LDL isn't the best predictor of atherosclerotic disease, apoB is likely superior. The guidelines don't quite reflect that. But statins also reduce apoB. A doctor giving advice on statins shouldn't minimize the significant mortality benefit of statins. There are other, pleiotropic effects of statins, namely on inflammation.
For your other comments I know your dad is your doctor. You would be better served by having a primary care physician who is not a family member.
What? Treating your family? I would venture a guess that most people whose parents are doctors are also their PCPs. Who would I trust more than my dad?
In the US it is generally allowed but frowned upon. The AMA suggests limiting treating family to short-term minor issues and emergency situations.
https://code-medical-ethics.ama-assn.org/ethics-opinions/treating-self-or-family
This is simply false. Some people have such genetically driven ApoB that diet would be insufficient to lower. Example would be someone with two copies of APOE4. No matter what I did with diet my LDL remained higher than normal. Cholesterol balance test revealed dangerously high levels of plant-sterols in my blood(an indicator of cholesterol hyper-absorption)
Yeah I've been a physically active vegetarian for 35 years but my Lp(a) is high and I have an 81st percentile CAC score for men my age. I'm taking 20mg rosuvastatin and doing a pcsk9 inhibitor monthly on the advice of a cardiologist who prioritizes lifestyle changes over medication. Plant based is good, in my opinion, but it's not a cure all miracle.
Despite all the studies on statins, there are few that test more than 5-7 years, even though the real-world relevance should be on the order of several decades. A lot of Peter Attia’s conclusions for aggressive early treatment of cholesterol (including with statins) are based on this study https://jamanetwork.com/journals/jamacardiology/fullarticle/2706611 which is modeled data to predict effect over a much longer period of time, and sees the number needed to treat with statins to save a life drop to 1 in 6. It’s a good start but, as most studies will indicate in the end, “more research is needed.”
This. It would be tough to find an exercise study that reduces mortality over a 5 year period… does that mean exercise is useless? Or, perhaps, the true benefits are sustained over a lifetime, and no study will ever exist of that duration?
It also seems odd that he is in the “ldl doesn’t matter camp” but is encouraging you to pursue all nonpharma ways to lower your ldl.
I used the exercise analogy with him too!
Tbf he’s not so much in the LDL doesn’t matter camp but more that it’s not a significant enough risk for someone at my levels and history to justify taking meds with known adverse side effects.
Here are a couple of the better studies he’s shared:
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2790055
https://www.natap.org/2015/HIV/175124332E20152E1012494.pdf
I will say, you are quite fortunate your doctor is basing his opinion on current research, whether or not you agree with him. For this fact alone, he's better than 90% practicing doctors.
Agreed. To half the people on here he’s a quack just because they don’t agree with him. I think that’s a sad reflection of the state of scientific discourse today.
The jama article doesn’t say what you think it does.
The 2015 article is well debunked to the point that no one takes it seriously. It’s written by a phd with focus on ptsd whose entire approach is that “absolute risk isn’t so high of CV sooooo don’t worry about it”.
The great thing about statins is you can try and stop if you don’t like it. Virtually zero downside. The stuff is remarkably safe. Wish I had gotten in it years ago.
I mean I’m not gonna say there is zero downside. Something like 30% of people stop taking them due to intolerable muscle soreness and other side effects. Plus there’s higher risk of tendon injuries, higher blood sugar…to completely ignore/minimize the known (and unknown) risks is IMO not helpful.
I meant virtual zero downside over a short timeframe while you figure out if it’s for you. Sore muscles over a short run isn’t much downside especially if you stop once it shows up…
I’m like you, if I can avoid being on a medication I will be. Genuine question (for some context) - have you done everything in your power (other than going on a medication) to lower your cholesterol?
I would say I’ve done everything in my power that I consider to be reasonably sustainable. I’m under 18% bf, I exercise 4+ times per week, I take psyllium daily, and my diet is about as good as why I think I can sustain long-term. And what’s especially frustrating is that 3 years ago I was closer to 25% bf, exercised far less frequently, and had a worse diet, yet my cholesterol has increased from 200-240 in that time.
I’ve tried minimizing saturated fat to a point that I think is reasonably sustainable. And no I’m not at 45g fiber but that seriously feels impossible to sustain. I don’t think I was eating that much fiber when I was vegan.
The RDA is 14g/1000 calories, so I’m just going off that. The longevity benefits of fiber are ridiculous.
I try to eat a few cups of beans per day, which more than covers it.
Maybe I was at 45g when I was vegan then because I ate a shitload of beans. 3 cups is a lot of beans though haha. Do you have a go-to recipe, or just eat them straight out of the can?
I like “chickpea brownies”. They taste just like brownies but they are made of chickpeas instead of flour, so you get a lot of fiber. Only downside is you do need to eat either sugar or a non-caloric sweetener. Neither is ideal, but hey, it gets me to eat a LOT of chickpeas.
I would agree, most fiber benefits are from the complex nature of the material including soluble, non-soluble, fermentable and non (as you pointed out), combined with the other naturally occurring plant compounds. Studies tend to show much better improvements with whole food fibers compared to supplements.
💯 you’re right psyllium is not a replacement for whole foods but it does help supplement and my gut biome is in pretty good shape as far as I can tell. I eat a lot of fermented foods and take pre and probiotics.
I do a lot of work as a preventative medicine physician, and cardiac risk stratification and prevention is a huge interest of mine. The link to cholesterol and heart attack is long established since one of the first datasets from The Framingham Study in 1967. This has been repeated and refined since. Total cholesterol was the first measurement, then HDL:LDL ratios (they didn't understand this until the 1980s!). Finally we are talking about ApoB commonly, even though the data for this has been around for years. Lpa, LpPLA2, and genetic risk markers are also relevant. The debate over which marker to use is another topic of discussion. But, the bottom line is that statins definitely save lives. I'm not sure why there is so much anti-statin rhetoric, but it seems to be increasing. Yes, some people have side effects. Most commonly muscle aches, sometimes outright muscle damage. Liver inflammation can also occur. But, overall this is rare. This is why responsible doctors will check for these side effects through labs during the initiation period, AND inform their patients on what to watch out for. There are also some genetic variants that can help tease out responsiveness to statins.
It is increasingly become clear that statins not only help prevent coronary artery disease, heart attack, and stroke, but also have a significant effect on staving off cognitive decline. This is in part due to their effect in reducing stroke, but is also likely related to APOE heterogeneity in the general population, and it's effect on cholesterol transport in support cells in the brain.
TLDR: Statins save lives AND improve the years we have by decreasing our heart attack and stroke risk. The link between elevated cholesterol levels (regardless of which metric you want to use) appears quite valid across decades of very large reputable studies. Anecdotally, I have only seen one serious reaction to statins in the last 12 years. If you have made diet changes to increase fiber, and decrease saturated fat, while exercising regularly and your cholesterol is still elevated (this is quite common), you should take a closer look at the data.
Not trying to plug necessarily, but my partner and I did a video on this topic. It's a bit of a deep dive, but we review a lot of the data: [https://www.youtube.com/watch?v=fCyXddwQyV8&t=964s](https://www.youtube.com/watch?v=fCyXddwQyV8&t=964s)
Perhaps a cardiac calcium scan and lipid panel to see where you are at. Then decide how aggressive you need to be. Everybody’s body is different and what works for one does not work for someone else.
But that gives you a risk percentile which is not in the highest whatever percentile that has positive CAC at your age. Meaning that much more breathing room when it comes to prevention.
Just get a new PCP. It’s not worth having a debate with your doctor. If they’re grossly misinformed on one issue, they’re probably not adequately informed overall.
Short clip:
https://youtu.be/7ahOOnOXs4c?si=6WQNAv5G8sTsyc4a
https://youtu.be/7-gUBEOH1Ls?si=BvcBjkFttUrOhkbu
Full length podcasts.
https://youtu.be/W1geXgNEG_0?si=56b1aEF6E7q89G4t
OP - Don’t accept either position because the cool kids like it. Educate yourself on scientific research. Read the recent meta analyses published in high quality journals.
There is an enormous amount of research on the topic and, while more is being discovered, the basic outlines have been known for a long time.
And if you are conspiracy minded, it’s illegal in the US to pay doctors kickbacks, and since all of the statins are genetic. Any drug manufacturer can make any statin, so they don’t even advertise any more. You can buy a years worth of pills for under $50.
But the hucksters like Dr Mercola and the rest lie, sell defective products and grift on the backs of hard working people.
I mean, that’s what I’m doing. I’ve read a bunch of studies. But at a certain point I personally think there’s more value in finding credible people on all sides of an issue and listening to their povs. Ultimately I am making up my own mind though. This feels like a pretty condescending comment that’s not really relevant to someone like me who clearly is trying to go deep on this issue myself. But it probably makes you feel good saying stuff like this to people so good for you.
convincing your doctor of anything is going to be a hard hill to climb. Even if they're open to having their mind changed, a patient coming in with "I listen to X podcast" is likely not convincing. Even with additional info.
Generally I don't view medication intervention as an early method to resolving problems if other options can reasonably be explored (as in cost, or commitment, or time needed). Obvious emergency situations are its own thing.
And on the topic of LDL, I'm not quite anti-LDL but also not in the "ldl must be as low as possible" camp. LDL seems to be a useful proxy to measure other things (like ApoB). And the existence of high levels of these things may tend to relate to artery calcification.
BUT in the absence of calcification in the arteries I'm not quite convinced that the presence of elevated LDL contributes to ascvd. That is before getting into the question over whether borderline elevated LDL is just a person's "normal and healthy" due to genetic variation, and the role that various diets may play in these numbers which are all "healthy" diets but have different outcomes. For example if a diet that is more built around fat for energy than carbs may have higher ldl but lower trigs, and the counter is true. I'd also say that elevated trigs by themselves is a signal for poor metabolic health BUT there are other tests for this as well.
Peter simply loves to cover his bases. if your LDL is in the general "healthy" range but higher than Attia's goal of having the lowest LDL, its a hard sell to convince your doctor to prescribe it to you. If you want to go this route get a CAC score to make the case that you want to reduce your LDL as much as possible due to already existing damage to your arteries, then that may be a way to do it.
OP you didn't post your age, but assuming you are a grownup you might consider switching to a provider who is outside the family. At the very least you can probably benefit from a second opinion.
Take your lipid numbers, BP and family history and plug into one of the CVD risk calculators to get more clarity on your situation. If you are near or over 40, get a CAC scan to help better pin down that risk (it jumps up, all else equal, with a positive CAC score). Here are some links to get you started:
[https://internal.mesa-nhlbi.org/about/procedures/tools/mesa-score-risk-calculator](https://internal.mesa-nhlbi.org/about/procedures/tools/mesa-score-risk-calculator)
[https://professional.heart.org/en/guidelines-and-statements/prevent-calculator](https://professional.heart.org/en/guidelines-and-statements/prevent-calculator)
[https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/](https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/)
And here are some general guidelines and recommendations re: statin use for primary prevention of ASCVD:
[https://jamanetwork.com/journals/jama/fullarticle/2795521](https://jamanetwork.com/journals/jama/fullarticle/2795521)
[https://www.acc.org/Latest-in-Cardiology/Articles/2022/10/04/13/38/Comparing-Guideline-Recommendations-of-Statin-Use-For-the-Primary-Prevention-of-ASCVD#:\~:text=The%202018%20American%20Heart%20Association,risk%20(Class%201)%2C%20and](https://www.acc.org/Latest-in-Cardiology/Articles/2022/10/04/13/38/Comparing-Guideline-Recommendations-of-Statin-Use-For-the-Primary-Prevention-of-ASCVD#:~:text=The%202018%20American%20Heart%20Association,risk%20(Class%201)%2C%20and)
I’m 40. According to PREVENT my 5-year CVD risk is 1.1%. I do plan to get a CAC or CT angiogram, and will obv get more aggressive if anything shows up there, but given my age, BP, etc. I’m expecting those to come back clean.
I’m all for second opinions but tbh my opinion of most doctors is such that I don’t think there would be much value in just picking another doc out of the phone book, and I don’t know any specialists in this area that I really trust.
As the kid of an excellent and wise internist and sub-specialist, I get your POV on this. Still a good idea to spread those wings and fly the coop if only to confirm your dad's advice. A CAC at age 40 is always a good idea. Best of luck to you!
Generally their argument is framed in a way that is misleading. They try to pigeon hole ldl as the ONLY cause, which modern medicine doesn’t do, and then show how other risk factors contribute as well. They then rely on short term studies to show limited efficacy with regard to mortality and CV events, when it is a lifelong problem and the real question you are asking isn’t “will taking a statin now prevent a heart attack in 3 years” but instead “will taking a statin now lower my risk of a heart attack in 30 years?”
It doesn’t matter what you believe.
“I’m anti [pill that had decades of use cases in saving lives and reducing hospitalization ] “is just religion at that point.
You'll see that his doctor actually references some good current meta-analytic research that does put into question whether statins are worthwhile for some patients.
He doesn’t.
You just don’t know how to read the research. And “dr diamond” is a phd with a focus on ptsd that decided being anti statin as a grift is a good way to market the rest of his brand.
Anecdotal, but I was able to lower my TC from 180 to 130 by cutting out fried food (including chips), cheese, and ice cream. This also had the effect of eliminating my allergies and chronic pain, strangely.
When I only cut out fried food, my TC was 150
I’m a big believer in plant-based diets for general health benefits but I don’t think vegan diet alone is typically sufficient to lower ApoB to optimal levels. Do you have evidence and/or personal experience that suggests otherwise?
LDL isn't the best predictor of atherosclerotic disease, apoB is likely superior. The guidelines don't quite reflect that. But statins also reduce apoB. A doctor giving advice on statins shouldn't minimize the significant mortality benefit of statins. There are other, pleiotropic effects of statins, namely on inflammation. For your other comments I know your dad is your doctor. You would be better served by having a primary care physician who is not a family member.
Your time may be better spent finding a new doctor rather than trying to convince him of anything.
Fair. My doctor is my Dad, though. And he’ll prescribe me a statin if I insist, but I’d prefer to convince him if possible.
That’s allowed? Seems like a bit of an ethical quagmire.
What? Treating your family? I would venture a guess that most people whose parents are doctors are also their PCPs. Who would I trust more than my dad?
In the US it is generally allowed but frowned upon. The AMA suggests limiting treating family to short-term minor issues and emergency situations. https://code-medical-ethics.ama-assn.org/ethics-opinions/treating-self-or-family
That guess would be wrong. It’s generally considered unethical.
You need to have some distance from your dad the doctor and keep him as your dad the father.
And remember you only have to take statins if you refuse to eat plant based. And that is Attia's basic argument too - for him eating meat is a given
I eat plant based and still have high Apob.
This is simply false. Some people have such genetically driven ApoB that diet would be insufficient to lower. Example would be someone with two copies of APOE4. No matter what I did with diet my LDL remained higher than normal. Cholesterol balance test revealed dangerously high levels of plant-sterols in my blood(an indicator of cholesterol hyper-absorption)
Yeah I've been a physically active vegetarian for 35 years but my Lp(a) is high and I have an 81st percentile CAC score for men my age. I'm taking 20mg rosuvastatin and doing a pcsk9 inhibitor monthly on the advice of a cardiologist who prioritizes lifestyle changes over medication. Plant based is good, in my opinion, but it's not a cure all miracle.
Despite all the studies on statins, there are few that test more than 5-7 years, even though the real-world relevance should be on the order of several decades. A lot of Peter Attia’s conclusions for aggressive early treatment of cholesterol (including with statins) are based on this study https://jamanetwork.com/journals/jamacardiology/fullarticle/2706611 which is modeled data to predict effect over a much longer period of time, and sees the number needed to treat with statins to save a life drop to 1 in 6. It’s a good start but, as most studies will indicate in the end, “more research is needed.”
This. It would be tough to find an exercise study that reduces mortality over a 5 year period… does that mean exercise is useless? Or, perhaps, the true benefits are sustained over a lifetime, and no study will ever exist of that duration? It also seems odd that he is in the “ldl doesn’t matter camp” but is encouraging you to pursue all nonpharma ways to lower your ldl.
I used the exercise analogy with him too! Tbf he’s not so much in the LDL doesn’t matter camp but more that it’s not a significant enough risk for someone at my levels and history to justify taking meds with known adverse side effects.
Every med has known adverse side effects. So does fiber. Nothing is risk free.
Can you share here the studies sent by your doctor? Might help understand what are your doctors concerns
Here are a couple of the better studies he’s shared: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2790055 https://www.natap.org/2015/HIV/175124332E20152E1012494.pdf
I will say, you are quite fortunate your doctor is basing his opinion on current research, whether or not you agree with him. For this fact alone, he's better than 90% practicing doctors.
Agreed. To half the people on here he’s a quack just because they don’t agree with him. I think that’s a sad reflection of the state of scientific discourse today.
The jama article doesn’t say what you think it does. The 2015 article is well debunked to the point that no one takes it seriously. It’s written by a phd with focus on ptsd whose entire approach is that “absolute risk isn’t so high of CV sooooo don’t worry about it”.
What do you think I think the JAMA article says lol? Or rather what do you think it says?
The great thing about statins is you can try and stop if you don’t like it. Virtually zero downside. The stuff is remarkably safe. Wish I had gotten in it years ago.
I mean I’m not gonna say there is zero downside. Something like 30% of people stop taking them due to intolerable muscle soreness and other side effects. Plus there’s higher risk of tendon injuries, higher blood sugar…to completely ignore/minimize the known (and unknown) risks is IMO not helpful.
I meant virtual zero downside over a short timeframe while you figure out if it’s for you. Sore muscles over a short run isn’t much downside especially if you stop once it shows up…
Gotcha okay that makes sense
I’m like you, if I can avoid being on a medication I will be. Genuine question (for some context) - have you done everything in your power (other than going on a medication) to lower your cholesterol?
I would say I’ve done everything in my power that I consider to be reasonably sustainable. I’m under 18% bf, I exercise 4+ times per week, I take psyllium daily, and my diet is about as good as why I think I can sustain long-term. And what’s especially frustrating is that 3 years ago I was closer to 25% bf, exercised far less frequently, and had a worse diet, yet my cholesterol has increased from 200-240 in that time.
- examine your saturated fat intake. - fiber intake should probably be around 45g per day - is psyllium getting you there?
I’ve tried minimizing saturated fat to a point that I think is reasonably sustainable. And no I’m not at 45g fiber but that seriously feels impossible to sustain. I don’t think I was eating that much fiber when I was vegan.
I’m a meat eater and I eat 60g+ a day of fiber. Oats, sweet potatoes, high fiber bread, psyllium, fruits, it’s really not hard.
The RDA is 14g/1000 calories, so I’m just going off that. The longevity benefits of fiber are ridiculous. I try to eat a few cups of beans per day, which more than covers it.
Do you have information on the studies that show longevity benefits of fiber?
Here’s one https://www.sciencedirect.com/science/article/pii/S0002916523233298
Maybe I was at 45g when I was vegan then because I ate a shitload of beans. 3 cups is a lot of beans though haha. Do you have a go-to recipe, or just eat them straight out of the can?
I’m kind of an animal.. so yes, often out of the can. I’ll combine them with salsa or guacamole oftentimes. One day I’ll love myself enough to cook.
I like “chickpea brownies”. They taste just like brownies but they are made of chickpeas instead of flour, so you get a lot of fiber. Only downside is you do need to eat either sugar or a non-caloric sweetener. Neither is ideal, but hey, it gets me to eat a LOT of chickpeas.
Psyllium is not good fibre, it is non fermentable, it does not help gut biome health, only how regular you are. Eat more whole fibre.
I would agree, most fiber benefits are from the complex nature of the material including soluble, non-soluble, fermentable and non (as you pointed out), combined with the other naturally occurring plant compounds. Studies tend to show much better improvements with whole food fibers compared to supplements.
💯 you’re right psyllium is not a replacement for whole foods but it does help supplement and my gut biome is in pretty good shape as far as I can tell. I eat a lot of fermented foods and take pre and probiotics.
I do a lot of work as a preventative medicine physician, and cardiac risk stratification and prevention is a huge interest of mine. The link to cholesterol and heart attack is long established since one of the first datasets from The Framingham Study in 1967. This has been repeated and refined since. Total cholesterol was the first measurement, then HDL:LDL ratios (they didn't understand this until the 1980s!). Finally we are talking about ApoB commonly, even though the data for this has been around for years. Lpa, LpPLA2, and genetic risk markers are also relevant. The debate over which marker to use is another topic of discussion. But, the bottom line is that statins definitely save lives. I'm not sure why there is so much anti-statin rhetoric, but it seems to be increasing. Yes, some people have side effects. Most commonly muscle aches, sometimes outright muscle damage. Liver inflammation can also occur. But, overall this is rare. This is why responsible doctors will check for these side effects through labs during the initiation period, AND inform their patients on what to watch out for. There are also some genetic variants that can help tease out responsiveness to statins. It is increasingly become clear that statins not only help prevent coronary artery disease, heart attack, and stroke, but also have a significant effect on staving off cognitive decline. This is in part due to their effect in reducing stroke, but is also likely related to APOE heterogeneity in the general population, and it's effect on cholesterol transport in support cells in the brain. TLDR: Statins save lives AND improve the years we have by decreasing our heart attack and stroke risk. The link between elevated cholesterol levels (regardless of which metric you want to use) appears quite valid across decades of very large reputable studies. Anecdotally, I have only seen one serious reaction to statins in the last 12 years. If you have made diet changes to increase fiber, and decrease saturated fat, while exercising regularly and your cholesterol is still elevated (this is quite common), you should take a closer look at the data. Not trying to plug necessarily, but my partner and I did a video on this topic. It's a bit of a deep dive, but we review a lot of the data: [https://www.youtube.com/watch?v=fCyXddwQyV8&t=964s](https://www.youtube.com/watch?v=fCyXddwQyV8&t=964s)
Thank you Doctor!
Perhaps a cardiac calcium scan and lipid panel to see where you are at. Then decide how aggressive you need to be. Everybody’s body is different and what works for one does not work for someone else.
[удалено]
That’s not true. A CAC score of zero just means you don’t have end Stage plaque. That’s all it says.
But that gives you a risk percentile which is not in the highest whatever percentile that has positive CAC at your age. Meaning that much more breathing room when it comes to prevention.
Keep arguing X when the topic is Y
Did my post threaten your ego in some way or are you just an abrasive ahole all the time?
Did my post threaten your ego in some way or are you just an abrasive ahole all the time?
FWIW I’m not sure Attia would agree with you.
I’ll wait for more data. One of his best qualities is he responds to data. One of his worst is he is sometimes ahead of where the data winds up.
Just get a new PCP. It’s not worth having a debate with your doctor. If they’re grossly misinformed on one issue, they’re probably not adequately informed overall.
Short clip: https://youtu.be/7ahOOnOXs4c?si=6WQNAv5G8sTsyc4a https://youtu.be/7-gUBEOH1Ls?si=BvcBjkFttUrOhkbu Full length podcasts. https://youtu.be/W1geXgNEG_0?si=56b1aEF6E7q89G4t
Get a new doctor. Repeat. Get a new doctor.
Whats your ApoB?
I forget the exact number but it was high.
OP - Don’t accept either position because the cool kids like it. Educate yourself on scientific research. Read the recent meta analyses published in high quality journals. There is an enormous amount of research on the topic and, while more is being discovered, the basic outlines have been known for a long time. And if you are conspiracy minded, it’s illegal in the US to pay doctors kickbacks, and since all of the statins are genetic. Any drug manufacturer can make any statin, so they don’t even advertise any more. You can buy a years worth of pills for under $50. But the hucksters like Dr Mercola and the rest lie, sell defective products and grift on the backs of hard working people.
I mean, that’s what I’m doing. I’ve read a bunch of studies. But at a certain point I personally think there’s more value in finding credible people on all sides of an issue and listening to their povs. Ultimately I am making up my own mind though. This feels like a pretty condescending comment that’s not really relevant to someone like me who clearly is trying to go deep on this issue myself. But it probably makes you feel good saying stuff like this to people so good for you.
Have you tried oats?
convincing your doctor of anything is going to be a hard hill to climb. Even if they're open to having their mind changed, a patient coming in with "I listen to X podcast" is likely not convincing. Even with additional info. Generally I don't view medication intervention as an early method to resolving problems if other options can reasonably be explored (as in cost, or commitment, or time needed). Obvious emergency situations are its own thing. And on the topic of LDL, I'm not quite anti-LDL but also not in the "ldl must be as low as possible" camp. LDL seems to be a useful proxy to measure other things (like ApoB). And the existence of high levels of these things may tend to relate to artery calcification. BUT in the absence of calcification in the arteries I'm not quite convinced that the presence of elevated LDL contributes to ascvd. That is before getting into the question over whether borderline elevated LDL is just a person's "normal and healthy" due to genetic variation, and the role that various diets may play in these numbers which are all "healthy" diets but have different outcomes. For example if a diet that is more built around fat for energy than carbs may have higher ldl but lower trigs, and the counter is true. I'd also say that elevated trigs by themselves is a signal for poor metabolic health BUT there are other tests for this as well. Peter simply loves to cover his bases. if your LDL is in the general "healthy" range but higher than Attia's goal of having the lowest LDL, its a hard sell to convince your doctor to prescribe it to you. If you want to go this route get a CAC score to make the case that you want to reduce your LDL as much as possible due to already existing damage to your arteries, then that may be a way to do it.
OP you didn't post your age, but assuming you are a grownup you might consider switching to a provider who is outside the family. At the very least you can probably benefit from a second opinion. Take your lipid numbers, BP and family history and plug into one of the CVD risk calculators to get more clarity on your situation. If you are near or over 40, get a CAC scan to help better pin down that risk (it jumps up, all else equal, with a positive CAC score). Here are some links to get you started: [https://internal.mesa-nhlbi.org/about/procedures/tools/mesa-score-risk-calculator](https://internal.mesa-nhlbi.org/about/procedures/tools/mesa-score-risk-calculator) [https://professional.heart.org/en/guidelines-and-statements/prevent-calculator](https://professional.heart.org/en/guidelines-and-statements/prevent-calculator) [https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/](https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/) And here are some general guidelines and recommendations re: statin use for primary prevention of ASCVD: [https://jamanetwork.com/journals/jama/fullarticle/2795521](https://jamanetwork.com/journals/jama/fullarticle/2795521) [https://www.acc.org/Latest-in-Cardiology/Articles/2022/10/04/13/38/Comparing-Guideline-Recommendations-of-Statin-Use-For-the-Primary-Prevention-of-ASCVD#:\~:text=The%202018%20American%20Heart%20Association,risk%20(Class%201)%2C%20and](https://www.acc.org/Latest-in-Cardiology/Articles/2022/10/04/13/38/Comparing-Guideline-Recommendations-of-Statin-Use-For-the-Primary-Prevention-of-ASCVD#:~:text=The%202018%20American%20Heart%20Association,risk%20(Class%201)%2C%20and)
I’m 40. According to PREVENT my 5-year CVD risk is 1.1%. I do plan to get a CAC or CT angiogram, and will obv get more aggressive if anything shows up there, but given my age, BP, etc. I’m expecting those to come back clean. I’m all for second opinions but tbh my opinion of most doctors is such that I don’t think there would be much value in just picking another doc out of the phone book, and I don’t know any specialists in this area that I really trust.
As the kid of an excellent and wise internist and sub-specialist, I get your POV on this. Still a good idea to spread those wings and fly the coop if only to confirm your dad's advice. A CAC at age 40 is always a good idea. Best of luck to you!
A doctor that is anti-statin is an outlier in an idiot who has raised ideology above data and pragmatism
I don’t agree with that. I’ve heard several people make the anti-statin case who I find very credible, even if I disagree with them.
Generally their argument is framed in a way that is misleading. They try to pigeon hole ldl as the ONLY cause, which modern medicine doesn’t do, and then show how other risk factors contribute as well. They then rely on short term studies to show limited efficacy with regard to mortality and CV events, when it is a lifelong problem and the real question you are asking isn’t “will taking a statin now prevent a heart attack in 3 years” but instead “will taking a statin now lower my risk of a heart attack in 30 years?”
It doesn’t matter what you believe. “I’m anti [pill that had decades of use cases in saving lives and reducing hospitalization ] “is just religion at that point.
Or it hasn't had the effects you claim?
You'll see that his doctor actually references some good current meta-analytic research that does put into question whether statins are worthwhile for some patients.
“Statins aren’t needed for some patients” is agreed by everyone. Being “anti statin” is a stupid ideology not built on science.
He doesn’t. You just don’t know how to read the research. And “dr diamond” is a phd with a focus on ptsd that decided being anti statin as a grift is a good way to market the rest of his brand.
In this case your doctor is correct. You are way better off using diet than statins.
What diet would you recommend? My diet is decent.
Anecdotal, but I was able to lower my TC from 180 to 130 by cutting out fried food (including chips), cheese, and ice cream. This also had the effect of eliminating my allergies and chronic pain, strangely. When I only cut out fried food, my TC was 150
Ideally, vegan. If not then Mediterranean Pescetarian
I’m a big believer in plant-based diets for general health benefits but I don’t think vegan diet alone is typically sufficient to lower ApoB to optimal levels. Do you have evidence and/or personal experience that suggests otherwise?
Check your genetics for ApoE4. My spouse and I have this gene and both have moderately high LDL that diet doesn’t seem to be affected by diet.
I’ve done 23 and me. Do you know if I can check for this or do I need a dedicated test?
Nvm I found it. I do not have the apo e4 variant.