Cycling UK Forum

Vetus Ossa wrote: ↑25 Jun 2023, 6:30pm As someone who is likely to be starting on statins soon, Atorvastatin 20mg, I have been following this topic with obvious interest.
I have come to the conclusion that I will take them and hope for the best.
I have a cycling chum who had a triple bypass op a year or so ago, so I asked him about his experience with them.
Before he knew he had to have an operation he was put on statins, after two weeks he was in so much pain he dialled 111 and was told to stop taking them.
After his operation he was put on a different low dose statin and was ok with it for a while, but after a year he was in so much pain all over he stopped taking them as instructed.
Which brings us up to date, he has now been given another statin to try.
As said previously both me in-laws are on statins and are trouble free, I can only hope I am as lucky as them.

What age is your cycling chum?

Cowsham wrote: ↑25 Jun 2023, 8:37pm

Vetus Ossa wrote: ↑25 Jun 2023, 6:30pm As someone who is likely to be starting on statins soon, Atorvastatin 20mg, I have been following this topic with obvious interest.
I have come to the conclusion that I will take them and hope for the best.
I have a cycling chum who had a triple bypass op a year or so ago, so I asked him about his experience with them.
Before he knew he had to have an operation he was put on statins, after two weeks he was in so much pain he dialled 111 and was told to stop taking them.
After his operation he was put on a different low dose statin and was ok with it for a while, but after a year he was in so much pain all over he stopped taking them as instructed.
Which brings us up to date, he has now been given another statin to try.
As said previously both me in-laws are on statins and are trouble free, I can only hope I am as lucky as them.

What age is your cycling chum?

Over 70, as am I

Vetus Ossa wrote: ↑25 Jun 2023, 8:47pm

Cowsham wrote: ↑25 Jun 2023, 8:37pm

Vetus Ossa wrote: ↑25 Jun 2023, 6:30pm As someone who is likely to be starting on statins soon, Atorvastatin 20mg, I have been following this topic with obvious interest.
I have come to the conclusion that I will take them and hope for the best.
I have a cycling chum who had a triple bypass op a year or so ago, so I asked him about his experience with them.
Before he knew he had to have an operation he was put on statins, after two weeks he was in so much pain he dialled 111 and was told to stop taking them.
After his operation he was put on a different low dose statin and was ok with it for a while, but after a year he was in so much pain all over he stopped taking them as instructed.
Which brings us up to date, he has now been given another statin to try.
As said previously both me in-laws are on statins and are trouble free, I can only hope I am as lucky as them.

What age is your cycling chum?

Over 70, as am I

Has he always been fit ? ( sorry for all the questions just trying to get a handle on this aging lark as I'm hopefully going to be 70 10 years from now -- highish but well balanced cholesterol levels always been slim and fit )

Cowsham wrote: ↑25 Jun 2023, 9:05pm

Vetus Ossa wrote: ↑25 Jun 2023, 8:47pm

Cowsham wrote: ↑25 Jun 2023, 8:37pm

What age is your cycling chum?

Over 70, as am I

Has he always been fit ? ( sorry for all the questions just trying to get a handle on this aging lark as I'm hopefully going to be 70 10 years from now -- highish but well balanced cholesterol levels always been slim and fit )

Oh yes, an audax rider who used to cover many more miles than ever I did, but not doing great at the moment.
Not wanting to worry you but we were both doing great until we reached 70.

Vetus Ossa wrote: ↑25 Jun 2023, 9:16pm

Cowsham wrote: ↑25 Jun 2023, 9:05pm

Vetus Ossa wrote: ↑25 Jun 2023, 8:47pm
Over 70, as am I

Has he always been fit ? ( sorry for all the questions just trying to get a handle on this aging lark as I'm hopefully going to be 70 10 years from now -- highish but well balanced cholesterol levels always been slim and fit )

Oh yes, an audax rider who used to cover many more miles than ever I did, but not doing great at the moment.
Not wanting to worry you but we were both doing great until we reached 70.

Scary but thanks -- wow an audax rider - respect -- I suppose we have to take genetics into consideration. The story of extreme runner Jim Fixx dead 52years old comes to mind but you have to remember his father had his first heart attack at 35 -- died at 42.

Since injecting myself with Repatha for the last seven years every fortnight - next injection is tomorrow - and having annual blood tests, they don't even get back to me with any concern at all. Dunno what it is, but it's fine and "normal" and I'm fine and completely symptom-free.

We've heard from Mick about his postive experience with Repatha - does anyone else have any experience of another statin alternative I'm aware of, called Inclisiran (marketed as Leqvio) that I read about recently?
https://www.theguardian.com/science/202 ... in-england

simonineaston wrote: ↑29 Jun 2023, 9:34am We've heard from Mick about his postive experience with Repatha - does anyone else have any experience of another statin alternative I'm aware of, called Inclisiran (marketed as Leqvio) that I read about recently?
https://www.theguardian.com/science/202 ... in-england

From memory, it's newer and even more expensive, so it may well be kept for people who can't respond well to a couple of statins, Repatha, Praluent and Nilemdo. I'm on the last of those now.

But I think inclisiran is delivered by injection like Praluent and I've not yet got really to the bottom of my adverse reaction to that, so it's still possible that I might have been reacting to the injection not the drug, and if so, inclisiran won't work for me.

Praluent, Repatha and Inclisiran all target the same mechanism (PCSK9) which is a different mechanism to statins.

Praluent and Repatha are biologics - monoclonal antibodies.

Inclisiran is an oligonucleotide - a synthetically made small double strand of nucleic acid known as SiRNA (silencing RNA)

All of these are injected, but inclisiran has a much longer period between injections (6 months)

Nilemdo is a traditional small synthetic molecule (bempedoic acid) taken orally and is generally regarded as less effective than the PCSK9 class or statins.

The EMA provides a very good summary of approved medicines, you can read here for Repatha and Nilemdo

https://www.ema.europa.eu/en/medicines/ ... AR/repatha
https://www.ema.europa.eu/en/medicines/ ... AR/nilemdo

roubaixtuesday wrote: ↑29 Jun 2023, 11:33am Nilemdo is a traditional small synthetic molecule (bempedoic acid) taken orally and is generally regarded as less effective than the PCSK9 class or statins.

Just to agree with that and give more detail by summarising the LDL reductions that I found on the EMA site:
[...list deleted - see discussion...]

So, yes, it's less effective alone, but still the same ballpark when combined with Ezetrol (aka ezetimibe), which may offer enough reduction, especially when combined with cycling and a Mediterranean diet.

For me, I also like that it inhibits the ACLY part of cholesterol production, rather than the HMG-CoA reductase part that statins inhibit or the cholesterol receptor breakdown that the PCSK9 inhibitors slow, because those didn't work for me so I'd rather try something that works on a slightly different step of the process (instead of next trying the other injected PCSK9 inhibitors, Repatha or more likely Leqvio). I think I read that Nilemdo's action is thought to be more tightly confined to the liver than statins, which I hoped might result in fewer side-effects and no repeat of past adverse events, but I can't find that reference now.

mjr wrote: ↑29 Jun 2023, 12:46pm

roubaixtuesday wrote: ↑29 Jun 2023, 11:33am Nilemdo is a traditional small synthetic molecule (bempedoic acid) taken orally and is generally regarded as less effective than the PCSK9 class or statins.

Just to agree with that and give more detail by summarising the LDL reductions that I found on the EMA site:..

....o, yes, it's less effective alone, but still the same ballpark when combined with Ezetrol (aka ezetimibe), which may offer enough reduction, especially when combined with cycling and a Mediterranean diet.

For me, I also like that it inhibits the ACLY part of cholesterol production, rather than the HMG-CoA reductase part that statins inhibit or the cholesterol receptor breakdown that the PCSK9 inhibitors slow, because those didn't work for me so I'd rather try something that works on a slightly different step of the process (instead of next trying the other injected PCSK9 inhibitors, Repatha or more likely Leqvio). I think I read that Nilemdo's action is thought to be more tightly confined to the liver than statins, which I hoped might result in fewer side-effects and no repeat of past adverse events, but I can't find that reference now.

Need to be very very careful quoting these sorts of percentages. There's a huge anount of devil in the detail of study design, analytical and statistical design, patient population and things like co-meds, exclusion criteria etc.

Just for instance, the 38% you quote from Repatha is from a paedaitric study in genetically predisposed children; in the adult population These studies found a substantial reduction in blood levels of LDL-cholesterol (around 60 to 70% more than placebo, and around 40% more than ezetimibe)

roubaixtuesday wrote: ↑29 Jun 2023, 1:04pm ...
Need to be very very careful quoting these sorts of percentages. There's a huge anount of devil in the detail of study design, analytical and statistical design, patient population and things like co-meds, exclusion criteria etc.
...

Well said. I can only repeat my concerns about this thread as a source of medical advice.

Jonathan

roubaixtuesday wrote: ↑29 Jun 2023, 1:04pm Need to be very very careful quoting these sorts of percentages. There's a huge anount of devil in the detail of study design, analytical and statistical design, patient population and things like co-meds, exclusion criteria etc.

Oh for sure, but you already posted "generally regarded as less effective" which hid even more detail.

Also, I make mistakes such as reading the wrong number when flipping between two tabs, especially on a site with poor accessibility like the EMA one. This is not a tightly refereed forum and everyone should check everything posted here with reputable sources like the EMA, but you'd have to consult at least a doctor and often a consultant to get any of those medications. I'll go edit the wrong number you mentioned. Edit to add: the benefits section of the Repatha page doesn't seem to give any other LDL reduction figure for Repatha alone, not in combinaton with other meds. Well, that sucks! I would expect similar performance to Praluent, given it uses the same mechanism, and that Leqvio isn't far off.

mjr wrote: ↑29 Jun 2023, 1:48pm
I'll go edit the wrong number you mentioned.

The table you've edited is now even more misleading

[deleted]

It implies that Reoatha lacks efficacy, and the Praluent figure you quote is a comparison with ezetimibe, not on its own.

And that's just from a cursory glance of obvious errors, there's also the overriding issue that these figures are probably not ever going to be directly comparable unless you run a head to head study,

I'd suggest deleting it.

roubaixtuesday wrote: ↑29 Jun 2023, 1:57pm

mjr wrote: ↑29 Jun 2023, 1:48pm
I'll go edit the wrong number you mentioned.

The table you've edited is now even more misleading [...] I'd suggest deleting it.

Bleah. The EMA site is a hard to read confusing mess (for starters, they should set background colours where they set text colours, and not hide key info in clicky drop-downs). Can you delete the table from your quotes too, please?

You're not immune, too: the "60 to 70%" reduction you quoted was a comparison that included taking Repatha in combination with other meds including maximum statins, which is why I didn't use that figure.

there's also the overriding issue that these figures are probably not ever going to be directly comparable unless you run a head to head study,

OK, so what are you basing your "generally regarded as less effective" on, please?

mjr wrote: ↑29 Jun 2023, 2:04pm You're not immune, too: the "60 to 70%" reduction you quoted was a comparison that included taking Repatha in combination with other meds including maximum statins, which is why I didn't use that figure.

The 60-70% covers studies without statins too according to the EPAR

Some of the studies looked at Repatha taken on its own, while others studied Repatha in combination with other fat-lowering medicines, including patients on the maximum recommended doses of statins.

If we dig a bit deeper...

https://www.ema.europa.eu/en/documents/ ... ort_en.pdf

We find the MENDEL-2 study, run in patients not taking statins

Here are the results from that

60-70% seems to apply in the non-statin population studied there too.