Statins when you’re homozygous APOE4

Alzheimer's, cardiovascular, and other chronic diseases; biomarkers, lifestyle, supplements, drugs, and health care.
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SusanJ
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Re: Statins when you’re homozygous APOE4

Post by SusanJ »

Nords wrote:I'm having that statin conversation with my family doc in August.
One last thing, that has been mentioned in other threads, is to look at sterols to understand if you are a hyper absorber. Something else might work better than statins for you, like Ezetimibe.

If you haven't already listened, here's a quick overview from a Rhonda Patrick interview of Peter Attia. Listen to the section about desmosterol, phytosterols, statins and AD.

Maybe see if you could get a Boston Heart Labs test for sterols to help guide your decision.

High lipids run in my family, and for me, it's been a constant challenge. So, I plan to do that test, if my last lifestyle interventions don't lower my ApoB far enough, before choosing a drug.

https://podcast.foundmyfitness.com/epis ... ives-attia

Good luck, and let us know what you decide.
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Re: Statins when you’re homozygous APOE4

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SIN wrote: Sat May 18, 2024 9:47 am Hi I’m 4/4 with a very high CT calcium score and 3 stents - I was advised to come off statins and instead take Repatha and Ezetimibe - seek out a Cleerly heart scan also - you’d be looking for old calcified plaques which are preferable to the softer new plaques which are more prone to rupture - heart disease nowadays is largely preventable - Alzheimer’s is moving in that direction also in my opinion
Why do you say Alzheimer's is moving in that direction? What are you doing to prevent it? I am discouraged. I am a 66 year old female 3/4 and just got a CAC score of 87 which is in the 50-75th percentile. I've heard that statins barely make a difference. I don't have good guidance from my doctors. I've read a lot here but still at a loss of direction. Any advice? I'd be happy with a health coach if they are good at the cholesterol and cardiovascular aspects.
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Re: Statins when you’re homozygous APOE4

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Nords wrote: Sun Mar 24, 2024 1:35 pm
JD2020 wrote: Sun Mar 24, 2024 10:53 am Maybe the answer depends upon the specific chemistry of each individual. I read Lipitor, Thief of Memory long ago.
Also with a half-dozen different types of statins (and a couple newer options for lowering apoB) I think the studies are going to need another decade or two before there's a clear trend.
Hello Nords!
I noticed that you are not taking vitamin K. I have been researching this in more detail, and I believe you may want to look into it.

This podcast is titled oral health, but he goes into detail about how Vit K works and helps our cardiovascular system. I thought I would share. I have been following the host, Ari Whitten, for years, and he is amazing.

https://theenergyblueprint.com/top-hack ... thy-teeth/

I hope this gives you some enough information to dig a little deeper for your situation.

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Re: Statins when you’re homozygous APOE4

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HennDJM wrote: Sat Jun 08, 2024 6:37 am I noticed that you are not taking vitamin K. I have been researching this in more detail, and I believe you may want to look into it.
Thanks. You'd hope that a good diet and a multivitamin would help avoid these issues.
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Re: Statins when you’re homozygous APOE4

Post by HennDJM »

Agreed!!
Research is definitely not my super power, but I have read in different places that APO E4/E4 individuals are hyper vitamin K absorbers. This is why I am looking into this, because we may need to do some modest supplementation.

Just tossing out a nugget to consider.
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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.
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.
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Re: Statins when you’re homozygous APOE4

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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.
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Re: Statins when you’re homozygous APOE4

Post by bombsh3ll »

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!
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Re: Statins when you’re homozygous APOE4

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rep wrote: Fri Jun 07, 2024 8:28 pm
Why do you say Alzheimer's is moving in that direction? What are you doing to prevent it? I am discouraged. I am a 66 year old female 3/4 and just got a CAC score of 87 which is in the 50-75th percentile. I've heard that statins barely make a difference. I don't have good guidance from my doctors. I've read a lot here but still at a loss of direction. Any advice? I'd be happy with a health coach if they are good at the cholesterol and cardiovascular aspects.
Hi rep! It sounds like you need a new doctor! I'm not one, but I recommend going whole foods plant based -- low fat, with only a few healthy fats in your diet. Skip the meat. Eat legumes instead. Increase fiber slowly. Increase viscous soluble fiber, in particular, from food. Cardiologist Dr. Danielle Belardo recommends at least 40-60 grams of fiber a day to lower your cholesterol. There is no upper limit. She herself eats 100 g of fiber in her diet a day. I also recommend reading books by Dr. Dean Ornish.

Here are some useful links:
Drs. Dean and Ayesha Sherzai have a podcast
Podcast "Your Brain on Fats"

Dr. Dean Ornish's study shows that eating whole foods plant based low fat and moderate exercise will significantly improve your bio markers. Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial

Nutritionfacts:
Can Alzheimers Be Reversed with a Plant Based Diet?

I hope you find a better doctor soon who will help you!
e3/4 MTHFR C677T/A1298C COMT V158M++ COMT H62H++ MTRR A66G ++ HLA DR
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Re: Statins when you’re homozygous APOE4

Post by rep »

Thank you Plumster. Unfortunately I cannot go all plant. Due to multiple courses of Cipro that killed off all my Oxalobacter and other good gut bacteria I cannot process oxalates correctly. As a result the oxalate builds up in my body and causes tremendous pain and urinary issues. I know I will need to eat mostly fish and shellfish and there are low oxalate vegetables to choose from, just not enough low-oxalates ones to be plant based. Almonds, for instance, are extremely high in oxalate.
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