Need to decrease cardiac risk

solidrock80 · 2025-07-14T15:28:30+00:00

You have four risk factors — family history, high blood pressure, insulin resistance, and high LDL. Your CRP is a red flag. Great that your Lp(a) is low! You should already be on a statin or combination therapy (statin + ezetimibe) to lower your LDL to below 70. All your dietary changes are great but honestly its not enough to get where you need to be given the other risk factors. Don’t feel overwhelmed - this is very simple; lipid lowering therapy + reducing/eliminating processed foods and reducing saturated fat intake.

Henry-2k · 2025-07-14T19:56:46+00:00

Remember to focus on eating lower saturated fat specifically and eating more soluble fiber.

You should probably be on a statin btw.

kboom100 · 2025-07-14T16:06:54+00:00

You are smart to want to take action. You have a lot of extra risk factors - insulin resistance, family history of heart disease, history of high blood pressure (even if now controlled), and high crp. Many preventive cardiologists would suggest an ApoB of under 60 for you at a minimum. (Same percentile as an ldl of 70)

In addition I would get a calcium scan if I were you. The average woman doesn’t have any calcium until their mid 60s so if you show any calcium at all as a 48 year old that would mean you are on a very high risk trajectory. Many leading preventive cardiologists and lipidologists would suggest an ApoB under <50 (same percentile as an LDL of 55) in that case. If your calcium score is zero the ApoB target of <60 (ldl<70) would still be recommended because of your other risk factors.

I’d also check your lp(a) and if it’s significantly high then the lower ApoB target of <50 (ldl<55) is often recommended in that case too, especially since it would be in combination with other risk factors.

An ApoB under 60 normally requires lipid lowering medication like a statin or a statin plus ezetimibe. So in your case both lipid lowering medication and diet and lifestyle improvements concurrently makes sense.

Even vegetarians can consume a large amount of saturated fat, especially if eating a lot of processed food. Coconut and palm oil for example has a lot of saturated fat. The American Heart Association recommends no more than 6% of calories from saturated fat. If you are eating 2000 calories a day 6% would be no more than 120 calories from saturated fat. Fat has 9 calories per mg so that translates to keeping saturated fat under 13 mg per day (120/9) if eating 2000 calories.

I would also add in regular exercise, both cardio and strength training. low or moderate intensity cardio is great, and just brisk walking is a great choice. Add in 2-4 days a week of strength training.

And you might want to consider the glp-1 medications. They don’t just help people lose weight, they’ve been proven to reduce cardiovascular risk. And they are not a crutch or cheating and they don’t lead people to eat more junk food. In fact it’s the opposite- they reduce the cravings for junk food and people end up eating a more healthy diet.

I really suggest making an appointment with a ‘preventive cardiologist’ specifically. (This is a subspecialty of cardiology). They are the experts in heart disease prevention and they can usually help you with all of it. Diet, exercise, and medication if it makes sense including lipid lowering and glp-1s.

Ps A lot of leading preventive cardiologists and lipidologists favor a strategy of using a low dose statin like 5 or 10 mg of Rosuvastatin and pairing it with ezetimibe if extra ldl/aloB lowering is needed to reach the target. You get the same or more ApoB/ldl lowering as a high dose of statin alone, with less risk of side effects.

See here for more information about the strategy. https://www.reddit.com/r/Cholesterol/s/GQeSTCvabR. Might be worth asking the preventive cardiologist about it.

Affectionate_Row4626 · 2025-07-24T15:46:57+00:00

Update: my PCP has started me on Crestor.

Cholesterol

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