ErinPharm Central. Aiming at a healthy longevity     If you like this page buy my memoir to know where I began:  
                                                                                                                                                            And how far I came: 
The history of the discovery of statins from fungal metabolites and their later modification to produce more potent biological activity for treating hypercholesterolemia has led to an estimated up to 43 million patients in the United States eligible for statin treatment while newer guidelines could raise that to 56 million. World-wide many tens of millions at least should have access to a statin but do not. Exercise, stopping smoking, having a nutritious diet, developing stress reduction tactics, having a positive attitude, reducing bodily inflammation, normalizing blood pressure, and taking a statin are the crucial methods to avoiding cardiovascular disease, heart attack and stroke, the beginning of stopping and reversing plaque that has already caused damage to your arterial system, coronary, carotid, and peripheral. It is now known that atherosclerosis can be reversed. Leading cardiologists are talking about the eradication of heart attack.  Current research indicates that the present falling incidence of heart disease can continue, that an objective of the elimination of most heart attack and stroke is attainable, that a clear vascular and blood circulation system can extend life by decades, that the means of  healthy life extension are on the frontiers of medical research. Do not just rely on a statin. Lowering cholesterol with a statin without specific objectives will not guarantee you protection against heart attack and stroke. There is much more to it. It is a more complex issue than that. You will need to adopt lifestyle changes.
Statins are powerful medications and must only be taken under the supervision of a physician. They have potentially serious side effects of muscle pain, fatigue, sleep disturbances, muscle wasting and more deadly consequences including death if the statin is not stopped immediately. So introduce yourself to a statin slowly and carefully while your physician monitors your lipid profile blood work. 
As clinical trials are being completed it is becoming clear that statins have a range of beneficial effects, reducing cholesterol biosynthesis in the liver, lowering bodily inflammation, and providing neuroprotection, while startling study results have been published showing immediate relevance to diabetics, a much lower risk of hip fractures among those taking a statin, a protective effect for breast cancer, colon cancer, prostate cancer, bone strength, stroke, and rheumatoid arthritis. It is expected that other benefits are as yet unfound. Statins will be essential to those intent on strategies to live longer and healthier in the years ahead as medical frontiers advance. This is the first step toward optimal healthy longevity.
It is interesting to reflect that a proof of reversal of arterial plaque with a statin is so recent. At the beginning of 2004 physicians were aware that patients at risk of stroke and heart attack should be treated with a statin to lower cholesterol and most physicians and healthy patients alike were accustomed to regarding a total cholesterol in a blood test within limits of 100 - 199 mg/dL (~2.6 - 5.2 mmol/L) to be acceptable. New study results reached general circulation April 8, 2004 in the New England Journal of Medicine when it was reported that high dose Lipitor unexpectedly showed not only a dramatic lowering of lipid levels but also a decrease in the marker for generalized inflammation, C-reactive protein, another indicator of cardiac risk, and a measurable halting of plaque progression and even reversal in some patients. 
The findings indicated that in patients with acute coronary syndrome, drastically lowering LDL cholesterol to levels substantially below then current target levels there was benefit, and that below 80 mg/dL  (~2.1 mmol/L) of LDL cholesterol, achieved with high dose Lipitor, plaque growth stopped This has profound implications for healthy individuals. These startling results indicate that monitoring otherwise healthy individuals and adjusting LDL to healthy levels will effectively prevent atherosclerosis and the many consequences of poor arterial flow. All statins have been shown to have this effect. Even more recent studies are leading to the conclusion that raising HDL-cholesterol levels gives further benefit. For those with existing plaque reducing C-reactive protein levels reduces the inflammation that leads to plaque rupture and consequent heart attack or stroke from the ejection of plaque debris into the bloodstream.
It was a powerful confirmation of many prior studies on the benefits of lowering blood cholesterol with lifestyle changes in nutrition, exercise, vitamin supplements, and stopping smoking. 
Since less than twenty five per cent of circulating cholesterol comes from the diet with seventy five per cent produced by the liver, spleen, lungs, muscle cells, brain, and other tissues, this is an early alert for all healthy individuals with high cholesterol levels to take advantage of this information to ensure optimal healthy longevity. 
Since the level of C-reactive protein is a blood plasma biomarker for generalized bodily inflammation, which is the precipitating factor in plaque rupture, it should be lowered to as near zero as possible. It is a prime marker for cardiac risk. The American Heart Association has defined C-reactive protein (CRP) levels as low risk, average risk, and high risk with values of less than 1.0 mg/L, 1.0 to 3.0 mg/L, over 3.0 mg/L.

Statins lower C-reactive protein levels and concomitant treatment with omega-3 fish oils will lower the level even further. For a complete review of generalized chronic inflammation and the various methods used to heal and protect read Life Extension Magazine articles. 

Omega-3 fish oils are of prime importance in lowering triglyceride levels as well as reducing inflammation, depression and mortality from numerous causes. Aim at achieving a triglyceride level low in the range of 50 - 150 mg/L  (~0.57 - 1.7 mmol/L).
Elevated homocysteine levels are associated with and indicative of cardiac risk though not believed to be the cause of the cardiac problem. Ideally homocysteine should be below 9.0 micromol/L. Folic acid, vitamin B6 and B12 are efficient in lowering homocysteine levels. 

Fibrinogen levels should be monitored and maintained between 170 to 460 mg/dL (1.7 -4.6 mmol/L). Discuss these facts with your physician; get regular blood tests.
For any individual seeking optimal healthy longevity that means taking the steps necessary to lower lipids, decrease C-reactive protein levels, and to develop a statin strategy to add to nutrition, omega-3 fish oils, exercise, and vitamins.      Always take supplemental Coenzyme Q10.
A medical treatment for reversal of atherosclerosis is also a treatment for the many degenerative diseases associated with early mortality, which have cut short the fullness of life to so many, with almost a million deaths alone in the United States last year. Increasing HDL-cholesterol levels is expected to give additional benefit to add to the benefit of reducing LDL-cholesterol levels. Pfizer's torcetrapib/lipitor clinical trials established that HDL-cholesterol levels can be increased by more than fifty percent but were halted due to unacceptable cardiovascular and mortality data in the study participants. Clinical trials continue in defining how low LDL and how high HDL levels should be for optimal benefit. Research pharmaceutical companies continue clinical trials to find a safe way of substantially increasing HDL-cholesterol levels.
Clinical trials by Merck with anacetrapib have raised HDL-cholesterol levels by 136%. 
Trials by Roche with dalcetrapib were ended May 7, 2012
Trials by Lilly with evacetrapib show promise.
The eventual verifiable safe and effective -cetrapib (CETP inhibitor) and subsequent FDA approval as a prescription medication will bring in a new era of an optimal healthy longevity for those of us not genetically fortunate to have a natural 'longevity syndrome'.                                                             Such an induced 'longevity syndrome' could well have an impact upon humankind even more dramatic than currently imagined. 
ErinPharm advises that you consult with your personal physician, begin adjusting to good nutrition and regular daily exercise, start a statin regimen if necessary to lower your LDL cholesterol to below 70 mg/dL (~1.8 mmol/L), drop triglycerides to below 150 mg/dL  (~1.69 mmol/L) using omega-3 fish oils, take 100 mg/day CoQ10 ubiquinol to resolve statin side effects, aim at increasing HDL to over 60 mg/dL  (~1.5 - 1.6 mmol/L) with exercise and niacin or tricor, encourage lowering of C-reactive protein with additional omega-3 fish oils and multi-vitamins. Lower elevated homocysteine levels with folic acid, B6 and B12. Monitor your fibrinogen levels and plan on living a long life. Follow medical progress in research to raise HDL-cholesterol levels by substantial amounts.
Since VLDL-cholesterol is mainly triglycerides then a VLDL (very low density lipoprotein) value is recorded as one-fifth that of the triglyceride level measured. 
For the bold and adventurous it may be instructive to reflect upon a condition known as hypobetalipoproteinemia
According to the Merck Manual hypolipoproteinemia usually has no clinical manifestations, the individual has plasma total cholesterol (TC) levels ranging from 70 to 120 mg/dL (~ 1.8 -3.1 mmol/L), HDL is normal to high, and LDL is 20 to 70 mg/dL (~ 0.5 - 1.8 mmol/L), usually below 60 mg/dL (~ 1.5 - 1.6 mmol/L), the individual has normal food intake and fat absorption, has a decreased incidence of coronary artery disease and other atherosclerotic sequelae and the condition has been referred to as a 'longevity syndrome'. No treatment is required.
With good nutrition, exercise, abstinence from smoking, statins, co-enzyme Q10, fish oils, niacin-inositol or tricor, and super booster vitamins it is possible to move toward those TC, HDL and LDL levels reproducing a 'longevity syndrome'
John Fahey   Life Extension Foundation Member
The conceptual logic of raising HDL-cholesterol levels is still intact. The devastating setback with torcetrapib has spurred on other research pharmaceutical companies in their approach to raising HDL-cholesterol by a substantial amount. Merck has anacetrapib, reported to raise HDL-cholesterol levels by as much as 136%. This CETP inhibitor (cholesteryl ester transfer protein inhibitor) could mark a major victory in the treatment of cardiovascular disease. In the meantime there are options to raise HDL-cholesterol  by smaller amounts. To be sure it is not as straightforward as monotherapy of a statin to lower LDL-cholesterol or monotherapy of omega-3 fish oils to lower triglyceride levels, which each have been established to be effective and safe, so a cautious and prudent approach is necessary. The place to start is with exercise and giving up smoking if you have not already done so. The second step is to examine and change your nutritional intake. When you have established those changes it will be appropriate to consult with your physician and begin to raise your HDL-cholesterol further with choices among such medications as niacin or Trilipix. If you are taking a statin do not take the other fibrate gemfibrozol (lopid) since that fibrate is known to raise the statin levels in the plasma. Lopid itself as monotherapy to raise HDL-cholesterol is an option  Carefully evaluate each medication option with your physician and its possible side effects with the other medications you already take as well as possible adverse reactions. You will need to schedule blood tests about every three or four months to establish that adverse effects are either not present or minimal. It would be very inadvisable of you to try to aim at a dramatic change over a short period of time. Even clinical trials are aimed at a gradual improvement.

The competition among research pharmaceutical companies to discover a safe and effective
 -cetrapib (CETP inhibitor) is intense. The implications of raising HDL-cholesterol and reversing plaque growth are profound and could have a major impact on society. A recent entry into this competition is evacetrapib by Lilly. Early stage yet for this -cetrapib but it is showing the strong profile discovered with other CETP inhibitors.

Although clinical reports on the remarkable plaque erosion properties of a sufficient daily quantity of pomegranate juice have so far been confined to carotid artery plaque it would be reasonable at this stage to speculate that such plaque erosion properties will extend throughout the entire arterial system and thus gives another nutritional option. The Life Extension Foundation has begun to sell a pomegranate extract in capsule form equivalent to the amount of pomegranate juice reported to cause carotid plaque erosion and is an option for those who find pomegranate juice and concentrate difficult to consume or too expensive. Caution must be taken for those also taking a statin. Pomegranate juice can inhibit the enzymes breaking down the statin thus elevating blood levels of the statin. A much lower dose of statin may be appropriate or even separating statin dosage and pomegranate juice with days between them. Discuss this factor with your physician.   
Read about one report of an interaction.
For those who smoke - stop. Smoking decreases HDL levels, oxidises LDL-cholesterol and promotes plaque accretion. Get a prescription for Chantix.
Warning: Do not take Lopid with a statin. 
A lower cholesterol is just the start to adjusting HDL-cholesterol, LDL-cholesterol, and triglycerides while you add lifestyle changes, an exercise program and improved nutrition to gain optimal healthy longevity.
For those who have already been diagnosed with atherosclerosis it is extremely important that you educate yourself on a full up-to-date medical perspective on this disease. Taking control of your lifestyle, learning of your options, putting into place changes in your life that will begin a slow steady reversal of the decades long damage to your arteries can be done. You need to decide. There are multiple factors involved. It is not as simple as taking a few pills. Your active full commitment to  participation in your own personal atherosclerosis reversal is essential.
LEF Protocol    
Lifestyle nutrition changes suggested by Dr. Dean Ornish in which coronary artery disease can be reversed by adaption to a balanced plant based food intake. 
Dean Ornish Nutrition   
LDL-cholesterol is a calculated value, derived from the Friedwald formula, in which the Total cholesterol = HDL-cholesterol + LDL-cholesterol + VLDL-cholesterol 
And since a VLDL-cholesterol is estimated as 1/5 0f a triglyceride level: 
Thus: LDL-cholesterol = total cholesterol - HDL-cholesterol - 1/5 triglycerides.
Coming on vacation from overseas?
Taking out membership with the Life Extension Foundation means you can shop at the LEF Retail Store in Fort Lauderdale, Florida, and get blood drawn for a full and comprehensive test analysis the same day. No appointment for a blood draw is necessary. Just arrive before 2:00 pm.

LEF Retail Store  

Arterial health can also be damaged by hypertension (high blood pressure). It is a condition often undiagnosed or ignored in and by the general population. It is a 'silent killer' since it can exist in an individual unaware of their high blood pressure for many years insidiously and incrementally damaging the blood circulation system prior to a catastrophic cardiovascular incident. The current impetus toward having households add a home blood pressure monitor to gauge the daily blood pressure status of those with hypertension could well raise the profile of the importance of regular blood pressure monitoring. ErinPharm recommends the Omron brand of blood pressure monitor as being inexpensive and easy to use. New data revealed May 2008 confirm that hypertension control in the general population appears to be better in the United States than in Europe though diabetics are ill served by the latest US guidelines and only about half of US patients achieve a blood pressure objective. This data comes from a comprehensive multi-country survey by investigators led by Dr. Y. Richard Wang, of Temple University and University of Pennysylvania, in which a total of 21,053 patients with a primary or secondary diagnosis of hypertension  in six countries were evaluated. These patients had visited 1,284 primary care physicians and 291 cardiologists. With a definition of control as a blood pressure less than 140/90 mm Hg it was found that 53% of US patients reached that objective compared to 27% to 40% of Europeans. In Canada new guidelines for hypertension management were released to the public in January 2007 and stressed the importance of recognizing "high normal" blood pressure, i.e. 130-139/85-89 mm Hg, and the warning that more than half of such individuals will develop hypertension within four years if they do not make lifestyle changes. The point is also made that for individuals who do not follow a healthy lifestyle more than 90% will develop hypertension. Since guidelines, medications, and lifestyle changes can and will bring blood pressure to a healthy level over a time period of up to six weeks there is a need to overcome this societal inertia on the part of health care professionals and the general population to not actively seek blood pressure normalization. Yes, it does take significant effort at times, needs ongoing attention, requires a personal commitment on the part of the patient BUT it will result in a healthier way of life with a much reduced risk of heart attack or stroke. The next few years will see the launch of a number of new antihypertensive drugs and combination 'polypills'. In India a 'polypill' with two antihypertensives, aspirin, and a statin is expected to gain acceptance. The years to come will see major advances in this combined approach to arterial health. 
Above all make the foundation of a healthy vascular system exercise, good nutrition, and  avoidance of smoke. Develop a positive attitude and treat medications and vitamins as additions to your quest and not as answers in themselves. Just taking a statin is not an immediate effective protection against heart attack and stroke. Reducing plaque burden must be a decades long endeavor.
If you neglect adopting a lifestyle change, medications and vitamins alone will not help you reach optimal healthy longevity.
As of December 15, 2008 FDA approval was given to Abbott for TriLipix, the first fibrate that can be used with a statin as therapy to raise HDL-cholesterol and lower triglycerides.
See ErinPharm Gazette December 2008

Statins, lowering cholesterol, and vascular health
The opinions here are my own. I have no affiliation with any pharmaceutical company or medical group. I look forward to the future with a sense of awe and wonder.
Understand the importance of taking a daily supplement of Vitamin D3 to reduce cancer risk and other diseases.
When you get your blood lipid work done make sure you also get a high sensitivity C-reactive protein level (hsCRP) 
measured at the same time. It is important in assessing risk of heart attack or stroke.
This information will give you the power to make an informed decision about  ways of maintaining and improving your health while aiming at an optimal healthy longevity. It is the result of decades of medical research that, in 2004, began an era in which we know the degenerative disease atherosclerosis can be reversed and realise it is a consequence of contemporary lifestyles that include lack of exercise, exposure to smoke, and over consumption of certain foods. This is for those seeking optimal health (atherosclerosis can develop for decades before symptoms develop), for those starting to have difficulty walking, those developing claudication and peripheral vascular disease as well as for those learning to ward off heart attack, stroke, acute coronary syndromes, and death. It is possible to adopt a lifestyle that can prevent and even reverse that damage. 
Medical advances are happening in research clinics and laboratories worldwide at an ever increasing pace. Update your knowledge on a regular basis using links on this page as some of your resources. 
The reason to use medications (statins) to help prevent this is because of a fuller understanding of how the body produces cholesterol, distributes it to the tissues, and retrieves excess amounts in a process known as 'the reverse cholesterol transport system'. 

Other blood fats, triglycerides, form part of this system and can usually be readily lowered to healthy levels with adoption of healthy diets, exercise, and supplements of omega-3 fish oils. 

The fat that retrieves excess cholesterol and returns it to the liver for disposal is known as high density cholesterol (HDL, so called 'good' cholesterol')
Until recent years invasive surgery for heart attack and stroke patients was the only option for those with cardiovascular disease, and still is for those who have reached that stage.

However, a revolution in thinking about heart disease is taking place. The major focus in this therapeutic approach consists of lowering low density lipoprotein (LDL, so called 'bad' cholesterol), which distributes cholesterol (made mainly by our organs), to all body tissues where it is used. It is believed that modern human diets and lifestyles have led to our organs producing excess amounts of LDL-cholesterol which is vulnerable to oxidation and is deposited as insoluble clogging plaque along the walls of arteries and other vessels of the circulation system. Hindered circulation of blood leads to high blood pressure; inflammation of plaque leads to rupture and release of contents and clot forming events, leading to heart attack, stroke, degenerative disorders and death. 

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I invite you to become a member of The Life Extension Foundation........John Fahey
BUT leading cardiovascular experts question the utility of fibrates.

Studies to take LDL-cholesterol below 60 mg/dL indicate that is a reasonable objective.
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