Dr. Baraki / Feigenbaum,
Had some lab work performed this year (been 3.5 years since my last workup) and wasn’t surprised at the results. We have established in previous conversations that I am sensitive to energy intake with my lipids trending up/down along with my weight and waist measurement. Link here: Triglycerides & HDL Improving, But Not LDL... - Medical Q/A with Drs. Feigenbaum & Baraki - Barbell Medicine Forum
Looking at my labs from this year, I was certain that my PCP would recommend a statin. To my surprise, they did not. They recommended CoQ10 and Fish Oil. She said she was not concerned since I did not have a family history of CVD. Having consumed all the podcasts on these supplements, I was skeptical towards both recommendations, especially the fish oil. My question is “should I get a second opinion on the statin recommendation, or try the CoQu10 and diet modification?” This is a new PCP that I am seeing for the first time at the local family clinic. She is a Nurse Practitioner there, practicing with other MDs (if that matters). Below is her write up affixed to my chart.
New Labs and Previous:
|
Total Chol |
Tri |
HDL |
LDL |
LDL C |
Non HDL |
Weight |
Waist |
kCal |
Carb |
Protein |
Fat |
Sugars |
Fiber |
Sat |
Mono |
Poly |
| 2007 |
247 |
284 |
38 |
151 |
179 |
209 |
240 |
43" |
|
|
|
|
|
|
|
|
|
| 2009 |
221 |
343 |
38 |
114 |
160 |
183 |
225 |
42" |
|
|
|
|
|
|
|
|
|
| 2018 |
163 |
108 |
40 |
101 |
104 |
123 |
195 |
37.5" |
2150 |
211 |
194 |
59 |
46.3 |
33 |
28 |
10 |
5 |
| 2019 |
222 |
79 |
47 |
159.2 |
157 |
175 |
205 |
38.5" |
2502 |
240 |
226 |
75 |
53 |
30 |
23 |
12 |
7 |
| 2024 |
260 |
171 |
52 |
|
176 |
208 |
209 |
38" |
2470 |
234 |
199 |
83 |
57 |
29 |
24 |
7 |
6 |
Write Up:
I am already planning to change my nutrition to work on getting my waist circumference and weight down. I’m increasing fiber intake and reducing the amount of fats (overall and saturated) in my diet. However, I feel like y’all’s recommendation would be to undergo statin therapy as well to get this under control.
Your NP is following current guidelines which recommend evaluating a person’s 10-year risk of heart disease and using that estimated risk to guide treatment decisions.
We have discussed on our podcast and in other content, the use of a 10-year risk is falling out of favor (we will likely soon be shifting to 30-year risk tools), because the approach to treating cardiovascular disease and risk factors is oriented at reducing the risk of having a heart disease-related complication in your lifetime, not just in the next 10 years. This can significantly change the calculus here, and the balance between potential benefits vs. downsides. I’m not able to provide an individualized recommendation for you here via the forum, though.
I see no reason why CoQ10 is necessary or helpful here. She may be recommending the fish oil on the basis of your triglyceride measurement, but that probably won’t be a life-changing risk modifier here either. See our existing podcasts on fish oil for more detail there.
1 Like
Austin, as always thank you for your invaluable insight. I’ve listened to the fish oil podcast, so it was a hard no on the NP’s recommendations for it. I do remember you mentioning in a response about some small studies on the benefits of CoQ10 in idiopathic cardiomyopathy (which I don’t have). If you were in my position, would you seek a second opinion regarding this lab work or reduce weight / waist measurement (15lbs and 1”) then have another lipid panel to see if the numbers improve?
As much as I don’t want to be on medicine, I’m want to get ahead of any CVD as much as I can. I need to get my weight/waist down regardless, but I was really surprised she didn’t recommend a statin as well - based on what I’ve ready and listened to from BBM.
You have several options here; if you think you can get back to the position you were in for that 2018 lipid panel, and accomplish that within, say, the first half of this year, you may be able to reasonably defer medical treatment (although I don’t have a complete picture of your risk factors here, either). But if it would take much longer than that or if that ends up not being feasible for you, I would not personally be comfortable living with non-HDL-c > 200 mg/dL for a prolonged period of time, and would opt for treatment in parallel/simultaneously with the lifestyle efforts.
Incidentally, a new 30-year risk calculator was just released today, in line with my discussion above: PREVENT Online Calculator - Professional Heart Daily | American Heart Association
Depending on what additional data you have to input, you could adjust lipid parameters and see the impact it would have on your long-term risk profile.
1 Like
Here are the 10 and 30 year results from the PREVENT Online Calculator.
