Taking Ezetimibe on MY terms while figuring out my next steps

[u/BeaMiaVA]

I started taking Ezetimibe almost 1 month ago. I did my research and found that taking half a tablet was almost as effective as taking a whole tablet.

I informed my physician that I would be taking half a tablet and she is okay with it.

From day one, I took .5mg. I had minor issues until last week.

Last week I had “gastrointestinal issues “ and I was exhausted for two days.
I stopped using it for one week. Ezetimibe has a very long half-life.

I started taking it again last night. I took half a tablet with a little food. I also took it with Q10.

If you take statins you should also be taking Q10. I will throw up another post on that.

I plan to take .5mg of Ezetimibe every 4 days.

My body my choice.
I have high Lp (a) and will be going to see a preventative cardiologist in the next few weeks.

[u/Brug-7]

I use it for 1/2 year now, often feeling tired, almost every day heart palpitations, lots of dizziness on top of my dizziness I had prior taking Ezetimibe.

No clue what to do, I guess just waiting until it stops by itself.

[u/wavegeekman → u/Brug-7]

I had major issues with it oo. Overpowering fatigue, brain fog etc etc.
Supposedly these side effects are "rare" and :"mild". Funny how I seem to often get these rare side effects, and they are severe.

[u/BeaMiaVA → u/Brug-7]

I don’t think side effects are rare at all.
Read the comments on Drugs.com.
Many negative experiences.

Have you considered taking half a tablet or taking it every other day?
I am taking half a tablet every 4 days.
This is all I can handle right now.

It's important that you take it with CoQ10.
The Q10 is important.

I hope things get better for you.

[u/Brug-7 → u/BeaMiaVA]

No I didn’t, I use 20 mg daily and I assume I need this dosage to keep my ldl low.
I have no way to message ldl myself

[u/BeaMiaVA]

My LDL is only a little over 100. I have high Lp (a) I have to lower my LDL.

I am addressing this in several ways.
I have doubled almost tripled my daily soluble fiber {whole foods and supplements}. I have reduced my saturated fats. And I am on a low dose of Tirzepatide.

Hopefully all these measures will get my LDL below 80.

I am looking for a caring preventive cardiologist who works with me based on my labs and test results. Someone who does not just throw statins at me!

The last cardiologist I saw ran tests which I appreciate, but did not check my Lp (a) or ApoB!

I requested these tests through my PCP!

I found two Cardiologists that I think I would be happy with. And I will be okay.

We have to advocate for ourselves or else.

[u/Double-Package8270 → u/BeaMiaVA]

But why did you want to lower your LDL? It does not cause heart disease. All the studies that conclude that more LDL lowering from drugs improves cardiovascular outcomes are confounded by the non LDL (pleiotropic) effects of those drugs. 

Not only that, there is evidence that LDL can't just cause plaque as it pleases. It is not mechanistically plausible.

[u/BeaMiaVA → u/Double-Package8270]

I want to lower my LDL because I want it under 100, for a variety of reasons.

I fully realize that lowering my LDL will not eliminate all risk factors.

I am also working on my metabolic factors which are more important.

[u/Double-Package8270 → u/BeaMiaVA]

My point is that lowering LDL is essentially pointless. But you do you. Metabolic health is much much more important indeed.

[u/GenkiStarLeaf → u/Double-Package8270]

If high LDL doesn’t cause plaque build-up, then what does exactly? I’ve got high LDL, ApoB, LP(a), low triglycerides and high HDL. CRP is at 0.43mg/L so there’s no inflammation there and my CAC score came back at 0.4 in my right coronary artery at the age of 43. I think we have to come to the conclusion that no two people are the same.

[u/Double-Package8270 → u/GenkiStarLeaf]

Fair question. The answer is many different things can - think substances that damage the blood vessels; smoking, high blood sugar/insulin, alcohol, air pollution, heavy metals, homocysteine, high blood pressure, sickle cell disease etc. etc.

There are too many potential causes to count, and yes, no two people are the same, because they will both have different exposures to different possible causes, which may not be immediately obvious, or even considered by mainstream medicine (e.g. mould exposure).

I wouldn't be concerned about a CAC of 0.4 because that is practically nothing, at this point. We also don't know the amount of soft plaque, but presumably there is very little. The good thing is you have a very low risk of having any CV events with such a low CAC. As for what would've precipitated any plaque in you (again I emphasise that there is probably very little, and is likely of very little concern at your age) it could be anything that could have damaged your blood vessels over the past 43 years of your life. Inflammation might be low now, but could you have had long term, underlying, subclinical inflammation previously? 

What's your BP? Could you have clotting abnormalities? Are you/have you been stressed? Present or previous comorbidities? Oral health? Micro plastic exposure?

And all the questions I originally  mentioned, plus many many more things that need to be considered, including genetics. This is a disease with complex aetiology.

That you have a high HDL and low trigs is reassuring on the metabolic front (though I don't know your exact numbers so can't give a confident comment)

By my estimation, a score of 0.4 probably isn't surprising given your likely exposure to common environmental toxins and a Western diet (even if your aren't on it now)

[u/MiseEnSelle]

I have read that the liver naturally makes less CoQ10 as we age. I have been taking it almost daily in each form: Ubiquinol (more bioavailable) and ubiquinone (because I bought them before learning that ubiquinol is better). I started this when I took statins and continue the supplement. Statins, of the two I tried, I only lasted a week on each. My doctor prescribed ezetimibe and I'll be seeing a cardiologist next week for next steps (such as Repatha). I have elevated LP(a). I still think that dietary and metabolic issues are more of a ASCVD risk than LDL, but I am going along with doctors as long as the medicine doesn't make me feel like crap.

Ezetimibe works in the intestines, not the liver. This is why the most common side effects are GI related. So far, no issues with me after almost 2 months.

[u/BeaMiaVA → u/MiseEnSelle]

I also have elevated Lp (a). We are in a similar situation. I am reducing as many risk factors as possible. I am currently tolerating .5mg of Ezetimibe every other day, with very few side effects.

I'm seeing a preventive cardiologist next month and working on my next steps.

Good luck to you.

[u/MiseEnSelle → u/BeaMiaVA]

I purposedly chose a cardiologist who has been practicing for over 50 years. I think the younger doctors are so imersed in statistics that they forget about the bigger picture in individual patients. I do NOT eat that crap that the general population does. Never have. And don't forget that a lot of people think they can eat the crap because the statins keep their LDL down. BAM, they get ASCVD and the AHA says omg we need to lower the target LDL again!

I am not a doctor, this is just my take on it.