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LDL level and Statin dosage

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  • LDL level and Statin dosage

    My latest blood work indicated Chol. 171, Trig. 190, HDL 61, and LDL 72. My cardiologist says that my "LDL is not adequately controlled", he wants to increase my dosage of Atorvastatin from 40mg to 80mg. I am reluctant to do so, should I?

    I also asked my Doc to run the inflammation panel, he said no matter what the results it won't change the treatment plan, so he wouldn't do it. He only ordered CRP and my value was 1.0, is this ok or bad? Also, Lipoprotein A is 13.0.
    Last edited by Taz; 08-29-2019, 12:00 PM.

  • #2
    I cannot make decisions on your case. But I would reconsider ANY case re: these issues:
    1. whether an LDL of 72 is causing the problem;
    2. whether an inflammation panel can be useful in terms of case management;
    3. is further increase in a high-dose statin is the best option; and
    4. whether atorvastatin is the best statin.


    • #3
      I would be more concerned about your triglycerides. They are very very high while your LDL is not that high. High triglycerides can be an indicator that your carbohydrate metabolism is not functioning properly. You would do well to reduce your carbohydrate intake so that your tri's get to 100 or less.


      • #4
        Dr. Brewer has to be careful about what might be considered giving medical advice. What he is saying is that you might want to talk with your doctor about switching from atorvastatin to Crestor/rosuvastatin. The main reason is that rosuvastatin will lower cardiovascular inflammation which is a significant cause of cardiovascular disease progression. Your cardiologist might want to drive your LDL-C down to 50 mg/dL or lower, and there are some studies out there indicating that lower LDL-C has some benefits. However, if you can lower your cardiovascular inflammation, you might not need to worry as much about bringing your LDL-C level down as far as 50 mg/dL. You can also point out to the cardiologist the equivalent amount of rosuvasatin vs. atorvastatin as far as lowering LDL-C levels goes. If you get a pill splitter, you can always split the pills to half the dose.

        Your hs-CRP level seems ok enough, but it would be better if you had a result of other inflammation markers such as Lp-Pla2 which would be part of an inflammation panel. If you take an ARB (e.g. losartan or other medication ending in "tan") for hypertension, consider an ACE inhibitor (e.g. ramapril or one ending in "pril"). An ACE inhibitor will also lower cardiovascular inflammation vs an ARB. Some people get coughing spells with ACE inhibitors, and if you change and that bothers you enough better to go back to an ARB than stop taking a hypertension medication entirely.

        In the end your diet is the most important component in health markers that you have control over followed by exercise and sleep. As mentioned in one comment your triglyceride level is high, perhaps indicating a metabolism issue with carbohydrates. Look at the food that you eat and when you eat to determine what might be better for your health if that is your goal. Try to limit food that has sugar/fructose or carbohydrates that are quickly metabolized into sugar. Sadly I had to stop eating fruit because the fructose caused my triglycerides/blood glucose levels to rise. Fruit juices or other juices can be an issue. Consider intermittent fasting for long-term health with limiting any food intake to less than 12 hours a day (some people eat only within an eight hour window or less). Some people go on a ketogenic diet to lose weight and reduce blood glucose/insulin levels, and some stay on it long-term. There are some keto supporters who often comment on the Forum. If you eat a good bit of carbohydrates, take a walk after the meal.

        Measure your blood glucose level an hour after eating various kinds of food to see how your body reacts to those foods. If your doctor will prescribe a CGM (continuous glucose monitor), that would be helpful to your understanding of your metabolism.

        Try to get a CIMT test done to give you an indication of the baseline that you are starting at as you make changes to your health. Dr. Brewer has several videos which you can watch on CIMT testing (use the Search function).
        Last edited by Tom; 08-30-2019, 03:44 AM.


        • Tom
          Tom commented
          Editing a comment
          Also your Lp(a) level of 13 should be ok enough, but best to identify the units of the measurements as that can make a difference sometimes.

      • #5
        Great point about the TG/HDL ratio. Elevate TG/HDL ratio usually indicates a prediabetes/diabetes problem.


        • #6
          Remnant cholesterol is something that some doctors are starting to look at. Take your total cholesterol and subtract from it your HDL and LDL (171 - (61+72)) = 38 mg/dl. That is at the high end of medium risk. It is an indication that your vldl (very low density lipoproteins) which carry triglycerides are not being cleared resulting in too high a level of triglycerides in your blood. Remnant cholesterol is considered to be highly atherosclerotic.
          No Risk <15.5 mg/dl
          Low Risk 15.5 - 23 mg/dl
          Low Medium Risk 23-27 mg/dl
          High medium Risk 27 - 42.5 mg/dl
          High Risk >42.5 mg/dl
          Your liver creates VLDL to carry triglycerides to your cells. After it has given up some of its triglycerides it becomes IDL and then after giving up more triglycerides it is converted to LDL. Something is causing these particles to stay in circulation instead of being converted to LDL. From my research, 2 things that I have seen cause this are a diet high in fat or something which results in your cells not efficiently metabolizing fat.

          Here's an easy to understand article. It's is written by high fat (ketogenic) advocates, so there is some bias in their Problems with the Research section. but overall a good article. It is also the source for the above risk table.

          If you give us an idea what your diet looks like, we might be able to find some clues.
          Last edited by rich; 08-30-2019, 08:17 AM.


          • #7
            Thanks everyone for your input. I have been doing a vegetarian diet and avoiding fats and meats (hi carb). I had a CIMT done, I haven't seen the report yet though my doc said "there is mild plaque in both arteries". I am diabetic and had a heart attack last year and have a RCA stent, 56 yo.
            Meds I am on: Aspirin, Metformin, Tradjenta, Metoprolol, Clopidogrel, Atorvastatin.
            Last edited by Taz; 08-30-2019, 07:53 PM.


            • Tom
              Tom commented
              Editing a comment
              If you are taking metoprolol, then you are already challenged to keep your weight down given the known side effects of beta blockers. If you can improve your health over time, perhaps your cardiologist would be ok with you switching from metoprolol to an ACE inhibitor like ramapril.
              On diet there is a third option between vegan and keto, and that is what I am doing. I find it easier to stick to which I think is very important long-term. I eat a good bit of carbs, but those carbs are the more healthy ones which have a low glycemic index. I add healthy oils like olive oil along with some meat (less than the amount I used to eat). I make sure that I eat one or two eggs daily. It seems to work well enough for me, and the trick I think is to limit processed foods for the most part with an occasional treat. When I do take more of those carbs, I know that I need to take a brisk walk which will cut the glucose spike significantly.
              There are many options out on the Internet for dieting, and try to find one that works for your health which you can live with long-term.

          • #8
            If you've already had an event, you will probably have plaque.


            • #9
              Tom, thanks for your detailed comments. I will discuss with my Doc the possibility of switching Meto with Rama. I will also switch from Lipitor to Crestor (he is ok with this).


              • Taz
                Taz commented
                Editing a comment
                My Doc switched me from Lipitor to Crestor, however, he said I should take Metoprolol for 3 years after the event?

            • #10
              So I switched to Crestor 40mg back in September. I just did new blood work in November and my values are C=136, Trig=205, HDL=58, LDL 37. Is LDL of 37 too low? Should I reduce the dosage? TIA


              • fatmax
                fatmax commented
                Editing a comment
                Your TGs are extremely high. I recommend you follow the advice of Dr Davis at

              • Tom
                Tom commented
                Editing a comment
                I think that many cardiologists would say that an LDL-C at 37 mg/dL is good for high risk patients. However, I think that you are missing the real point that Dr. Brewer made in his comments above. You have done a water fast in the past, and so you obviously want to make some changes to your health. Rather than just focus on your LDL-C, step back and take a look at your diet. You are likely at the point where your body no longer can adequately dispose of a lot of carbohydrates. It appears that you should cut down on refined carbs as those are the most likely to cause this problem. If I recall correctly you have a glucometer. Use it to check your blood an hour after different meals to see how your body reacts. Your high triglycerides indicate that you definitely have insulin resistance. Also consider your exercise and sleep routines to see if those need adjusting, but diet is the most important factor. It is more important than taking a high dose statin. After you correct your diet and see your triglycerides go down to under 100 mg/dL, then consider cutting that Crestor/rosuvastatin in half with a pill splitter.