a very individual decision that requires one-on-one consultation to figure out.
Thanks doc! I checked the PREVENT and the gave me the following:
CVD: 30 year risk is 10%
ASCVD: 7%
Heart Failure: 4.2%
I’ll double check with a cardiologist though their advice seems to wildly vary depending on who you see - anecdotally from friends/family (take a statin, don’t take one etc. and it’s the same patient)
I’ll begin doing cardio with the latest Low Fatigue program I got from you guys and reduce fast food/snacks and see how it goes by October! Thanks