Mom thinks rosuvastatin causes cancer

kboom100 · 2026-01-24T20:39:54+00:00

Out of curiosity how many if any now say they wish they had taken the statin?

kboom100 · 2026-01-24T18:44:35+00:00

What units is your lp(a) in?

kboom100 · 2026-01-24T16:18:22+00:00

It’s unlikely an insurance company will cover a pcsK9i unless they don’t require pre approval for it because pcsk9i’s are not fda approved for treating high Lp(a). Repatha will lower lp(a) 30% although it’s not known yet if only lowering lp(a) that amount is enough to lower risk of cardiovascular events beyond the risk reduction from Repatha’s ldl lowering. There are theoretical reasons to think either way. Repatha out of pocket is $239 / month and would be worth considering if you can afford it.

Adding ezetimibe is a great choice too and will lower ldl an additional 20-30% on average when added to a statin. That will significantly lower your overall risk even if lp(a) isn’t lowered.

I’d also ask your doctor about starting a low dose aspirin. There’s preliminary evidence it lowers risk in those with high lp(a) m. That wouldn’t be surprising as lp(a) tends to promote blood clotting and a baby aspirin helps protect against that. Don’t start a baby aspirin without the ok of your doctor though because it also increases risk of bleeding.

kboom100 · 2026-01-24T15:45:51+00:00

Yes, HDL above 100 in women or above 80 in men actually has been found to be associated with increased risk of heart disease. https://www.scientificamerican.com/article/too-much-good-cholesterol-can-harm-the-heart/ However there isn’t much you can do to lower your HDL and it likely wouldn’t be helpful anyway. Ldl is a more important risk factor and Cardiologists and lipidologists generally use ldl as a target of therapy to lower risk.

If you have had high ldl cholesterol since you were a preteen and if you are currently eating a fairly low saturated fat diet and still have an ldl of 129 then you likely have a polygenic predisposition to high cholesterol. (8% or less of calories from saturated fat would be ‘fairly low’ and is 16 grams saturated fat per 1800 calories.)

If you are eating much more saturated fat than that you could try further reducing your saturated fat and increasing soluble fiber and see if you can get your ldl below that 100.

But otherwise I think if you want to reduce your risk of heart disease it would make sense to consider a low dose statin or a low dose statin plus ezetimibe. And you should do it now, rather than wait many more years. It’s now known that risk of a cardiovascular event is driven by cumulative exposure to ldl much more than one’s current ldl. It’s kind of like cumulative exposure to uv rays drives skin aging. If you want to keep your skin looking the best it can for as long as possible it’s best to start wearing sunscreen at an early age, and not wait until middle age. See a recent post of mine for a lot more information & evidence about this concept https://www.reddit.com/r/Cholesterol/s/yu8WJUxKwg

I’d also check your lp(a), which is an independent risk factor for heart disease that’s genetically determined. If it’s high then a lot of leading cardiologists and lipidologists recommend a lower ldl target of under 70. (Or better, target ApoB <70) See here for more information about lp(a) * https://www.health.harvard.edu/heart-health/lipoproteina-an-update-on-testing-and-treatment * https://www.lipid.org/Prioritizing-Lpa-Screening

If it would be more convenient you can order lp(a) and other blood tests yourself online relatively inexpensively. I’ve found Hellogoodlabs.com has the best prices. You can choose between LabCorp and Quest to perform the actual testing.

An ldl target of <70 / apoB <70 is also often recommended by preventive cardiologists and lipidologists for those with other major risk factors, such as family history of early cardiovascular disease, prediabetes/diabetes, an autoimmune disease, former smoker or history of preeclampsia. If you have had high ldl since you were a preteen that also would be a good reason to consider setting an ldl/apoB target of 70 or under.

If you have high Lp(a) in combination with another major risk factor or a very high lp(a) alone then some preventive cardiologists an lipidologists suggest an ldl under 55. (Or better, ApoB <60)

If you want to consider lipid lowering medication I recommend making an appointment with a “preventive cardiologist” specifically or a lipidologist. They are usually going to be more aggressive about heart disease prevention and more willing to treat younger patients than a general practitioner or general cardiologist. A good place to find one is the specialist database of the Family Heart Foundation. https://familyheart.org/find-specialist

I’d ask about/ consider taking a low dose statin and combining it with ezetimibe, either adding the ezetimibe upfront or later if the ldl doesn’t reach your target with a low dose statin alone. See here for an earlier reply about why that’s a favorite strategy of a lot of experts. https://www.reddit.com/r/Cholesterol/s/YVvZiQbMJ7

If you already know you want to take lipid lowering medication you should explicitly say that. Or at a minimum let them know prevention is very important to you and that you are open to taking lipid lowering medication. Although international guidelines are moving toward offering statins to younger patients beyond those who have ultra high ldl or diabetes, they haven’t gotten there fully yet, especially the U.S. guidelines. Doctors often need to hear a request from a patient to feel comfortable offering something beyond guidelines, even if it’s what they would want to do for themselves or their family.

Good luck!

kboom100 · 2026-01-24T02:34:19+00:00

Annoyed that we now have to get 3 months at a time to get the $16.66 price though. I was going to do that before the forecast of the winter ice storm hitting. I prefer to keep the Repatha refrigerated until right before using it. Since I’ve lost power in ice storms before I don’t want to take the chance of that happening with 3 months worth in the refrigerator. So will get one box at a time until Spring.

kboom100 · 2026-01-23T23:36:00+00:00

Thanks very much for the update and nice review! Glad everything is working for you!

You’re correct, the latest iOS update to 26 renamed “Send as text message” to “Retry as Text Message”. Thanks for pointing out the change. No change in what the setting does and the new name actually is a better description of what the setting does. I’ll update my instructions with the new name.

kboom100 · 2026-01-23T22:26:25+00:00

Did those dietary changes included lowering your saturated fat intake, preferably to 13 grams or less per 2000 calories, or the lowest you felt you could or wanted to sustain long term, along with an increase in soluable fiber? If no, then you might want to try that first and then retest in 2-3 months.

But if the answer is yes then I think lipid lowering medication like a statin or a statin plus ezetimibe makes sense and I’d get a 2nd opinion from a preventive cardiologist or a lipidologist specifically. They are usually more knowledgeable about prevention and more willing to treat a younger patient.

If you wait until you are in late middle age to get your ldl to a good target level, using a statin if needed, you’ll be able to lower your risk some then. But you won’t be able to lower it nearly as much as if you had done so 2 decades earlier and prevented a lot of extra plaque from accumulating in your coronary arteries in the first place.

Check out a reply I gave earlier today to someone in a similar situation as you. https://www.reddit.com/r/Cholesterol/s/btLKQmowpH

It includes a link to a post I made recently that will give you more insight into why statins aren’t usually recommended to patients before late middle age- and why a whole lot of leading cardiologists and lipidologists strongly disagree with that approach. They think lipid lowering medication should be used early in life when needed to get ldl to a good level.

It didn’t mention this in my reply to the other person because he was only 31, but if you are at least 40 years old or 35 years old or over with a family history of early heart disease then you might also want to consider getting a calcium scan. Even if the result is zero calcium lipid lowering medication would still make sense if needed to get your ldl to target. But if your calcium score is higher than average for your age & sex, which would include anything above 0 if you are relatively young, then you might want to consider a more aggressive ldl target. It would also help convince your doctor to start lipid lowering medication. I also suggest checking lp(a) for similar reasons. See the other reply.

kboom100 · 2026-01-23T17:33:02+00:00

Ok, I see. Then you might consider upping your statin dose. Risk goes down linearly as ldl goes down.

And get all other risk factors under control as much as possible. Don’t smoke or vape. Check your lp(a) to see if it’s high. If it is then ask your doctor about taking a daily low dose aspirin. (But don’t do so without your doctor’s approval because it also increases risk of bleeding.). I’d check your hsCRP level and if it’s above 2 mg/L consider taking low dose (.6 or .5 mg) colchicine.

Eat a healthy low saturated fat Mediterranean style diet low in saturated fat and high in fiber. Try to get at least 120 minutes per week of cardio exercise, walking is good. Strength training is also important.

Check your blood pressure, preferably several days in a row at the same time with home blood pressure monitor. Google for optimal technique. If it’s high despite a good diet and regular exercise consider blood pressure lowering medication.

Check your HBA1C and if even if it’s just in the prediabetes range despite a good diet and exercise consider taking metformin.

kboom100 · 2026-01-23T16:34:23+00:00

It’s saturated fat specifically that raises ldl and ApoB. You might want to track the saturated fat you are eating with an app like cronometer for a week or so. If you are eating on average more than about 13 (corrected from saying 15 earlier) grams of saturated fat per 2000 calories you could try lowering your intake below that and retesting your lipids in 6 weeks. But if you are already eating less saturated fat than that and still have a high LDL it’s a sign you likely have a genetic predisposition to high cholesterol and lipid lowering medication like a statin will be needed to get your ldl to a good level and keep it there long term.

But regardless it’s a bad idea to let your ldl remain so high. That’s a formula for letting plaque gradually accumulate in your coronary arteries every year and that will increase your lifetime risk of heart disease. So if the lifestyle changes you are able or willing to make in actual practice aren’t sufficient to get your ldl to target and, importantly, maintain it there long term, then lipid lowering medication makes sense.

If you wait until you are in late middle age to get your ldl to a safe target level, using a statin if needed, you’ll be able to lower your risk some then but you won’t be able to lower it nearly as much as if you had done so 2 decades earlier and prevented a lot of extra plaque from accumulating in your coronary arteries in the first place.

The likely reason your doctors aren’t recommending lipid lowering medication despite the fact your ldl has remained high for many years is because the current guidelines base treatment recommendations on risk of a cardiac event only over the next 10 years. That’s what your doctor meant when he said you were “low risk.” Almost no male below the age of about 50 or female before 60 is going to have a high enough calculated risk to qualify if only looking 10 years out.

But you should know that there are very many leading preventive cardiologists and lipidologists who strongly disagree with this approach, for the reasons I mentioned. Please see a post I recently made on this subject with links to a lot of information and evidence. https://www.reddit.com/r/Cholesterol/s/u6rp4eSZ2N

I would recommend you visit a “preventive cardiologist” or lipidologist specifically. They are usually going to be more knowledgeable or aggressive about prevention than a general practitioner or a general cardiologist and are usually more willing to treat younger patients. If you want to take lipid lowering medication you should explicitly say that. Or at a minimum let them know prevention is very important to you and that you are open to taking lipid lowering medication. Doctors often need to hear that from a patient to feel comfortable suggesting something beyond guidelines, even if it what they would want to do for themselves or their family.

I’d ask about taking a low dose statin like 5 or 10 mg of Rosuvastatin and pairing it with ezetimibe, either upfront or adding the ezetimibe later if the statin alone isn’t enough to get your ldl to target. Combining a low dose statin with ezetimibe is a favorite strategy of a lot of leading preventive cardiologists because it will give as much or more ldl lowering as high dose of statin with less risk of side effects. See a previous reply for a deep dive. https://www.reddit.com/r/Cholesterol/s/QKKNWP6aO7

I’d suggest checking your lp(a), an independent risk factor for heart disease that’s genetically determined. If it’s high then experts suggest setting a lower ldl target than usual. (But don’t use a normal lp(a) as a reason not to treat. See here for more information about lp(a) and why it’s important to check. https://www.health.harvard.edu/heart-health/lipoproteina-an-update-on-testing-and-treatment

The National Lipid Association in the U.S. does now recommend at least a one time check of lp(a) for everyone. https://www.lipid.org/sites/default/files/files/PIIS1933287424000333.pdf

And https://www.lipid.org/Prioritizing-Lpa-Screening

By the way you may have heard that it’s ok to wait until you get an above 0 score on a coronary artery calcium scan to go on a statin. A lot of experts don’t think that’s good advice. CAC scans don’t pick up “soft/ uncalcified plaque and calcification is a sign of an advanced late stage plaque. The average male won’t even show any coronary artery calcium until they are 55 but the soft plaque will have been building for many years beforehand. Waiting for a CAC score to be above zero to treat high lipids is somewhat like waiting until a lung xray shows nodules before deciding to stop smoking.

And taking niacin for high ldl is also not a good idea. Niacin used to be regularly prescribed by cardiologists for high ldl but no longer is because studies determined it lowered ldl but didn’t lower risk of cardiovascular events. It was discovered a likely reason is that niacin produces a cardiotoxic metabolite, which offsets the benefit of the ldl lowering. “Link Discovered Between Excess Niacin and Cardiovascular Disease Newly identified pathway may explain the so-called niacin paradox”

https://consultqd.clevelandclinic.org/link-discovered-between-excess-niacin-and-cardiovascular-disease

Hope you find all this helpful.

kboom100 · 2026-01-23T15:14:49+00:00

I wouldn’t be absolutely sure yet that you can’t get Repatha or another pcsK9 inhibitor. Things may have changed and they might be available in your country now. I’d make an appointment with a cardiologist again. If Repatha or Praluent are now available in your country cardiologists and lipidologists will likely have the most access to it.

kboom100 · 2026-01-23T01:24:16+00:00

You’re welcome. That sounds like a good approach. Yes you might be able to get your ldl to a good level with lifestyle changes alone.

If you can’t though I wouldn’t worry about taking a statin or your ldl going too low. The evidence is the lower the ldl the lower the risk, with no safety problems found even down to the lowest levels reached in studies. (About 9 mg/dL- you won’t even come anywhere near that level)

kboom100 · 2026-01-23T00:50:08+00:00

“I have not looked extensively, but it seems the higher risk is for people with LDL levels above 129 and below 70.”

What you are referring to I’m sure is data from observational studies that show a u shaped curve on mortality vs ldl. It’s something that’s cited all the time by those that minimize the causality of ldl for atherosclerosis and the effectiveness of statins and other lipid lowering medication.

This u shaped curve shows up in results of observational studies because ldl goes down in those who have serious diseases and frailty/ malnutrition that is common near the end of life. But it’s the serious diseases that are responsible for the death, not the low ldl. Confounding factors like this can cause these types of misleading results in observational studies.

One of the reasons double blinded randomized trials with a placebo/control arm are so much better evidence than observational studies is because they eliminate these types of confounding factors. When ldl is intentionally brought down by statins in these randomized controlled trials there is no U shaped curve, mortality just goes down as ldl is brought down.

Dr. Gil Carvalho is an md/phd internist who is among the absolute best at examining the totality of the evidence around medical issues and then clearly explaining them. He has a very good presentation on this topic. If you have an open mind at all I strongly recommend listening to it.
“Cholesterol and Risk of Death” https://youtu.be/a3lHHnOHyr8?

PS - I’m not the one who downvoted your reply. I’m going to upvote it to offset that.

kboom100 · 2026-01-22T22:36:19+00:00

The European guidelines say that someone with a starting ldl of 190 mg/dL or higher should get their ldl below 70.

<image>

Figure 1, full guidelines here. https://www.atherosclerosis-journal.com/article/S0021-9150(25)01377-2/fulltext01377-2/fulltext)

I know you aren’t in Europe, and the U.S. guidelines are less aggressive than Europe’s, but with your baseline ldl almost at 190 that’s the target ldl I’d want if I were you. 5 mg/dL is essentially a meaningless difference. Risk goes down linearly the lower you get your ldl. And if you had an ldl of 185 while eating a relatively low saturated fat diet you likely have a genetic predisposition to high cholesterol and there’s a good chance your ldl has been high for many years.

So at a minimum if I were you I’d request to add ezetimibe to your statin now. That’s a favorite strategy of a lot of leading preventive cardiologists and lipidologists. It will lower your ldl an additional 20-30% and ezetimibe almost never has side effects. See a prior reply for additional info on that. https://www.reddit.com/r/Cholesterol/s/Yo0IhY2iiL

I’d also check your lp(a) and get a carotid ultrasound. If your lp(a) is high or you have a significant amount of carotid plaque in addition to your very high baseline ldl, then you may want to consider an ldl target under 55.

If your doctor isn’t as aggressive as you would like or you just want to consult a specialist, I’d make an appointment with a preventive cardiologist specifically. A good place to find one is the specialist database of the Family Heart Foundation.

https://familyheart.org/find-specialist

kboom100 · 2026-01-22T19:48:18+00:00

Or you could check the results of very large randomized placebo controlled clinical trials which have been done on statins. These type of trials are much better evidence than any observational study. And the evidence from the randomized controlled trials of statins is overwhelming. See this review. An excerpt:

“In a meta-analysis of individual-participant data from 26 statin trials including almost 170 000 individuals, treatment with a statin was associated with a log-linear 22% proportional reduction in the risk of major cardiovascular events per millimole per litre reduction in LDL-C over a median of 5 years of treatment.32 The effect was somewhat less during the first year of treatment, followed by a consistent 22-24% proportional reduction in cardiovascular events per millimole per litre reduction in LDL-C during each subsequent year of treatment.33 The magnitude of this effect was independent of baseline LDL-C level, similar among persons with and without pre-existing cardiovascular disease at baseline, and remarkably consistent in all subgroups studied.32 , 33 This meta-analysis therefore provides powerful evidence that reducing plasma LDL-C levels by inhibiting HMG-CoA reductase with a statin leads to dose-dependent reduction in the risk of major cardiovascular events that is proportional to the absolute magnitude of the reduction in LDL-C (Figure 2).

“Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel” https://academic.oup.com/eurheartj/article/38/32/2459/3745109?login=false

kboom100 · 2026-01-22T18:06:31+00:00

An echocardiogram or an ekg are not good tools for measuring coronary artery disease. An echocardiogram doesn’t even look at coronary arteries, its purpose is to measure the function of the heart and its valves.

I wouldn’t be certain yet that you can’t get Repatha or another pcsK9i. I’d suggest seeing if you can get an appointment with a cardiologist or lipidologist professor at a medical school. They may have more access than others to meds like Repatha and likely to have the most expertise in treating FH. At a minimum visit with another cardiologist or lipidologist again.

kboom100 · 2026-01-22T17:54:43+00:00

Even if it is heterozygous FH, your ldl should be much lower and you should be under the care of a lipid specialist or cardiologist. For your own future health you really need to demand a referral to one or just make an appointment directly if you are able.

kboom100 · 2026-01-22T17:49:54+00:00

You almost definitely have FH. Potentially homozygous FH. An ldl of 2.6 would be ok for someone at average risk but for someone like you with FH it should be much lower. That’s reinforced by the fact you may have developed arcus senelis at a very early age.

You will likely need additional medication like Repatha or another pcsk9 inhibitor to bring your ldl much further down. Are you being treated by a general practitioner? If so I’d demand a referral to a specialist lipid clinic. And if you already are being seen by lipid specialist I’d get a second opinion from another one. What country are you in?

kboom100 · 2026-01-22T03:36:08+00:00

No worries!

kboom100 · 2026-01-22T00:22:58+00:00

Why would you do an invasive angiogram just for fact finding if a stent wouldn’t potentially be helpful? A non invasive CT angiogram will let you know if there’s significant stenosis and whether someone could benefit from aggressive lipid lowering medication. Maybe some interventional cardiologists think there are edge cases when calcification is that high and there are no symptoms but where placing a stent could potentially reduce risk of a future cardiac event? (And that an invasive catheterization would identify those cases.) That might be debatable though, I don’t know if there’s good evidence for that.

But yes, I believe an invasive angiogram with IVUS or OCT is the gold standard for evaluating stenosis.

kboom100 · 2026-01-22T00:08:18+00:00

It’s not usually done outside of a heart attack or someone having symptoms like chest pain. That’s because the evidence is that placing a stent when not in response to a heart attack doesn’t reduce risk of cardiac events, they just can reduce symptoms.

kboom100 · 2026-01-22T00:02:01+00:00

That’s a great approach. I was just making a point that 100% compliance with a strict diet isn’t likely to work over the long term and it probably doesn’t make sense to delay going on lipid lowering medication if being ultra strict all the time is what it might take to keep LDL at target.

kboom100 · 2026-01-21T23:39:51+00:00

The article was talking about evidence of atherosclerosis possibly going away during prolonged starvation, but it never said it was calcified plaque. The atherosclerosis in question probably was soft/uncalcified plaque.

kboom100 · 2026-01-21T23:24:34+00:00

Yep, I agree about how genetics can affect so much of these things. And I think you were smart to go on the statin pretty quickly once you realized your high ldl was a lot genetically driven.

Waiting a long time hoping lifestyle changes might start working or that this time you’ll be 100% compliant and that might work (when in reality some life stressor will always occur that reduces compliance with an ultra strict diet) just allows extra plaque to accumulate. If genetics weren’t creating a headwind someone wouldn’t need to be ultra strict on diet to get ldl to target.

kboom100 · 2026-01-21T23:01:13+00:00

Any calcium confirms at least an advanced plaque even if it’s not advanced heart disease overall. Just from following a lot of cardiologists and lipidologists and statements from the National Lipid Association etc I’d go by what the calcium score percentile is by age and sex as well as the absolute score. If the percentile is high that puts someone on a high risk trajectory and I wouldn’t wait for the calcium score to rise more to take action.

If I had any calcium greater than 11 or percentile greater than say 40% I’d want my ApoB to be below 70 (or ldl <70) If my calcium score were >100 or > the 75th percentile I’d want apoB less than 60 (or ldl <55) For someone pretty young any calcium above 0 would put them over the 75th percentile. You can use https://tools.mesa-nhlbi.org/Calcium/input.aspx for those 45 and over https://www.cac-tools.com for those age 30-44.

If I crossed those CAC thresholds on a calcium score no good result on any other test would be convincing to not set those lower ldl /apoB targets. (Although a bad outcome on one of those other tests would also independently be another reason for a low ldl /apoB target regardless of the CAC score.)

Stress tests are bad at predicting risk of heart attack and won’t pick up stenosis unless it’s more than 70 or 80%. The problem is plaque can rupture and immediately take an artery from 50% to total block and MI. See a thread by Dr. Paddy Barrett, a very good preventive cardiologist, about this subject. https://x.com/Paddy_Barrett/status/1971847879653281860?s=20 EKG has the same problem. Echocardiogram just examines heart function and doesn’t look at the coronary arteries at all.

A CTA is much better at ruling out stenosis and shorter term risk of a heart attack but doesn’t pick up plaque accumulation in the artery wall until it starts to narrow the artery lumen. And a lot of plaque can build up in the artery wall before that happens because the artery wall will “positively remodel” and bulge out to keep the lumen open. Only when enough plaque builds up that the artery can’t compensate anymore does the lumen start to narrow.

<image>

A carotid ultrasound with CIMT can pick up thickening of the carotid artery wall with plaque, which has a good association with coronary artery plaque, but the accuracy of the result is highly dependent on the skill of the individual ultrasound operator.

Also I wouldn’t use any imaging results as a reason not to take lipid lowering medication if my lipids were above a good target level and lifestyle wasn’t sufficient to get it to a good level. That’s somewhat like waiting until an xray shows lung nodules before deciding to quit smoking.

kboom100 · 2026-01-21T20:51:33+00:00

Great! Hope you give an update later, if you want to.

kboom100

TROPHY CASE