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Heart Attacks From Steroids | How To Prevent It | Decrease LDL Cholestrol | Statins and Ezetimibe

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In this video I go over ways you can decrease your LDL cholestrol whilst on a steroid cycle or cruising on steroids. I discuss research related to statins (atorvastatin and rosuvastatin) as well as Ezetimibe. This is one of the better ways to decrease risk of atherosclerosis (which can lead to strokes and heart attacks).

Hi guys welcome back to the channel i’m dr downey and today we’re going to discuss heart attacks or heart disease and more specifically we’re going to talk about your cholesterol and controlling your cholesterol on cycle and this directly links to plug build up and the whole atherosclerosis um so i thought this was quite an important video because of all the

Cardiovascular incidents happening in the bodybuilding industry at the moment while some are unknown and we are unsure of the cause we do know that most have been atherosclerosis related which is plaque buildup essentially in the arteries so we are going to discuss how you can treat that if you have high levels because most individuals on steroids will have skewed

Lipids orals affected more so than injectables but at the same time it’s they’re still going to be skewed in most individuals and lifestyle measures do work but to a certain extent so this video is just going to talk about therapeutic options so essentially medical intervention so this topic is important because it is quite well known that under certain levels i

Think it’s 2 millimoles per liter or 80 something milligrams per deciliter that of ldl that plug buildup is not really possible and below this reversal is actually does occur in some instances again this guide is for steroid users only and this is all about risk reduction or harm reduction so um because statins are known to decrease muscular performance and strength

However if you’re taking exogenous hormones the effect is probably much less pronounced i’m not only going to talk about statins i’m also going to talk about ezetamide or mibe um but we’ll mostly be focusing on statins because whilst there is a benefit to decreasing your ldl with zetamibe though the access to it is quite limited um and it’s quite over commercialized

So it’s one of the more expensive treatments it’s not incredibly expensive but i’ve had an email from someone saying what can he do because he doesn’t have access to it because they don’t sell it close to him so and not only that a zeta mibe shouldn’t be first line necessarily it can be if you only have slightly skewed ldl levels but the problem is the primary

Outcomes have never really been are still yet to be shown so the problem is it whilst it does decrease ldl it very rarely decreases that to the therapeutic level that statins are able to correct it to because it’s a bit variable in its results and whilst it does decrease myocardial infarction it doesn’t reduce the uh the incidence of cardiovascular mortality or

Morbidity oh well morbidity i don’t know about that but it doesn’t improve death so furthermore statins should be included because they have these cholesterol independent pleiotropic effects so there are other benefits to them besides the fact that they lower cholesterol quite aggressively such as stabilizing plaque development decreasing the pro-inflammatory

Cytokines or chemokines that tend to worsen the effect and cause a possible abruption of the pluck or worsening of the plaque so this guide is also just for steroid users because in terms of using a statin in a non-steroid user just in the general population it’s found that the risk of having a heart attack or i think it was dying of a heart attack you’ll have

To correct me on that for a non-statin user compared to statin user the relative risk was 36 percent higher in the non-statin using individuals however in absolute terms if you looked at these studies the risk the abs the absolute risk of dying of a heart attack for a non-statin user compared to a statin user um was three percent in the non-statin user and two

Percent in the statin user so that’s the important to look at relative risk versus absolute risk because they reported the relative risk and not the absolute risk there’s a bit of influence there from possible outside sources so the recommendations for statins and non steroid users which is normal individuals i’m not too sure about nor am i too convinced unless

Obviously you have reason to be such as risk factors um so these recommendations i’m going to make are just to ensure safety on cycle and possibly if you’re cruising because even at a cruise you still may have those skewed lipids and since statins do come with their side effects um which are type 2 diabetes it is like it it causes slight lizard liver toxicity as

Well as the well-reported muscular or my uh muscular side effects we’d like to minimize these side effects especially if you are using a statin and you want the benefits from them but not the side effects because the side effects are under reported in the literature in clinical settings it tends to be a lot higher than that in reported in the literature so since

We want to reduce these side effects we need to look at what causes these side effects and it appears that a higher total weekly dosage of the drug or of the statin tends to cause a higher chance of one developing the type 2 diabetes and side effects so this led me to thinking what about intermittent dosing so essentially not dosing every day but um dosing every

Other day or a few times a week in order to minimize your weekly dosage and reduce the side effects because it would theoretically work since whilst statins do have half-lives of 10 to 19 hours um this would this would um support using a daily doses however its effect on its downstream effects on hmg co-reductase tend to last three days up to three days or two

Days so theoretically you could use an intermittent dosing protocol and there are many observational studies done on this protocol however observational observational studies are unable to prove causation they can show correlation and things but they’re unable to prove causation so we actually have to put it to the test as some doctors say and put it in a

Randomized control trial but in fact we have something even better than that we have a meta-analysis and systematic review of this so this study i’m going to refer to is the efficacy and safety of alternate day dosing versus daily dosing of statins so the study didn’t really look at whether it caused fewer side effects which is what we would like it just looked

At whether different dosages were or whether different dosing schematics changed the ldl cholesterol and they found that in the study that atorvastatin and versus statin when compared to their daily dosing versus their alternate daily dosing was as effective as as daily dosing when it came to lowering triglycerides and ldl cholesterol it didn’t reduce total

Cholesterol to the extent of daily dosing however ldl cholesterol tends to be a more important marker so essentially we can decrease um ldl cholesterol to the same point as daily dosing if we use alternate daily dosing whilst we’re using essentially half of the dosage per week so let’s look at another way we could possibly decrease that dose even further the

Dose of the statin i mean and in this they study we are going to look at now they did co-administration with acetamine and as we see there were three different groups and the co-administration group at torva stadium and the zodomide were compared against receiver saturn in a tour of a stabbin this isn’t a randomized control trial there’s no placebo but they were

Just comparing it to different treating regimens and they managed to show that all treatment strategies in this study were as efficacious as each other however the receiver statin and 10 milligrams daily in the five milligrams or two satin five milligrams of acetaminophen had more favorable outcomes so they written they not only reduced ldl but they tended to

Improve the ldl hdl ratio as well as d had no significant change on hba1c which is a marker of glucose control long-term glucose control and as we said type 2 diabetes does occur from these statins however and there was no impairment of glucose tolerance however in the atorvastatin 20 milligrams group there was a bit of deterioration in that aspect so it would

Seem that you could further decrease the dose with the addition of acetaminophen and this is actually shown in another meta-analysis and systematic review they found that adding on azenamide was more effective than doubling the dose of the statin so where am i going with this so essentially we found that the five milligram atovus atom five milligram sediment group

Was as effective as the 10 milligram receiver stating group and so you’re already using a lower dose five milligrams of the torvo statin is quite low but if if we remember the first study i mentioned it found that with the torva seven or superstatin alternate day alternate day dosing was almost as effective as daily dosing so you could decrease the dose even

More by doing five milligrams of the zettamine daily with five milligrams of atovus stat statin every other day and this was actually done in a study in the study ezetimibe was used by itself at 10 milligrams daily i think and it showed its uh reduced ldl cholesterol by 20 which is the most commonly reported figure in the literature and with the addition of a

Torvastatin at 10 milligrams only twice a week they there was the reduction in ldl was almost double so that again proves that you can use this alternate daily dosing scheme but the problem is as we mentioned at the beginning is that not everyone has access to his nmi and whilst combining the two is very effective it’s as effective as the receiver stand in 10

Mil at 10 milligrams a day which means that 10 milligrams a day or every other day would be as efficacious and therefore you could use that instead and use a lower dose of a superstat in a week and there are studies that look at just receiver statin however they’re observational and quite small but they did show favorable outcomes but we can’t conclude much from

Them but there are limitations to what i’ve said above and that’s because they only looked at ldl they looked at the ldl value and not many other markers of atherosclerosis and things that would are important for the outcome of someone uh with cardiovascular disease so they didn’t look at platelet activation markers after stimulation platelet aggregation plasma

Chemokine levels which are also important in preventing the development of plaque as well as just atherosclerosis and that critical stenosis where a vessel occludes so if your ldl is your concern this protocol would work however we don’t know about its how effective it would be in clinical practice since it does is since the platelet markers and things like that

Were not looked at and using a lower dose of the statin statins being the most effective drug at reducing cardiovascular events this would tend to show that maybe it wouldn’t reduce cardiovascular resentment events although it does reduce ldl cholesterol but we don’t know since that hasn’t really been looked at they haven’t really done too many long-term studies

And the long-term studies and have a long term they’re about five years so in summary alternate day dosing appears to be as effective as daily dosing of in atorvasanan and receive the standin and the addition of a zetamide should be constitu considered instead of upscaling your dose if you do have access to a zetamide so the best protocol would be five milligrams out

Of my daily with either 10 milligrams of vitorvo standing twice a week or five milligrams of atorvastatin every other day if you don’t have access to his adamab remember receiver 7 was as effective as the um of receiver statum was as effective as the five milligram five milligram group so receive the statin at 10 milligrams every other day could be as effective

With supposedly limited side effects so i hope you enjoyed that video and you learned something from it and let me know what you think if you agree with what i said and if you didn’t and i’ll see you in the next one

Transcribed from video
Heart Attacks From Steroids | How To Prevent It | Decrease LDL Cholestrol | Statins and Ezetimibe By Nicholas Downey