Statins and those 'Pesky Fat Balls'

If you’re reading about longevity and considering starting some longevity medicine interventions, then it is likely that you have come across the question of statins, and maybe have even considered going on a Statin to lower your risk of death from cardiovascular disease and stroke. At the time of writing this, using statins in healthy young people without existing cardiovascular disease as a longevity and healthspan booster is not the standard of care and almost no one in the larger medical community is practicing this way. This guide is written to help you navigate the questions surrounding this issue.

Summary (TLDR)

Not having ever met you I already know the most likely way you are going to die is from cardiovascular disease. The cardiovascular disease process starts very early in life and takes decades to progress. There are three mechanisms (plus time) that drive cardiovascular disease, one of which is apoB. Lowering apoB with a statin is safe and effective and a viable option for many people. Get apoB as low as possible, as soon as possible, for as long as possible. 

The theory behind why we would do this

At the time of writing this, cardiovascular disease and stroke are the leading killers of both men and women by a very very wide margin (Cancer is the #2 killer and kills ½ the number that cardiovascular disease does). This disease process starts really early in life, like in your mid to late teens with fatty streaks forming in your arteries. It takes decades to progress until it ultimately kills you. 

The way this works is by 3 primary mechanisms. Thing the first, you need to have damage to the inside of the blood vessels (endothelial damage). Thing the second, you need to have fat deposit through the damaged lining and into the blood vessel itself (apoB particles are the fat laden entities that deposit in the blood vessel). And thing the third, you need an inflammatory response that tries to correct and seal off the improperly deposited fat. Over time all three of these mechanisms build up and get worse. It is best to reduce all three of these mechanisms as early as possible to delay and even reverse the disease process.

We address the first thing, damage to the blood vessels by stopping smoking (smoking chemically damages the endothelial lining of the blood vessel), maintaining blood pressure at or under 120/80 (elevated blood pressure causes mechanical damage to the endothelial lining of the blood vessel), optimizing your metabolic health (conditions like hyperinsulinemia and diabetes damages the endothelial lining of the blood vessel through various means), and keeping your blood vessels spry and healthy (a good diet and exercise help with this)

We address the third thing, inflammatory response by controlling inflammatory markers through exercise, diet low in inflammation, vitamins like B6, B9, and B12, stress management, and good sleep practices amongst other interventions.

So now we need to address the second thing, those pesky little fat balls (apoB particles) that are lodging in the blood vessels. The apoB particles move through the injured endothelium through simple diffusion. That is, the more aopB particles there are (and to a lesser extent the smaller each apoB particle is) the more go through the damaged holes and lodge in your blood vessels. A statin is a medication that can effectively reduce the number of fat balls (apoB particles), reducing the lodging of particles in the blood vessel, thus leading to less of a cardiovascular disease state.

How low is too low?

ApoB particles are pesky little fat balls with an apoB protein wrapped around the outside like a bacon wrapped date. There is one and only one apoB protein for every fatball, so if we know the apoB concentration then we know how many pesky fat balls are in your blood. These little balls of fat with a protein coating transport fats around your body via your blood and are critical to keeping you alive. So where is the sweet spot? Most people live with an apoB particle range around 100 mg/dL. There are people with genetic mutations that live in the 10-20 mg/dL range. Neonates also live in this 10-20 mg/dL range. What horrible things happen to humans when they have this mutation and live in this very low state of ApoB? Nothing… well other than the fact that they almost never get cardiovascular disease. So, how low is too low to get your apoB? The answer is that no drug on the market today can get your apoB too low. So get it as low as possible, as soon as possible for as long as possible. 

What about side effects?

Now comes the big question on side effects. We are working in the field of longevity medicine, so our criteria of effective interventions are a bit different than traditional medicine. We are taking relatively healthy people and looking at a much longer time horizon, trying to improve both healthspan and lifespan. This means that when evaluating any intervention, our cost benefit analysis must meet several criteria. The intervention has to have a very very very low risk of harm. The intervention should be effective. If it is a recurring intervention (such as taking a daily drug) it also has to be pretty inexpensive since you will be incurring that cost over many decades. The side effect profile has to be basically non-existent and/or all side effects that may arise have to be non-catastrophic and also reversible when you stop the intervention. Statins satisfy all of these requirements. They are safe, effective, cheap, and side effects are all reversible when you discontinue the medication.