Should You Take Cholesterol-Lowering Medications?
ฝัง
- เผยแพร่เมื่อ 5 ก.ย. 2024
- 1 in every 5 deaths in the United States is from heart disease, which is inexcusable given that there are so many ways to reduce our risks. For some people, one of those ways is to use cholesterol-lowering medications.
For weekly health research summaries and extra sights, sign up here 👉 drstanfield.co...
💊 Supplements I Take: drstanfield.co...
💊 MicroVitamin (multivitamin & mineral that I take): drstanfield.co...
📜 Roadmap - how to look young & feel strong: drstanfield.co...
✔️ Twitter: / bradstanfieldmd
✔️ Patreon: / bradstanfieldmd
Here are the links to the research papers referenced in the video:
www.cdc.gov/he...
pubmed.ncbi.nl...
pubmed.ncbi.nl...
www.sciencedir...
www.sciencedir...
www.ahajournal...
pubmed.ncbi.nl...
pubmed.ncbi.nl...
www.uptodate.c...
www.uptodate.c...
www.thelancet....
pubmed.ncbi.nl...
www.cochrane.o...
www.cochrane.o...
pubmed.ncbi.nl...
my.clevelandcl...
www.nejm.org/d...
www.ncbi.nlm.n...
The links above are affiliate links, so I receive a small commission every time you use them to purchase a product. The content contained in this video, and its accompanying description, is not intended to replace viewers’ relationships with their own medical practitioner. Always speak with your doctor regarding the content of this channel, and especially before using any products, services, or devices discussed on this channel.
Hope you've had a great start to 2024!
💊 MicroVitamin (multivitamin & mineral that I take): drstanfield.com/products/microvitamin
📜 Roadmap - how to look young & feel strong: drstanfield.com/pages/roadmap
please make a section on your site FOR medical providers. One doctor here had no problem giving me rosuvastatin, was actually happy to do so. But my family doctor disagrees with it. I don't want to be an argumentative patient, but I think it would be great if I could direct her to a specific section on your site where you cite sources and explain reasoning. My doctor would not give me finasteride, because she said I didn't have hair loss that warranted it, even after I explained your video.
Rosuvastatin 2.5mg and 5mg ezetimibe took my ApoB from 116 to 43 and Ldl-c from 99 to 35. No side effects.
I just hate when they always have to come back later and say they are taking it off the market because they found it caused a neurological disorder or something else dangerous…if you’ve lived long enough, you’ve seen that over and over, more times than you can count….
@@Simon-talks Statins are highly specific in what they target unlike some drugs. We know exactly the mechanism of how statins work to a very precise degree. Also the effect of statins lowering apoB is very good for brain health and is preventative of dementia.
that's what they said about fen phen...and boniva and on and on.....
medical doctors highly recommended smoking back in the 1950's, in order to reduce stress. They also recommended leaches and blood letting a few decades before that....in a few decades, this will be looked at as goofy and dangerous too...
Isn’t Zetia only available in 10mg doses?
This was so well-articulated. Your analysis of these important studies was easy to understand and extremely informative. Your recommendations are spot on!
"we have evidence that cholesterol lowering medications do not cause neurodegeneration"
Really? I took statins for 7 months and I was loosing by god damn mind. Many people have had the same. I won't trust what ANY doctor says about anything.
With in 24 hours I stopped taking them, I felt 50% better. One week later, I was my old self.
Here is my story. I have CVD! My high cholesterol is familial. In my early 40's I started taking statin drugs. I am now 77, I have a high calcium score (>2000), I have 70% blockages in 3 locations (determined by cardiac cath). I have not had a heart attack that I know of. My cholesterol numbers are within normal range. I am starting ezetimibe to bring LDL-C number lower based on these recent studies. Now here is anecdotal testimony regarding statin vs no statin therapy. I have an identical twin brother; our lives took separate paths in our early 20's. I cannot comment on his lived lifestyle; though I know he was an avid outdoor adventurer, wilderness trekking, white water kayaking, snowboarding etc. I was fairly active myself. We both are fairly lean, looking at us you would not think we fit the description of someone who has CVD. A few years ago, while snowboarding out West my brother had a mild heart attack; a stent was put in. six months later he had bypass surgery and aortic valve replacement. He now lives with "heart failure" and can no longer live the lifestyle he was used to. In the past we never discussed health issues; but I now know that he was also prescribe statins in his early 40's, however he chose not to based on the "muscle pain" side effects. You are free to draw your own conclusions. One other fact our father lived to be 95; he had a quadruple bypass at 75.
"we have evidence that cholesterol lowering medications do not cause neurodegeneration"
Really? I took statins for 7 months and I was loosing by god damn mind. Many people have had the same. I won't trust what ANY doctor says about anything.
With in 24 hours I stopped taking them, I felt 50% better. One week later, I was my old self.
What were your high and is your lower ldl levels??
Yeah those “muscle pain” are not a joke. I am in my 40s and taking atorvastatin 10mg for the last 5 years ( now I am on atrovastatin before was on some other type, my doctor changed few do to muscle pain) I have such a bad bad muscle pain that sometimes it wakes me up in the middle of the night and i have to take pain medicine, its that strong. I am constantly in pain and my life quality is worsen for this time. I walk and feel like I’m 80 years old. So you’re lucky just like my husband that you don’t have this painful side effect l, bot don’t minimize others reaction and experience. You are putting yourself on pedestal and looking down on your brother. I am going to stop it and try something else , if my doctor is willing to give me. Can’t stand this pain anymore
I looked at the PESA study referenced. It doesn't have any data on VO2 max or other tested fitness metrics. It does mention a self reported vigorous physical activity stat, but most people think they're in better shape than they are. I think there are much better studies on fitness vs. CVD risk. Also, absolute values of all cause mortality should be included in any studies like these.
I also checked it out last time he mentioned it and there were 5-10% of the healthy group that were obese.
This dude is obviously Big Pharma talking or he just dont know how read research. Could point multiple examples in his videos as you probably noticed
Your videos always help me better understand my health and supplements that are beneficial. I am shocked that you have not addressed my problem with taking statins and often happens to others. I have taken Pravastatin since I was 28 years old and thought I did not have any side effects. Then one day when I was cleaning up outside I tore my bicep from my elbow. I have since had the tendon replaced with an Achilles tendon because there was nothing left of the old one. It was my cardiologist that informed me that it was likely the statin I was taking. Can you please create a follow up video discussing this? Please.
I've known multiple people that had cognitioin and memory problems while on statins. The people that realized this early and got off statins reported their memory came back and they could once again think much better. One friend that had a heart attach says he doesnt care what the risk is, he will NEVER take statins again after trying them and having trouble thinking and with his memory and functioning at work as a business analysts in IT. Once he got off the statins he returned to normal. Just because the studies didnt find memory/cognition issues doesnt mean they dont exist.
I am female, almost 70, eat a very healthy Mediterranean diet, exercise daily, and maintain a lean bodyweight and have no family history of early heart disease. My LDL is always high, but mostly all of large particle size. My HDL is usually around 100, give or take a few points. Given my strange numbers over the years, my cardio doctor suggested a cardiac calcium test. My score was zero, and my heart is pretty strong from decades of distance running (now race walking). We are taking a 5 year wait and see approach.
EXACTLY..... HIGH CHOLESTEROL DOESN"T MEAN YOU HAVE PLAQUE BUILD UP!!!
@@walterski8377. Hopefully!!
LDL was 190. I received a stent due to high calcification. I went on Rosuvastatin 20mg and Ezetimibe. LDL went down to 84. Adjusted my diet, exercise a lot more, switched from coffee to green tea and 2 teaspoons psyllium every day. Now my LDL is 79. I'm eager to try Bempedoic Acid when it becomes available in Thailand hopefully in fall 2024
Indian gooseberry (Amla) and bergamot both have small, but reasonable studies that show LDL cholesterol and cardiovascular risk factor reduction similar to low dose statins. In my statin intolerant patients I consistently saw 20to 35% reductions in LDL cholesterol levels, reduced triglycerides, and increased HDL levels.
Yes, it is impressive. Dr. Greger is a big fan of it. I find it helps my exercise routine at the gym if I take it with Cordyceps about 3 hours before.
Thanks Brad, you've excelled yourself with this highly informative vlog...
Thanks for the informative video. Ok, high ApoB resp. LDL cholesterol is strongly associated with increased risk for cardiovascular disease and a respective mediction is accordingly associated with risk reduction. But how can this be reconciled with the studies that have shown, for example, an increased all-cause mortality risk for middle-aged, non-statin taking men with an LDL-C below 70mg/dl (Sung et al. 2019, n~350,000)? Also other studies seems to point to a rather protective effect of higher cholesterol levels in older patients. How sure can we be that lowering cholesterol levels with medication is really beneficial for a person with otherwise no particular cardiovascular risk factors?
Other videos say that the muscle pain effects of statins appear in 5% to 20% of users or more. One explained that the drug maker funded studies lower the side effects by administering the drug during a six week pre-trial period, and then removing the persons reporting side effects at the commencement of the trial. I’m just getting back to regular exercise after two months of unexplained shoulder pain. That was after taking rosuvastatin for a year and a half. The pain has no apparent cause - not an injury, not related to weightlifting. Given a choice between exercise and a statin, I’ll go with exercise.
I took Fish Oil capsules. My LDL shot up from 91 to 148.
Thanks Brad for another great video. Any guidance on how to convince GP to prescribe statins in Australia or NZ if your LDL is normal according to the guideline but far from ideal?
Same question from France !
I’m presently using all four of these interventions with great success. My cholesterol was”high” but not into FH ranges. A CT-CAC showed some calcified plaque.
Happy to see this information, hopefully it will help stem the tide of “cholesterol is a myth” misinformation that’s growing.
Same here, recently have really high LDC-C, so I got precribed statins was doubting cause all the amount of misinformation and the wave of not bad cholesterol but after hearing both sides I prefer to be safe and use them
If you're interested in up to date information on this topic, and not studies from 10 years ago given by a primary care physician, Research Dr Aseem Malhotra, he specialises in cardiology and has been practising for over 20 years, recieved his fellowship into the Royal College of physicians and his up to date information blows holes many of Brads points. In saying this, Brads info on supplements is good, but best leave the specialist topics to the experts, or at least research some recent papers rather than highlighting half a sentence feom a 11+ year old paper, links to the studies referenced for transparency would also be more honest to the viewers.
Since the big push to get everybody on statins started and the definition of high blood pressure lowered resulting in an increase of numbers being treated for hypotension, CVD has rapidly increased, all cause mortality increased and life expedience decreased.
More and more people are saying 'Something Does Not Compute' and questioning if there is any honestly remaining in health research.
Always very informative. Thanks from France!
My family doctor checks Creatine Kinase levels when prescribing Statins, like Atorvastatin (Lipidor).
Choloesterol does not past the Blood-Brain Barrier. That is why that is why your brain cholesterol level is independent from your cholesterolemia.
Think one issue in analyzing LDL is the fact that it must be calculated. If you have low triglycerides the Friedewald equation likely overestimates your LDL levels. If your doctor isn't math aware, they may well overestimate the issue.
What about Nattokinase?
It'a nice to see someone on TH-cam rationally assessing the evidence instead of venting angry opinions based on misrepresenting the evidence base.
What do you think of the UK's NG238 patient decision aid 'should I take a statin?'
German physician in his early 30s here. I started with 10mg Rosuvastatin a year ago to reduce LDL from 80mg/dl to 50mg/dl. I've never been 100% sure if it was necessary, as my general lifestyle is pretty healthy. Now I am glad that you come to the same conclusion as I did.
Thank you Dr Brad.. But i disagree with you regarding controlling cholesterol by drugs.. most studies did not take into consideration what the participant diet, survey a non healthy population will not give good results..
Male 57 years with controlled T2D for two years with drastic lifestyle change my doctor put me on very low dose statin even my ldl was around 100 for long time. After 3 months my average blood sugar was up %20 and weirdly I developed itchy skin. I stopped taking statin and symptoms stated fading. I have allergies to tetracycline and symptoms were extremely similar with statin use. For now I am not taking it and maybe give it a go again to be sure I am allergic to statin ingredients. Eliminating process what I did with food after I got CGM.
My GP told me it can cause memory loss and took me off it.
Hi Dr. Brad. Thank you for you do and really appreciate this video. Can you please share what blood tests you are doing to help you decide if should add Ezetimibe?
How about taking plant sterols/stanols with a meal? Like CholestOff from NatureMade? I just take that and Omega 3 from Nordic Naturals and canned sardines/mackerel/salmon.
I would have to see real studies done.
@@Seanonyoutube Which atherogenic particles are raised by plant sterols?
@@Seanonyoutube hmm I didn't see it. No notification. Just names of particles would suffice. Thanks
Their have been studies that show it reduces overall cholesterol around 10% tops but i think it only works on dietary cholesterol not cholesterol made in the liver could be wrong
We should focus on the small dense LDL. The value of LDL cholesterol itself does not mean much .
What about "Red Yeast Rice" + coq10 as a cholesterol-lowering supplement?
Does it work?
Interestingly Red Yeast Rice actually contain a natural statin chemically identical to lovastatin as its main active component. When using it, it is important to make sure it is a quality tested product, because contaminated red yeast can produce toxins.
I want to know that too.
Eating heathy is the answer not taking a drug that will most likely cause issues down the road. My father took statins for over 30 years. His finale 10 years were filled with neurological problems to the point where he couldn't walk. I'm still very skeptical of them.
@@stevet5549 there's just a lot of what-ifs still on statins and neurological issues, and not enough study.
Good information thank you. I just added Zetia to my 5mg of Crestor and my LDL dropped significantly. I’m also on a low carb diet, which apparently helps the Zetia work even better.
I heard that Oreo cookies outperform statins in lowering LDL, and it sounds so much more pleasurable.
I was on that therapy and wasn't responding as well as hoped, so my doctor had to change my prescription to Double Stuf.
They also cure diabetes permanently and remove a pre diabetic state.
Truly a superfood!
@@peterRobinson10101 at least good to eat before doing annual routine labs.
Oreo cookies seems to work good to lower ldl
@@Joseph1NJthat doesn't exist according to Brad.
😂😂
@DrBradStanfield: Please walk through these studies comparing relative and absolute risk.
Thank you for accurate information. 5 mg of statins has reduced my Apo b and LDL by 35% with no side effects.
Thank you for this information. I have struggled with finding anything to help guide my decision making about taking my statins. The muscle pain was so intense on simvastatin that I couldn’t take it. I’m now on a low dose of rovistatin and it is not causing any muscle pain. I’m going to keep taking it.
LDL is a causal factor of atherosclerosis, however, LDL levels are very poor predictors of heart disease. Insulin resistance, blood pressure and triglycerides levels are much better predictors of CVD.
Additionally, having very low LDL is a strong predictor of poor health, specially in the elderly (No, it isn't due to reverse causality). However, it isn't clear whether statin-induced very low LDL is a a cause for concern.
Yes it is reverse causality. What evidence do you have that it isn't? Clinical trials clearly show that reducing LDL to very low levels reduces the rate of adverse events.
It would be informative if you would mention the studies on statins and overall mortality. This would be particularly beneficial for those in middle age or later trying to decide if taking a statin is worth it. The research indicates that taking a statin to lower LDL has a minuscule impact on overall mortality. The studies show that taking a statin for 5 years will only reduce mortality by 2 to 10 DAYS. So to have any meaningful impact on mortality you better plan on taking your statin early in life and continue it for the next 20 to 40 years. Even if you do this, the best case result indicates your lifespan may be increased by 6 months to 1 year. The worst case result only gives you 1 to 3 months.I say “may” because you have a good chance of dying by some other cause unrelated to heart disease before your statin “benefit” becomes available. Something to think about.
Please consider adding the next video link to the Infos, as the links in the end cards do not work in Browsers like Brave.
why are the arterial anti-inflammatory properties of statins hardly discussed?
Because it would alert the average idiot to the fact that cholesterol is not the enemy. Lol
the potential anti-inflammatory actions of statins warrant further research: "statins appear to reduce arterial inflammation, but whether that’s from cholesterol reduction or something else is being debated."
www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/inflammation-and-heart-disease
@@DrBradStanfield thank you
forgot red yeast rice
Did you forget to buy red yeast rice when you were in the grocery store ? How is your memory problem relevant to the subject ?
Doctor you did not mention the fiber Pysilium Husk or Isab Gol which lowers cholesterol.
Bempedoic acid side effect is tendon damage. This drug may raise the risk of tendon tear or injury.
What about red yeast rice based supplement? I'm using red yeast rice supplement, which lowered my LDL and APO B almost to the levels I got using 15mg of statin.
What are your views on the recent study undertaken with oreos that were more effective than statins at lowering LDL in certain individuals? And no mention of triglycerides? The information on supplements is good but rather listen to specialists when it comes to specialist medical fields. Primary care givers only know so much.
Shh, Brad has already decided that high LDL causes atherosclerosis.
Dr Brad, did you see the Harvard researcher whose LDL goes way up on a low-carb diet? He added a couple Oreos to his daily regime for a few weeks and it dropped his LDL lower than Crestor!
My mother got pre diabetes from statins. I forced her to stop the pills and pre diabetes reversed. Her memory partly revovered. Also her muscles weakened. She is ok now.
This is more present in certain statins than others and more present in higher doses than lower doses. This just means you need to switch the statin you’re using.
My mother changed her statins twice and the results were the same. 2 hours after dinner and a statin her glucose level was around 200. Next day dinner without the pill her glucose was 140. Repeated this for 15 days and we concluded that statins had this side effect. @@meltedsnowman9637
Make sure you monitor her ApoB carefully. You don't want to swap pre-diabetes for a sudden heart attack.
Same happened to me.I got pre diabetes after starting Statins so decided to come off them.
@@MrDonniemaclennan If you manage to lose 10 percent of body weight your prediabetes will most likely disappear as long as you don't regain the weight back. That's regardless of statins.
Hey Brad
Which of those 4 medications is generally speaking overall the safest/ the one with the least amount and severity of side effects? (if one only cared about this fact)
Thanks for this. This was timely for me, as I just got my latest blood tests yesterday. Good on most items, high HDL (85) I take Omega-3 maybe that does that, low triglycerides (80), low CRP / low inflammation, but high LDL-C (146) and ApoB at 104 mg/dL which is borderline high. I want to lower Apo B to below 80 mg/dL, which would be in ~10th percentile of US adults my age, but don't want to over-medicate. Tests say my CVD risk is below average but would be lower if I could get ApoB/LDL down. your video confirms low-dose Statin + Ezetimibe is a decent approach for someone in my situation. I will talk to doctor about it.
Any comments on taking CoQ10 with statins?
Covered this in a previous video 😀
Multiple randomized controlled trials done, no benefit seen with CoQ10. If there was good evidence, CoQ10 would be regularly prescribed with statins as part of a guideline
Why don't more people who are concerned lower the satured fat foods instead? It's quite easy to cut out 90% of it.
Unless you have genetic pre-disposition to high LDL regardless of diet, statins makes little sense.
Exactly. But they push the drugs because of the massive profits and just like with semiglutides, they just know that people are gonna keep eating McDonald’s and drinking Mountain Dew
Saturated fast is the healthiest fat you can eat in big amounts
Said absolutely no studies, ever.@@stefdiazdiaz7067
Im a Kiwi and have high cholesterol, Im about to do a fasting blood test to see what its like now. Im 70 this year and have always had elevated cholesterol but now my Dr is recommending I do start statins assuming my test remains high. It seems that there are some possible side effects and from what I hear they are not as uncommon as reported but I dont know. However what is concerning me is a recent meta study that basically showed that taking statins didnt have any benefit but may have the side effects. Im really struggling to know what to do here, how can it be there are so many conflicting studies from reputable sources, I am totally confused. With our health system in the mess it is and the lack of doctors, it took me 2 months to get my last appointment, I try to take responsibility for my own health as recommended but it seems impossible to "be informed" with so much opposing information. I would prefer not to take any drugs but Im not averse if they have proven benefits but I cant say statins fall into this area with what Im seeing. I have no doubt you are saying what you honestly believe but I get the impression those saying the complete opposite also believe what they are saying. so what do I do
Informative and data supported presentation. Some comments. I think you forgot to mention what low dose of statins is... I know it varies depending on a statin type but I think it is still work mentioning. Also berberine works and fairly reliably so but effects are small just 20% LDL-C lowering. However, on a flip side unlike statins, it actually reduces insulin resistance. Now moving on to more effective treatments. As there is currently pharma subsidy for PCSK9 inhibitors , one can get them in the US for just $5 per month after insurance. Hence, I think, while the subsidy lasts, the combo of a statin and PCSK9 inhibitor is the most effective way to go to reduce LDL-C levels.
He said 5 to 10 mg for low dose statin. I had to go back and check, he said it quickly.
Dr Brad,
I hope you are well.
I find it really hard to find an answer regarding total Cholesterol level. So I get the mentioned study show strong link between higher LDL and heart disease but the question is: what if the total Cholesterol level is high but LDL level and tri are normal? What if the total Cholesterol is high because of HDL level? Is that still at high risk?
AFAIK, the answer is no, only LDL is the risk factor.
HDL is called the 'good cholesterol' because high HDL is not a risk and does not cause CVD, in fact is actually associated with lower CVD risk. If you have high HDL and low LDL, you can celebrate your good numbers, you are at lower risk from CVD.
@@patrickmcguinness1363 well thank you for your answer. I find it very confusing why my doctor trying to put me on statin treatment where I have only higher HDL cholesterol levels?
@alialwayel6706 go listen to Dr dayspring on a you tube with Dr Carvalho and it might give an Answer. My HDL and LDL were both on high side, with HDL at 85. Anyway, Dayspring said that could be due to HDL used in transport of cholesterol from gut, sign of a hyper absorber. For such a person ezetimibe, which blocks gut absorption of cholesterol, could help lower blood lipid levels.
@alialwayel6706 some doctors don't know better, sigh. If you apoB is high, statins are helpful. Goong based on HDL is just wrong.
You're pretty badarse doc. I'm a skeptic of statins (partly due to their unselective effects in the body and its links with insulin resistance; Dr Ronald Krauss' research also shed light that they aren't the most efficient at targeting the bullet LDL) but i'm starting to appreciate the benefit of them by watching some of your content. I'm more optimistic of bempedioc acid though. I think part of the fear towards pharmaceuticals is the distrust towards the industry from previous scandals e.g. the painkiller scandal among US doctors. There is also a lazy approach towards healthcare where docs give the impression of being pill-pushers. Another important factor is the supplement industry influence in the market as a natural solution. I am curious where statins come from because i was surprised when i discovered that metformin is a natural pharmaceutical.
Thanks! Could you talk about higher than normal lp(a) please? I know it's genetic but is there anything we can do?
Thank you for this information. This helps a lot.
Can I combine berberine with with Rosuvastatin?
Not sure if any definitive studies have been done, but NATTOKINASE supplements (Soy Beans) are supposed to be highly effective in lowering LDL. Fermented soybeans, Katto (a popular dish in Japan) contain high levels of Vitamin K are thought to prevent calcium deposits in the arteries.
Dr. Stanfield, do you measure you LDL after fasting or non- fasting? ( I started on 5mg of Rosuvastatin and my LDL is now 79 fasting and 55 non-fasting.) Please let me know. Thanks. Big fan! Dimitri
I have seen studies with a graph that goes back about 100 years showing as processed sugar use increased heart problems increased in an almost perfectly parallel way.
Do you know how many other variables you could plot that have the same increase? You can't just prove something is causal because it correlative. You could also show that ice cream causes drowning because during the summer when there is an increase in swimming (and so increase in drownings) there's also an increase in ice cream sales.
I stopped taking omega 3 (fish oil) because i bleed easily. I put fish oil in the same "don't use" category as baby aspirin. I'm male, old, with no history of heart problems, so the recommendation is that the risks of aspirin (brain bleeding) outweigh the benefits.
I would appreciate any advice about fish oil. I know the action is different but the outcomes are similar.
According to Nootropics Expert on TH-cam, some animal studies showed that berberine causes DNA damage. Adding silymarin milk thistle; however, was able to counter this effect. Should we also supplement with silymarin milk thistle if we supplement with berberine?
Can you please link or tell me video name in which nootropics expert says this? The only data I could find is that berberine caused DNA damage in cancer cells
@@bravo8017 I must admit that I only repeated what David Toman, author of Nootropics expert said about berberine. I also realize that any questions about DNA damage/repair is beyond the scope of the guidelines and is probably inappropriate for this channel. By revealing the data that you just found provided me with more information than I already knew. So, thank you.
Take Nattokinase instead
Great video!!👍
I have high ApoB, Lp(a), etc. I’m realizing it’s likely time to consider medication. Who would you say would be the best to manage this? Cardiologist, Lipidologist, GP, or ? I am so curious who to see. Thanks!
All three if you can afford it. Good ones preferably. If money is an issue, there's an algorithm that they will likely follow. Tests for fasting blood glucose, CRP, HbA1c, apoB, Lp(a), Triglycerides, measure blood pressure and resting heart rate, calculate BMI. Then will be standard recommendations to improve diet, stop smoking,start exercising (strength and cardio) , moderate salt and sugar intake, manage sleep and stress,lower BMI if needed. If the numbers are really bad dumb ones will put you on high dose statin, smart ones will put you on low dose statin and ezetimibe. If numbers are super bad they will consider using PCSK-9 inhibitors if you can afford it. A few years into the future if olpasiran is proven to better the outcomes best ones will recommend that for wealthy patients or those at extreme risk. That's all I can think of immediately .
@@demonfedor3748 Thank you so much for your in-depth reply! I'm an otherwise very healthy woman with healthy markers and lifestyle habits. My GP says she will put me on a statin, but it isn't in a hurry (when does that happen? lol); therefore, I'm thinking I need to speak with a specialist for a more detailed discussion. I guess I will try to get in to see either a cardiologist or a lipidologist with a good reputation.
I had a stent put in 2 months ago. I have been on crestor 20mg for the last two months. my LDL-C is 40mg/dl and my Apo B is 0.8 g/l (80 mg/dl) my triglycerides are 1.0 mmol/l (18 mg/dl)
You may check AIM HIGH trial more carefully. Despite their summary, all they shown is that Niacin alone or combined with statins helps not significantly better than statins alone. Not that it doesn't help.
Can you discuss the increase in type 2 diabetes when taking statin drugs?
Actually watch this video, he discusses it.
On supplements, what about red yeast rice? I started on RYR and it lowered my cholesterol
Yeah the supplements are a better way, since pharma has become so money hungry and corrupt in recent years and drugs are often discovered “later” to be unsafe and causing so many deaths
@@Joseph1NJ no, you’re buying into the propaganda….no health enthusiasts are dying from taking niacin, lol. Wake up
Red yeast rice works great 👍 and niacin is safe and effective. Don’t believe the propaganda.
@@Joseph1NJ no, you have no clue what you’re talking about. They are overwhelmingly dangerous and a scam.
Red yeast rice works great 👍
what does it mean (or would happen) if you lower your LDL levels with statins BUT the statins for some reason elevates your triglycerides ?
and what do you think about Dr Paul Mason work and being against statins. Apparently the creator of statin, the japanese bloke refused to take statins when he was diagnosed with high cholesterol
Could you comment on cyclodextrin or Cavadex or is it too early to assess?
You've mentioned the PESA study before and I've critiqued it in your comment before.
I'll repeat, 5-10% of the healthy group were obese.
Just say we cannot conclusivey say at this time and soon we will have the LMHR study to inform us of the mechanism of action better.
Obese by what measure? If it was BMI, that means little because BMI doesn't account for body composition. Many extremely fit athletes with low body fat are 'obese' by BMI standards because they have a lot of lean mass. So, they would definitely fit in a 'healthy' group despite their 'obesity'.
@@RickinICT I am overweight by the BMI. You've got to be a body builder to be obese.
From memory the average muscle mass in the study was really low. The obese group also included women and that couldn't be due to muscle mass.
First thing that comes to mind is: what IS my current blood cholesterol level? I’d really like to experiment more with measuring stuff like this, but it’s not common practice to do your own blood tests… Or for doctors to test healthy patients. Any product you would recommend?
Lots of independent labs in the US will do 'on demand' blood tests for consumers. Out of pocket, of course, but most of them aren't very expensive.
What about garlic supplementation?
I use garlic and red yeast rice
@chrisjenkins5707 red rice yeast is a statin just not pharmaceutical grade
@@Gamingwithmatteo311yes, that’s why I use it
why not a statin then, it's cheaper and more reliable in dosing@@chrisjenkins5707
Can you do an update on your supplementation regime? Do you still take a separate niacin?
Recommendations that do work 05:20. Self reminder for later.
He makes a number of claims that have no support in good research. Like so many in this field it's good to ask show me the study. My Kaiser dr said I should be on a statin because of my age (80 at the time) because my age alone was a "health risk." I laughed. Then I said show me the research study that Kaiser uses for this recommendation and I bet I can show you it's crap research. ( I was a psychotherapist who loved debunking claims for the clinical superiority of this or that theory or treatment methodology.) So he send me the study. 100 men WHO HAD ALREADY HAD HEART ATTACKS.) Well that should be the end of it because that's secondary prevention. I have never had a heart attack. But then the findings was a 24% reduction in the chance of a heart attack taking the statins. So I explained the difference between absolute and relative risk. To his credit he was troubled and said, "What am I to do. This is Kaiser's protocol and I have to follow it." I said you could explain to patients that this is the protocol but the decision is yours and if you are interested I can give you some information about the drug and it's effectiveness to help you decide. He left Kaiser about 6 months later and I don't know how he handled this issue
Thank you for this anecdote.
Thank you.
The Japanese creator of the first statin 'Akira Endo' refused to be on a statin.. what doea that tell you.
That tells me absolutely nothing. Unlike dozens of studies showing benefit for people at risk of heart disease.
Hey Brad, any comment on tendon rupture risks with bempedoic acid? NIH says only when combined with high dose statins, but my cardiologist disagrees.
You picked the studies about statins that agree with your recommendations. There is research saying they cause diabetes, among other things.
I go through those concerns in the video 👍
Yes, certain statins can create problems. Not all of them, infact small doses of rosuvastatin benefits are very likely to extend life. ezetimibe in it's self is ridiculously safe and excellent benefits. Can't say that about others.
He showed studies covering over 2 million people. Do you have specific concerns about those studies and more importantly do you have names of studies showing statins cause T2DM? Note: just because statins can raise A1C by a tenth of a point does not mean it causes diabetes. It means you are already severely metabolically unhealthy before starting statins.
@@robertusga that is the problem, most people who takes statins, are metabolically unhealthy before they take drug. At that point usually they also tidy up their diet and any positive results usually result in the statin being the hero.
@@JayJay-un3rp not in many people's case. I cleaned up my diet years before going on pharmaceutical intervention. Increases exercise dramatically. My lipids improved, but not enough. Genetics are suspected. Either way, plenty of folks who do the right thing with diet and exercise who still needl treatment with drugs to get in healthy range. Kudos to those where lifestyle changes are sufficient. For everyone else, thankfully we have excellent treatments.
Would a low dose statin with a low dose metformin lower ApoB?
@DrBradStanfield Any comment on plant sterols/phytosterols as a supplement?
Any chance you can do a review of the literature on if it is possible to reverse atherosclerosis/plaque size?
Isn't red-yeast rice a form of low-level statin? at least that's what several doctors (including my cardiologist) told me. I was taking red-yeast rice and berberine but still had 201 LDL. Adding Ezetimide + PCSK9 took my LDL from 201 down to 27 in 6 weeks, whee! There's a lot of evidence that high triglyceride is also dangerous, but idk how to control that :-/
I mostly cleaned up my diet a few month back. I will soon get my numbers and see where I am. If they aren't good then rosuvastatin 5 mg and ezetimibe 10 mg are already waiting for me. Wanna see how low can I drop them.
HI which foods contain high doses of bempedoic acid?
It's a new drug, i don't think it's in any food.
Citrus bergamot 500m and Niacin 500mg
Based on what?
lowering cholesterol, especially LdL. Been demonstrated for years.
what about lecithin..?
you say 5-10mh of rosuvastatin. a hypothetical person has been on 5mg now for at least 6 months and is in the low 90s for cholesterol. Would it be a "better" idea to try 10mg rosuvastatin, or ezetimibe?
Mentioned at 7:30
@@RickinICTim not rewatching the whole thing, but at another point in the video, doesn't he say he is thinking about going from 5 to 10? 10 is still considered low does. So if they are on 5, should they try 10 first and see if their numbers go down, or try ezetimibe first and see if the numbers go down? Just wondering about optimal order i guess.
Well, I start doing intermittent fasting 17 to 20 hours a day five days out of the week and loss 60 pounds in two months
Hey Doc, are you aware of any interactions between statins and creatine?
Thanks 😮
Dr. Brad, you (and other TH-cam doctors) always point out the "blood-brain" barrier risk, when talking about benefits of using hydrophilic statins vs. lipophilic versions.
My question to you Brad = Why would you not want a statin to clear up plaque in the brain vessels?
Clotting in the brain, I believe, is a possibility as well? 🤔😉
pubmed.ncbi.nlm.nih.gov/34958045/
Good question. They have different effects on the brain in Parkinson's as well apparently: "This study suggests that hydrophilic, but not lipophilic, statins may be associated with faster PD progression."
Because cholesterol doesn't pass the blood-brain barrier, so the brain cannot rely on circulating hepatic cholesterol to make up any shortfall in its own production. So, why would you want to introduce a statin that could cross the blood-brain barrier and interfere with the brain's ability to create the cholesterol necessary for neuron function?
@@RickinICT Hi there! 🙂
I already dug a little bit more into this topic, turns out, both versions can cross the blood brain barrier....the hydrophilic versions is only a bit less likely. My current conclusion, is that the statin dose is the more important parameter, instead of solubility! 😉
Why do all of these studies zero in on just LDL and don't always take into consideration HDL and triglycerides, which have been shown to be of crucial importance as well?
Also, why do all of these studies correlate high LDL with heart disease causally, without considering that the increase of LDL might be a symptom and not the cause of the problem?
Can't take those studies seriously like this.
HDL is the 'good' cholesterol and has no impact on CVD / doesn't cause any problem. High Triglycerides are a problem, both for CVD and insulin resistance / T2D reasons.
@@patrickmcguinness1363 HDL is the good cholesterol so it obviously has an impact: the more of it you have, the lower the chance of heart disease. If you watch how arteriosclerosis happens, HDL can combat it. That's why the ratio total cholesterol / LDL is important too.
So all of them matter, that's why focusing on LDL doesn't tell the whole picture.
@@Leonhart_93No it doesn't. 39 randomised clinical trials where HDL was directly increased showed no benefit of higher HDL for cardiovascular health. That's why there are no medications out there that specifically increase HDL. Case closed.
@@demonfedor3748 Case closed? No way, I have seen studies showing exactly the opposite: reduction in CV deaths for incremental HDL increases. Also it's really obvious it has an impact since it has a role in reduction of deposits since it's involved in removing excess cholesterol from peripheral tissues, that's one of the reasons it's there in the first place.
@@Leonhart_93 I know what you are talking about. These were associative epidemiological studies. They basically showed that HDL is a good indicator of heart health in a population. Just like the people who carry around a lighter with them is a good indicator of lung cancer. However we know carrying a lighter around doesn't cause lung cancer, smoking does. Same with HDL. People who have it high tend to have lower heart disease rate. But does higher HDL actually improves heart health? To test that idea pharma companies funded 39 huge randomised clinical trials. Just for context, randomised clinical trials carry much more weight in terms of evidence than epidemiological studies. 39 huge randomised clinical trials weight as much as a mountain, while epidemiological studies weight as much as a brick. These 39 trials all showed that increasing HDL doesn't improve heart disease whatsoever. Pharma companies were displeased since they lost billions on these trials and with all of them failing they won't be profiting on HDL increasing drugs. They abandoned the idea and there are still ZERO drugs on the market that are designed to increase HDL. There can't be no bigger proof of HDL being useless. But people still call it good cholesterol and say it removes plaque. The existing evidence doesn't support that idea.
Ignores Fatal side effects !!!
I am one of those two patients in a hundred where Rosuvastatin muscle soreness is concerned. I developed myositis in my calf muscles. I'm a runner, so it was particularly troubling. It felt like extreme lactic acid buildup. They were very stiff. I tried to go for a run. I started out jogging flat-footed, thinking they'd loosen up, but no. I made it about fifty yards and had to limp back to my car. It took a couple months to resolve once I discontinued the statin. I have no idea if it was low or high dose. I know my NP advised me to take half a pill instead of the full, but I wanted it to resolve first. maybe I'll try the low dose. Or, ask about the Bempedoic Acid. Thanks for the info.
You can try ezetimibe alone and see where your numbers land a month or two down the road.
@@demonfedor3748 I have a script for that as well. In another video, Brad said that Ezetimibe and Rosuvastatin work well together. So that was the plan. It was back in August, and I was experiencing a side effect that I can't recall now, but I stopped it right about the time I got the additional script for Rosuvastatin, so I went with that. Maybe it's worth a revisit. Maybe I'll try a small dose, as Brad suggested here. Thanks for the suggestion!
@@davidperfette1425Good idea. Hope low dose statin will gives you minimal trouble. If not there are other statins to try,or bempedoic acid if finances allow. I've seen studies comparing rosuvastatin+ ezetimibe vs atorvastatin+ezetimibe. The latter combo was slightly better,but higher chance if side effects. However your mileage may vary.
@@GiveMeMyStapler Thanks for that
This video made me concerned about high dose niacin. Seems to be really harmful yet very popular for it's theoretical benefits.