Statin thoughts……

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Sharron1 said:
I had read about that option. Will see and listen to what GP suggests, but he is keen for me to waiit a while.
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The doctors I’ve encountered seem only too keen to get you onto Statins. Your’s sounds like he’s taking a more measured approach.
 
Eddy Edson said:
Many experts in the field seem to be recommending low intensity statin + ezetimibe as first line treatment now. Versus high intensity statin, generally delivers the same or superior LDL-C / apoB reduction with lower side effect risk.
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I've been looking into Ezetimibe following your post and having watched the interviews with the lipidologist Dr. Dayspring - link to the video series page here - Link - which has links to the YouTube videos. Ezetimibe is discussed in video 3 starting at around the 55:45 timestamp.

He mentions in the video that there may be secondary benefits to the medication in preventing fat accumulation in the liver, something that has only been proven conclusively in animal trials at this time. Looking into this further I found this study - Link - which appears to show a reduction in liver fat in a small study of patients with fatty liver disease. The liver fat angle isn't proven conclusively in big human trials yet but it certainly looks promising.

This medication sounds pretty fantastic to me - having lost a mess of weight to get fat out of my liver to try to achieve remission, keeping the fat from accumulating again is a very high priority. Being able to reduce my statin dose and perhaps getting some fatty liver protection as a bonus seems like a good deal. Will definitely bring this up with my doctor to see if I can switch from 20mg Atorvastatin to a 10mg/10mg Atorvastatin/Ezetimibe combination tablet.

Edit - study on mice fed a high-fat diet while on Ezetimibe showing effects on liver fat and, notably, insulin resistance here: Link Mice aren't humans of course, but as I would like to be on a lower statin dose anyway this all seems like a win/win... assuming my doctor is okay with the change.
 
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PerSpinasAdAstra said:
I've been looking into Ezetimibe following your post and having watched the interviews with the lipidologist Dr. Dayspring - link to the video series page here - Link - which has links to the YouTube videos. Ezetimibe is discussed in video 3 starting at around the 55:45 timestamp.

He mentions in the video that there may be secondary benefits to the medication in preventing fat accumulation in the liver, something that has only been proven conclusively in animal trials at this time. Looking into this further I found this study - Link - which appears to show a reduction in liver fat in a small study of patients with fatty liver disease. The liver fat angle isn't proven conclusively in big human trials yet but it certainly looks promising.

This medication sounds pretty fantastic to me - having lost a mess of weight to get fat out of my liver to try to achieve remission, keeping the fat from accumulating again is a very high priority. Being able to reduce my statin dose and perhaps getting some fatty liver protection as a bonus seems like a good deal. Will definitely bring this up with my doctor to see if I can switch from 20mg Atorvastatin to a 10mg/10mg Atorvastatin/Ezetimibe combination tablet.

Edit - study on mice fed a high-fat diet while on Ezetimibe showing effects on liver fat and, notably, insulin resistance here: Link Mice aren't humans of course, but as I would like to be on a lower statin dose anyway this all seems like a win/win... assuming my doctor is okay with the change.
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Would be interested to know what your dr says.
 
PerSpinasAdAstra said:
Will definitely bring this up with my doctor to see if I can switch from 20mg Atorvastatin to a 10mg/10mg Atorvastatin/Ezetimibe combination tablet.
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Interesting to see if that works. Current UK primary prevention guidance says this:

• If maximum tolerated dose of statin does not achieve non-HDL-C reduction > 40% of baseline value after 2-3 months consider adding Ezetimibe 10mg daily (NICE TA385)

So statin+Ez not first-line treatment at the moment, but presumably your doc can prescribe if he/she thinks justified.
 
Eddy Edson said:
Interesting to see if that works. Current UK primary prevention guidance says this:

• If maximum tolerated dose of statin does not achieve non-HDL-C reduction > 40% of baseline value after 2-3 months consider adding Ezetimibe 10mg daily (NICE TA385)

So statin+Ez not first-line treatment at the moment, but presumably your doc can prescribe if he/she thinks justified.
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I'm not in the UK I'm in Ireland so I'm not sure what rules apply to me here. My main argument will be that I'm about to finish my weight-loss diet when I hit target, and after that I'll need to up my calorie intake substantially to maintain my weight. As part of that I intend to eat a whole lot of eggs (5 or 6 per day) to help make up the calorie balance without adding carbs back into my diet. A partial switch from the statin to Ezetimibe should be more suited to managing a diet that is quite high in dietary cholesterol. If that argument fails I'll bring up the possibility that it might also conceivably help to manage the risk of developing a fatty liver while on a diet that is quite high in fat. The doctor might not buy it, but I'll give it a shot.
 
PerSpinasAdAstra said:
I'm not in the UK I'm in Ireland so I'm not sure what rules apply to me here. My main argument will be that I'm about to finish my weight-loss diet when I hit target, and after that I'll need to up my calorie intake substantially to maintain my weight. As part of that I intend to eat a whole lot of eggs (5 or 6 per day) to help make up the calorie balance without adding carbs back into my diet. A partial switch from the statin to Ezetimibe should be more suited to managing a diet that is quite high in dietary cholesterol. If that argument fails I'll bring up the possibility that it might also conceivably help to manage the risk of developing a fatty liver while on a diet that is quite high in fat. The doctor might not buy it, but I'll give it a shot.
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A nice clear guidance summary for Ireland:

link.springer.com

Abbreviated lipid guidelines for clinical practice - Irish Journal of Medical Science (1971 -)

Background Lipid disorders are now considered causal for atherosclerotic cardiovascular disease (ASCVD) which remains one of the most important contributors to morbidity and mortality in the developed world. Identification and early treatment of lipid disarrays remains the cornerstone of good...
link.springer.com link.springer.com

Similar Ez guidance as for the UK.
 
Eddy Edson said:
A nice clear guidance summary for Ireland:

link.springer.com

Abbreviated lipid guidelines for clinical practice - Irish Journal of Medical Science (1971 -)

Background Lipid disorders are now considered causal for atherosclerotic cardiovascular disease (ASCVD) which remains one of the most important contributors to morbidity and mortality in the developed world. Identification and early treatment of lipid disarrays remains the cornerstone of good...
link.springer.com link.springer.com

Similar Ez guidance as for the UK.
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Many thanks. Also - curses! I'm going to need a better argument than wanting to eat loads of eggs 😉
 
Teadance said:
The doctors I’ve encountered seem only too keen to get you onto Statins. Your’s sounds like he’s taking a more measured approach.
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Maybe... he didn't sound that convinced that Statins might be problematic for liver enzymes. Felt like advising him to take a look at NHS and Liver Society websites. But decided against that approach.
 
Teadance said:
The doctors I’ve encountered seem only too keen to get you onto Statins. Your’s sounds like he’s taking a more measured approach.
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Probably because he can see I would like some thinking time, rather than backwards and forwards every 3 months for blood tests to see which Statins are ok for my temperamental liver. Sigh.
 
PerSpinasAdAstra said:
I'm not in the UK I'm in Ireland so I'm not sure what rules apply to me here. My main argument will be that I'm about to finish my weight-loss diet when I hit target, and after that I'll need to up my calorie intake substantially to maintain my weight. As part of that I intend to eat a whole lot of eggs (5 or 6 per day) to help make up the calorie balance without adding carbs back into my diet. A partial switch from the statin to Ezetimibe should be more suited to managing a diet that is quite high in dietary cholesterol. If that argument fails I'll bring up the possibility that it might also conceivably help to manage the risk of developing a fatty liver while on a diet that is quite high in fat. The doctor might not buy it, but I'll give it a shot.
Click to expand...
You may find that after achieving remission by weight loss you can stabilise your weight through cautious upping of calories without regard for amount of carbs. You’d need to do some experimentation to find out. This has been my own experience (i.e. carbs don’t matter for me) and Lean told me it was also the experience of every single one of those Direct participants who maintained their remission by maintaining their reduced weight.
 
childofthesea43 said:
You may find that after achieving remission by weight loss you can stabilise your weight through cautious upping of calories without regard for amount of carbs. You’d need to do some experimentation to find out. This has been my own experience (i.e. carbs don’t matter for me) and Lean told me it was also the experience of every single one of those Direct participants who maintained their remission by maintaining their reduced weight.
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This is my rough plan, but I have to wait another 9.5 months for my next hba1c
 
childofthesea43 said:
You may find that after achieving remission by weight loss you can stabilise your weight through cautious upping of calories without regard for amount of carbs. You’d need to do some experimentation to find out. This has been my own experience (i.e. carbs don’t matter for me) and Lean told me it was also the experience of every single one of those Direct participants who maintained their remission by maintaining their reduced weight.
Click to expand...
I intend to do some experimenting as you suggest, though cautiously. I don't actually plan to eat 6 eggs a day - I'm more grasping for a good argument to convince the doctor to lower my statin dose while still keeping very tight cholesterol control. Low doses of both a statin and Ezetimibe seems like a very good option. I don't have any side effects from the statin and I would have nothing against staying on the current dose, except that they're known to raise blood glucose levels. Not a problem while I'm also on Metformin, which seems to more than counteract that effect, but I do want to come off Metformin soon as it's known to inhibit muscle growth in response to exercise. I don't want to come off it only to find that my blood glucose levels go up as much due to the statin as due to stopping the Metformin.

Unfortunately - guidelines. It appears that Ezetimibe is typically only offered when a person can't tolerate a sufficient dose of statins, due to muscle pains or whatever. I'm not sure a letter to the doctor explaining that I want to go on Ezetimibe so that I can lower my Atorvastatin dose so that I can drop Metformin so that paying for a gym membership wouldn't be a total waste of money would quite do the trick 😉
 
It may be that your weight loss has already yielded sufficient benefit to have obviated the need for Metformin long ago. Significant weight loss very quickly rectifies hepatic management of glucose.
 
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