My Recent Calcium CT Scan

I take 10mg rosuvastatin (just started). 5000 IU D3, 300mcg K2/MK7, 200 mg CoQ10, 400mg Magnesium Glycinate, Krill Oil and 81mg aspirin.

I am eating a low carb (keto) with a Mediterranean flavor (try to keep saturated fat intake low). I eat small amounts of Kim chi and yogurt to try to help gut bacteria.
 
In 2019 I pulled a CAC score of 35 at the age of fifty. I didn't do too much about it other than trying to maintain a better diet and exercise. In 2023 I pulled a CAC score of 356. I went to a cardiologist and did a stress test, stress echocardiogram, and all turned out good. I tried to get my ldl down, by diet alone, under 100 but couldn't manage it. It would stay around 100. That was the deal I made with the Dr.; if I couldn't get ldl below 100 with diet/exercise alone I'd take crestor. So I have been on Crestor (rosuvastatin 5mg) for about 18 months and my ldl hangs around 55-60. My father had quadruple bypass surgery at 58.
I seem to be tolerating the rosuvastatin well and thinking I should go with 10mg Crestor or add the ezetemibe?
 
Why not stay with rosuvastatin or are there some side effects?
No side effects, although the earlier discussion of "clarity" gained after ceasing rosuvastatin use has me wondering whether some "dimness" is occurring ;)

Interestingly, I found this study below suggesting 5mg ezetemibe is just as effective at lowering LDL as 10mg typical dosage.

Ezetimibe 5 and 10 mg for lowering LDL-C: potential billion-dollar savings with improved tolerability - PubMed

This is similar evidence that the majority of the lowering of LDL through rosuvastatin use is with its lowest dose of 5mg and higher doses only see a minute further lowering yet the higher doses see greater side effects.

"The company's recommendation for the initial dose is 10 mg, which reduces LDL-cholesterol by an average of 46–52%. This reduction far exceeds the recommendation by the National Cholesterol Education Program
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of a 30–40% reduction in LDL-cholesterol for high-risk patients. Indeed, the lowest dose of rosuvastatin that is marketed, 5 mg, reduces LDL-cholesterol by 45% on average, still more than initially necessary for many patients."

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17304-2/fulltext
 
...and my ldl hangs around 55-60. My father had quadruple bypass surgery at 58.
I seem to be tolerating the rosuvastatin well and thinking I should go with 10mg Crestor or add the ezetemibe?
Has your cardiologist given you a target LDL? Mine has rold me to shoot for 55, so I'm hoping the 5 mg Crestor will do it.
 
Has your cardiologist given you a target LDL? Mine has rold me to shoot for 55, so I'm hoping the 5 mg Crestor will do it.
He definitely was shooting for the '50s range or lower but he is of the impression that because I am in good shape and passed the stress test and echocardiogram that there is no alarm going off that is driving his treatment recommendations. That's why he was flexible enough to go ahead and give me a few months to just try to lower my LDL with diet and exercise. After that didn't work, he was fine with me taking the lower amount of crestor as I'm not wanting to take anything I don't absolutely have to. He's in his late '60s and in good shape, a runner, and he said that he takes a statin to keep his LDL down. He said he's not asking me to do anything he isn't willing to do. Well, I should hope not LOL 😂
 
It's good that he gave you the opportunity to attempt LDL reduction non-pharmaceutically (diet and exercise) for a while.

I wonder how much of a link exists between dietary cholesterol and serum cholesterol. There's also evidence that not all LDL is bad...I read that 80% of our LDL is cardiovascularly neutral, comprised of large "fluffy" lipoproteins, whereas the small dense LDL is the bad stuff. Who knows? I think having a non-zero CAC score puts us in a different category perhaps, so I'm taking the statin.
 
I think you should do whatever you think best, without regard to anyone else's situation.
I got a calcium score close to 400 about 15 years ago, and my LDL has almost never been below 200.
Yet I don't take any statins and I'm perfectly happy with my numbers.
 
I'd love to hear why, if you don't mind.
Some of us (well outside the mainstream of medical advice) believe that LDL numbers are meaningless.
But I would never advise anyone else to think that way. It's important to do your own research when your own health is at stake.
 
If you want to dig deep into the mechanism of lipoprotein causing atherosclerosis there is an excellent three part interview with Thomas Dayspring on The Proof podcast on you tube.

However, Dayspring is a statin pusher. Other people think that insulin resistance causing inflammation and damaging the artery lining is the root cause of the LDL getting into the artery wall and causing plaque.

My opinion is that you need to address lifestyle and metabolic health whether or not you decide to take statins.

Quest-Cleveland Heart Lab has a set of blood tests called Cardio IQ. That includes several inflammation markers and advanced lipid panel testing.

From what I have watched it seems that for most people dietary cholesterol is not that related to serum cholesterol. Most of the high serum cholesterol is either because the liver is making too much or the mechanism for the liver removing it from the blood is not working properly.

20% of people are hyper-absorbers. In this case a process that prevents the intestine from absorbing too much cholesterol is not working properly.

Thomas Dayspring says that before starting stations he would order the Cholesterol Balance Test from Boston Heart Lab. If you are a hyper-absorber it is better to start with ezetimibe which blocks absorption. You can also try to figure this out by trying ezetimibe first to see how much effect it has.
 
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Here is a video on the Quest Cleveland Heart labs.

 
Anyone can write a book but it does not mean that the contents are accurate. Everyone can have an opinion. For me, I trust my doctors and believe in main stream medical practice.
I wholeheartedly agree. Most researchers are...doing research and publishing in MEDICAL JOURNALS - they aren't writing books. There are exceptions but I'd tread carefully. I tend to read the primary research (but I have a background in research methodology and stats).
 
At 63 my LDL was a little high. Doc said “might need to medicate that” MD ordered a CAC. My score was zero. A1C was 5.3 No med needed.
I attribute it to a lifetime of hard workouts especially heavy weight lifting.
 
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