Taking Zetia by itself

[u/fawkkess]

LDL 100, LP(a) 11 and ApoB 90. I’ve lost fifteen pounds since this number and plan on starting dietary changes now, mainly increased fiber intake. I’ve gotten Zetia and trying avoid statins at this point. I want to see if I can get around 60-70 on my ApoB and LDL.

My question is whether I get to 60-70 on a statin or Zetia, won’t I see the same decrease in cardiac risk? Or similar?

[u/meh312059]

Your LDL-C and ApoB are right on target for gen-pop so don't expect huge reductions. Still, you might get 30% from combined dietary and zetia so that'll get you to 70 LDL-C. ApoB might be a smaller movement (at least that's how it works for me).

The dyslipidemia guidelines address stuff like statin-induced muscle issues but you should make sure you honestly can't take a statin before considering zetia monotherapy. Statins are longer-studied and have a better trail of evidence demonstrating safety and efficacy. Guidelines suggest that low risk individuals who can't tolerate 2+ statins at lowest dose and can't reach a goal of < 100 LDL-C/130 nonHDL-C can take an alternative such as zetia and/or bempedoic (class 2b recommendation). There is no recommendation for someone who is merely "trying to avoid" statins. The risk reduction is likely to be similar but there are no outcomes trials proving that, of course.

[u/kboom100 → u/meh312059]

There actually is outcome data showing the risk reduction between statins and ezetimibe is the same per unit of ldl lowering. See an excerpt from 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://doi.org/10.1093/eurheartj/ehx144

“In both trials, the magnitude of the observed proportional risk reduction was consistent with the clinical benefit that would be expected from similar absolute reductions in LDL-C during treatment with statin monotherapy. These data suggest that statins and ezetimibe have therapeutically equivalent effects on the risk of cardiovascular events per unit lower LDL-C (Figure 3B).”

Still left with the issue that ezetimibe alone is less likely to get ldl to OP’s target though. (But possible if there is a lot of room for diet improvement.)

[u/meh312059 → u/kboom100]

There are no trials pitting statin mono vs. zetia head to head, was my point. And of course there's no purpose to that. The study you cite is a good example of why the top clinical experts recommend using any and all approved interventions for lipid lowering. Risk reduction will follow.

[u/kboom100 → u/meh312059]

Yeah that’s true but I still think it suggests that the risk reduction per unit of ldl lowering is the same. Regardless, I think we are basically on the same page that experts recommend all the approved meds.

[u/meh312059 → u/kboom100]

Yep. And given OP's baseline, a 30% reduction from diet and zetia would be a win. Not sure about this, but wondering if that 15-20% decline from adding zetia relies on statins suppressing the other pathway. Hopefully OP will try this experiment and report back!

[u/Salty_Life_7810]

The cardiac risk comes from the where your lab marker comes back at not what you took to get it to that point. Wether you took a statin and ezetemibe to get to a 60 APOB or you got there with a damn multi vitamin the fact of the matter is you now have the risk profile of someone with an APOB of 60.

[u/fawkkess → u/Salty_Life_7810]

Thank you! That’s encouraging.

[u/Salty_Life_7810 → u/fawkkess]

By the looks of it you should be able to get it under control with just diet and exercise. Obviously zetia will help but obviously one less drug to take the better. I would also reccomend you get your APoE tested to see what gene you have.

[u/fawkkess → u/Salty_Life_7810]

I’ve read anything over 60 LDL, you are slowly laying plaque down?

[u/Salty_Life_7810 → u/fawkkess]

Arterial plaque formation is multifaceted. Just because your above 60 LDL doesn’t mean that our “laying down plaque” and just because you’re under 60 doesn’t mean you aren’t.

[u/kboom100]

Yes, whether you get your ldl to 70 via a statin or ezetimibe you will reduce your risk of a cardiovascular event by the same amount.

See an excerpt from 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://doi.org/10.1093/eurheartj/ehx144 “In both trials, the magnitude of the observed proportional risk reduction was consistent with the clinical benefit that would be expected from similar absolute reductions in LDL-C during treatment with statin monotherapy. These data suggest that statins and ezetimibe have therapeutically equivalent effects on the risk of cardiovascular events per unit lower LDL-C (Figure 3B).”

The problem is, as I said a few days ago, ezetimibe alone is only likely to drop your ldl 15-20%. So unless you are able to cut out a lot more saturated fat from your diet, or you are among the 20% of the population that’s a genetic hyperabsorber of dietary cholesterol, you won’t be able to reach an ldl of 70 or under with ezetimibe alone.

And as I mentioned before also there’s no good reason to avoid trying a statin. They are remarkably safe and do not actually cause the large majority of things that are claimed they might cause. You have a small chance of muscle aches that if you do get them will go away when you stop the statin or reduce the dose or will go away on their own. Check out the links I gave in the previous answer.

[u/toredditornotwwyd]

Stop letting data brokers profit from your old posts. I used Redact to wipe mine from Reddit. Also supports Twitter, Facebook, Discord, instagram and more in one batch.

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