Statins when you’re homozygous APOE4

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Re: Statins when you’re homozygous APOE4

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bombsh3ll wrote: Sat Jun 08, 2024 2:52 pm
rep wrote: Sat Jun 08, 2024 12:35 pm
Do you consider 66 to be too late to make changes?

Unless you are on your deathbed it is NEVER to late to make improvements! They may be less impactful than if you'd made them at 20 but if there is something you know you can do to help yourself, the next best time to do it is now!
Thank you! Making plans to make changes soon!
BTW I don't quite have the hang of this yet. I don't see how I can reply withOUT the quote. Would appreciate guidance if you have a minute. If not no problem.
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Re: Statins when you’re homozygous APOE4

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rep wrote: Sat Jun 08, 2024 12:35 pm AnnieV - Do you consider 66 to be too late to make changes? With the exception of eating saturated fat (and margarine for my first 30 years before most people knew better) I lifestyle has been good for E4 but cholesterol and CAC scan nonetheless bad for my age putting me in the 75th percentile.
Annie, I've seen studies where even folks our age can improve our chances by exercising, even if you had not done much before. Even a little can help. Start walking. Do some light weights. Work your way up bit by bit.
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Re: Statins when you’re homozygous APOE4

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rep wrote: Sat Jun 08, 2024 12:16 pm Nords - May I ask your age, as the CAC score must be placed in the context of age to understand it. I am a female, 66 and just got a score of 87. I have very high cholesterol and expect my cardiologist to suggest a statin at my appointment in a couple weeks.
I'm 63 years old, but starting my 60s was the primary reason for my risk factor edging higher.

The ~10% risk of a heart attack during the next decade doesn't seem so bad, but compounding those odds over the next three decades (perhaps the rest of my life) makes the probability more discouraging.

I'm not that concerned about rising cholesterol levels, and I've already reasonably reduced it in my diet. Yet having a higher ApoB and direct evidence of calcium in my cardiac arteries is a much more compelling reason to consider statins.
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Re: Statins when you’re homozygous APOE4

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Nords wrote: Sun Jun 09, 2024 1:04 pm I'm not that concerned about rising cholesterol levels, and I've already reasonably reduced it in my diet. Yet having a higher ApoB and direct evidence of calcium in my cardiac arteries is a much more compelling reason to consider statins.
I've tried a number of Statins and they all caused muscle breakdown. There are newer drugs out there. Repatha seems to have helped. I've recently been given Nexletol, but haven't yet tested since. Because of my diabetes, I've been lowering carbs and increasing my fat intake, and even so, my cholesterol has been dropping the last few years. I'm close to normal for most of the measures.
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Re: Statins when you’re homozygous APOE4

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Nords wrote: Sun May 12, 2024 8:27 pm A month ago on this thread, my family doctor was politely pushing back on my long-term trend of rising cholesterol. I also scored a moderately high Lp(a) of 107 and a moderately high ApoB of 106.

Coincidentally, the week after those results came back, a family friend (a retired Marine) had urgent triple bypass surgery. He’s in his mid-50s and he still exercises like, well, a Marine, but he frequently felt tired during the day and had less stamina.

He went to his local clinic on Friday afternoon for a routine checkup. One question led to another, a stethoscope check led to an EKG, and the data was alarming enough that they operated on Monday morning. He’s recovering just fine with his substitute cardiac arteries, but I felt like I was supposed to pay attention to a not-so-subtle message about risk factors.

I’ve just finished my coronary artery calcium scan. It’s... all right... at 194 with “mild non-obstructive coronary artery disease” and “mildly calcified plaque resulting in minimal stenosis of the left anterior descending artery.”

For those who aren’t familiar with the process, we spent extra to do the CT scan with an iodine contrast (Iohexol). The techs spent about 15 minutes fussing over the setup and the first set of scans while monitoring my blood pressure. (Apparently people get pretty upset in the machine with a combination of white coat syndrome and claustrophobia, but I’m a submarine veteran.) After consulting with the duty doctor, they decided my blood pressure was good enough (115/60!) to administer a nitroglycerin tablet (under my tongue) to dilate my blood vessels. The effect feels like a tingly hot flush, and it dropped my BP down to 105/53 with a pulse of 52.

The scans are synchronized to record images when the heart’s between beats, so a slow heartbeat meant that the entire test moved faster. I was only in there for another 15 minutes.

The scan also showed no blood clots and no valve degeneration.

However the trend is the important part, not so much the score. Or, as my family doc wrote, “You do have some narrowing of your main coronary artery. Your total score was 194, which places you at moderate risk for future cardiac events. It would be my recommendation that we lower your cholesterol to mitigate risk of progression.”

As I’ve written before, the risks are relatively low over the next decade-- but a little scary in the context of three decades.

Since all of the indicators are heading in the same direction, and since there’s slightly more evidence that APOE4s can tolerate statins than not, I’m willing to experiment with a low dose.

As others have mentioned, the doctor and I going to chat about a hydrophilic one-- probably rosuvastatin.
I’m doing a Cleerly scan - which uses AI to accurately assess a CCTA - in about 6 weeks. My calcium score five years ago at age 52 was zero, but calcified plaque is only part of the story. A CIMT scan of my carotid showed good thickness (that of someone 20 years younger) but also the start of some mild plaque.

At that point I did start a statin - 5 mg Rosuvastatin - and it nicely lowered my ApoB from 91 to 70. At the same time I saw my a1C rise from 5.4 to 5.7 over eight months - an issue I flagged on my own with self-testing and a known side effect of statins, particularly Rosuvastatin and Atorvastatin. As insulin resistance is also a significant risk factor for Alzheimer’s I discontinued the statin (against my doctors advice) but in the spirit of shared decision making he agreed to try ezetimibe. It’s not anti-inflammatory like a statin but all my tested inflammatory markers are already quite low.

My a1C fell back to 5.4 and my ApoB fell to 75. I’ll take it.

But - if the Cleerly shows significant plaque I may need to revisit a statin - possibly Livalo. It’s lipophilic but studies seem to indicate no difference in Alzheimer’s/dementia prevalence and it’s supposed to have the smallest effect on metabolic health.

So - my point is it seems like a trial of Rosuvastatin would be a good idea for you and many have no issues - but some (like me) do - despite being what my wife calls a “health extremist” with diet, exercise, sleep etc. Make sure you track your blood sugar.

Good luck!
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Re: Statins when you’re homozygous APOE4

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Verbow wrote: Mon Jun 17, 2024 7:55 am Make sure you track your blood sugar.
Thanks-- I will.
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Re: Statins when you’re homozygous APOE4

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mike wrote: Mon Jun 10, 2024 9:25 am
Nords wrote: Sun Jun 09, 2024 1:04 pm I'm not that concerned about rising cholesterol levels, and I've already reasonably reduced it in my diet. Yet having a higher ApoB and direct evidence of calcium in my cardiac arteries is a much more compelling reason to consider statins.
I've tried a number of Statins and they all caused muscle breakdown. There are newer drugs out there. Repatha seems to have helped. I've recently been given Nexletol, but haven't yet tested since. Because of my diabetes, I've been lowering carbs and increasing my fat intake, and even so, my cholesterol has been dropping the last few years. I'm close to normal for most of the measures.
Mike,
Are you still mostly carnivore? Is Repatha alone (no other drug) keeping your cholesterol low enough for Dr. Bredesen's recommendations?
I can no longer eat fish/shellfish and my cholesterol has gone way, way too high. Do you have any side effects from the Repatha? I know I have a bad gene for myopathy from statins and reluctant to take them anyway. Do you know if Medicare covers Repatha?
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Re: Statins when you’re homozygous APOE4

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rep wrote: Sat Jul 06, 2024 9:42 pm Mike,
Are you still mostly carnivore? Is Repatha alone (no other drug) keeping your cholesterol low enough for Dr. Bredesen's recommendations?
I can no longer eat fish/shellfish and my cholesterol has gone way, way too high. Do you have any side effects from the Repatha? I know I have a bad gene for myopathy from statins and reluctant to take them anyway. Do you know if Medicare covers Repatha?
Yes, mostly meat and dairy and low carb vegies. Repatha seems to have helped, though the doc wants it lower. No side effects. Don't know about Medicare. Let us know if you find out. I've been taking Nexletol recently and will test lipids and muscle breakdown again in a week or so.
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