Ticker: Don't die of heart disease

You really should push for an ApoB test in general - most people are bit by LDL-C and not other atherogenic particles like Lp(a), but it's still common enough to find out. The good news is Lp(a) is largely genetic so if you know you have low levels you likely don't need to test again anytime soon.

A CAC will show calcified build-up, not reversible (or at least not in any appreciable way)

A CTA will show soft plaque buildup, which IS reversible with a low enough atherogenic particle load. This generally means keeping your LDL-C below the 50-70 range, though if Lp(a) is the cause you'll likely need a PKCS9 inhibitor or an upcoming CETP inhibitor to drive it down.

I didn't stop changing doctors until I found one that would work with me. I didn't go to a fancy concierge doctor - I just shopped around. I didn't go through a string all at once, but when I needed to go to the doctor, if I hadn't liked the last one, I went to the new one. After 4-5 years of this, I found one.

Younger guy. Keeps up with the research. Is interested in hearing about the research. He'd recommended statins to me when I first started seeing him, but I really wanted to see if lifestyle/diet modifications could help - I didn't succeed long term. He was supportive. I came back a few years after and mentioned statins again, but that I was particularly interested in pitavastatin because it looked to have the best side effect/positive effect ratio. I also said I'd like to try to target an even lower level moving forward, even if pitavastatin would likely get me in range, and he agreed that the research showed this should be a positive, so he added ezetimibe.

As noted in the other comment, in most of the US you can just walk in to labcorp or quest or another provider and get tests done without a doctor. NY is to the best of my knowledge the only exception here. The providers have them for order on their websites, and you can usually go through places like jasonhealth or privatemdlabs to get even lower pricing for the same labs at the same places.

Arguing against nonsense like this gets so exhausting.

Statins do not destroy your muscles. Newer statins make this already exceedingly rare side effect even rarer, but let's look at them as a general class:

https://pubmed.ncbi.nlm.nih.gov/36049498/

Blinded RCT/Meta-analysis shows about 11 complaints per 1k patient years, with 90% of them not actually being due to the statin. But because people act like they're common, they mistakenly believe it was the statin, which just reinforces this idea. And that's for muscle pain.

https://www.ahajournals.org/doi/10.1161/atv.0000000000000073

https://academic.oup.com/eurjpc/article-abstract/26/5/512/59...

https://pubmed.ncbi.nlm.nih.gov/15572716/

For actual significant muscle injury? Even lower. 1 or less per 10,000 patient years.

Effectively, you might get one muscle ache per year per 100 people and at most a 1 in 10,000 chance of serious myotoxicity.

As for diabetes, rosuvstatin usually has a neutral to positive impact on insulin sensitivity, and pitvastatin almost always has a positive impact. Some statins do have negative impact, but it's not universal.

It's not like duct tape on a leaking pipe - it's like removing items in a pipe that damage the pipe walls. Yeah, ideally they're not in the pipe to begin with, but removing them is better than letting them stay, and diet and exercise only do so much to remove said items.

Your body can synthesize LDL de novo in the organs that use it, and one of the heaviest users, the brain, can't get cholesterol out of your diet/serum levels at all - LDL cannot pass the blood brain barrier.

There are people with genetic mutations that mean they don't produce LDL, or at least not at high levels - their increased longevity and incredibly rare incidents of ASCVD is what drove the creation of PKCS9 inhibitors.

Statins also lower LDL-C levels - they don't make your body stop producing cholesterol in general, or even LDL-C. Even if your body couldn't make it on-demand where needed, statins aren't going to drop your serum levels to 0.

I'm a big statin sceptic so just putting that up front.

I think things haven't changed because most people underestimate how slow institutional scale change is. There is a reason why HR departments and consultants have Change Management experts. The inertia is huge. Young people don't appreciate this because they thrive on new ideas. Old folks don't and will subconsciously push back, like a form of institutional homeostasis.

Also, while I believe your heart attack stats are correct, I'm more interested in all cause mortality. I believe there statins are a net negative.

Reading this thread it seems like you're the only one moralizing and looking down on people. I don't see anyone here shaming people for their choices. But somehow you seem to have read the worst interpretation of every reply.