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Cycle Advice ACE Inhibitor or ARB?

Swim15

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Ive been reading up on some of the cardio protective effects that ACE inhibitors and ARBs can have, specifically protection from cardiac fibrosis.

From the reading Ive done so far it seems like ACE inhibitors and ARBs are roughly comparable in their effects with ACE inhibitors appealing more to me due to the likelihood of a less significant decrease in blood pressure as mine isnt high.

Can anyone input on which they feel would be better for these purposes?
 
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CFC

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Strictly from the point of view of blood pressure, they are roughly equal.

ACE inhibitors have a vasodilatory effect (via bradykinin) which ARBs do not. Though that may also cause an annoying cough for some.

However, from the POV of AAS use and elevated angiotensin > tgf > fibrosis etc, ARBs are superior. This is because the ACE (enzyme) isn't the only one involved in the production of angiotensin, and so only inhibiting it via ACE doesn't really fix things for us.

Therefore, blocking its activity rather than its conversion - with an ARB - is generally considered superior for us.

Other options might include calcium channel blockers, which also appear to help with AAS-induced issues, but they can have sides that might be off-putting (as calcium channels have all kinds of uses).
 

Swim15

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Appreciate the input and figured you might say that.

I likely won?t be able to get a script from my doc so have to go outside the US and the ARB class is a lot more expensive than ACEI from my overseas pharmacy. Might pick your brain on that some.

CFC - do you have an opinion on statin drugs? I?ve always been hard edged against them but have had some discussions recently that made me want to at least look at some literature and get other thoughts.
 

Genetic Freak

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Appreciate the input and figured you might say that.

I likely won?t be able to get a script from my doc so have to go outside the US and the ARB class is a lot more expensive than ACEI from my overseas pharmacy. Might pick your brain on that some.

CFC - do you have an opinion on statin drugs? I?ve always been hard edged against them but have had some discussions recently that made me want to at least look at some literature and get other thoughts.
They effect levels of Coenzyme Q10, and Vitamin K2 (responsible for calcium facilitation from blood to tissue), this can cause calcium build up in coronary arteries.. (the exact opposite of what the recipient generally wants)..lol

On a plus, they have been shown to increase length of telomeres (biomarkers of aging)..
 

Genetic Freak

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Thanks for the input Genetic Freak! Found a study I put below talking about those factors.

https://www.ncbi.nlm.nih.gov/m/pubmed/25655639/


Going to be doing some more reading on this but are you aware of those effects could be negated by supplementing K2 (as well as CoQ10 and selenium)?
In theory, yes.. Why would you wish to include a statin, the whole methodology is flawed..?
 

Swim15

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Dont really want to per se, just wanted to understand more of the mechanisms, sides, potential mitigation, etc as opposed to having an opinion on them without as much concrete reasoning.

Although I have read some literature that statin use can potentially reverse and remove plaque depositis as well which would be a huge potential benefit if other risks were appropriately mitigated.
 
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kleinerkiffer

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Don't forget that ACE inhibitors have an uncommon/rare adr called angioedema, this is a potentially lethal side effect that can happen right after the first dose (because of that ACE inhibotors should be first given in a clinical setting) or even after years of use.

You might wanna check out Sacubitril but afaik you can only get it in a fixed combo with valsartan, called entresto
 

CFC

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Regarding statins, there is a lot of controversy, some good some bad, and there's a lot of info to read.

I think if you have substantial plaques already, then it would be foolish to not at least give them a try. But as a prophylactic, in the way I recommend using an ARB, we have other options, which we don't really have for controlling angiotensin-inflammatory-related issues.

First and foremost, don't allow bodyfat levels to get too high (to preserve leptin function), and make sure you do cardio (or HIIT) a few times a week to keep insulin sensitivity high and thus blood glucose levels reduced while on cycle. This (and AMPK activation in general) attenuates the activity of HMG-CoA naturally.

Then, you can also take supplements like niacin and 'good fats' regularly, to further help keep LDL in check. You can also use supps like NAC or even raw cacao and flavanoid-rich teas to help improve endothelial health/function/NOx and elasticity. Then there's also very low dose aspirin which may help reduce minor clots (a component of plaques).

And of course, use sensible doses of AAS and duration of use, always maintain a healthy level of oestrogen on cycle, and cut back on the excessive use of stimulants and preworkouts.

But actually, ARBs may substantially reduce the risks of plaque formation anyway because they inhibit parts of the inflammatory cascade, are plaque-stabilizing, antithrombotic and have anti-proliferative effects. So even without any of the other supplements, just using an ARB should confer substantial, broad-spectrum benefits.

The effect of some or all of these practices should be sufficient to function not only as a decent prophylactic, but also provide wider benefits to general health.
 

Genetic Freak

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Dont really want to per se, just wanted to understand more of the mechanisms, sides, potential mitigation, etc as opposed to having an opinion on them without as much concrete reasoning.

Although I have read some literature that statin use can potentially reverse and remove plaque depositis as well which would be a huge potential benefit if other risks were appropriately mitigated.
Increase HDL by consuming foods rich in saturated fats, devoid of refined fructose, rather than employing statins..
 

TrenE

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Regarding statins, there is a lot of controversy, some good some bad, and there's a lot of info to read.

I think if you have substantial plaques already, then it would be foolish to not at least give them a try. But as a prophylactic, in the way I recommend using an ARB, we have other options, which we don't really have for controlling angiotensin-inflammatory-related issues.

First and foremost, don't allow bodyfat levels to get too high (to preserve leptin function), and make sure you do cardio (or HIIT) a few times a week to keep insulin sensitivity high and thus blood glucose levels reduced while on cycle. This (and AMPK activation in general) attenuates the activity of HMG-CoA naturally.

Then, you can also take supplements like niacin and 'good fats' regularly, to further help keep LDL in check. You can also use supps like NAC or even raw cacao and flavanoid-rich teas to help improve endothelial health/function/NOx and elasticity. Then there's also very low dose aspirin which may help reduce minor clots (a component of plaques).

And of course, use sensible doses of AAS and duration of use, always maintain a healthy level of oestrogen on cycle, and cut back on the excessive use of stimulants and preworkouts.

But actually, ARBs may substantially reduce the risks of plaque formation anyway because they inhibit parts of the inflammatory cascade, are plaque-stabilizing, antithrombotic and have anti-proliferative effects. So even without any of the other supplements, just using an ARB should confer substantial, broad-spectrum benefits.

The effect of some or all of these practices should be sufficient to function not only as a decent prophylactic, but also provide wider benefits to general health.
Thanks for your detailed information.

Would you recommend to take an ARB also without taking AAS or on TRT to get benefits to general health? What would be your recommended dosage? If not what would be the amount of steroids (maybe total grams per week) from then on you would recommend taking an ARB?

Same question for low dose aspirin (100mg)?

Currently taking 1g of AAS and will start taking an ARB (Losartan), but at a low dosage (25mg per day) and check blood pressure levels for a week to ensure they do not go to low. Then maybe up the dosage to 50-100mg, depending on the blood pressure results.
 

Swim15

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Cant comment quite as much on recs for ARBs but personally ill be using them any time I?m running gear (for the rest of my life lol) and take 40mg telmisartan daily. They shouldnt drop your BP too low unless it?s already stupid low which I doubt it is. I dont think 25mg is really an effective dose from my reading though and would go with 50mg, preferably 100 but telmisartan or valsartan are better options imo

As far as low dose aspirin, its no longer indicated for reducing CV risk in most patients as of this year I believe and NSAIDs arent great long term so Id personally opt out and just make sure blood counts look good.

My .02 but CFC has a lot of knowledge so Id see what he says
 

Genetic Freak

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Cant comment quite as much on recs for ARBs but personally ill be using them any time I?m running gear (for the rest of my life lol) and take 40mg telmisartan daily. They shouldnt drop your BP too low unless it?s already stupid low which I doubt it is. I dont think 25mg is really an effective dose from my reading though and would go with 50mg, preferably 100 but telmisartan or valsartan are better options imo

As far as low dose aspirin, its no longer indicated for reducing CV risk in most patients as of this year I believe and NSAIDs arent great long term so Id personally opt out and just make sure blood counts look good.

My .02 but CFC has a lot of knowledge so Id see what he says
Be aware of ibuprofens, negative affect on your gut microbiome..
 

Swim15

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Be aware of ibuprofens, negative affect on your gut microbiome..
Very. Didnt even know until I was diagnosed with colitis last year so now I try to steer clear unless Ive got a really legitimate reason for using them
 

CFC

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Thanks for your detailed information.

Would you recommend to take an ARB also without taking AAS or on TRT to get benefits to general health? What would be your recommended dosage? If not what would be the amount of steroids (maybe total grams per week) from then on you would recommend taking an ARB?

Same question for low dose aspirin (100mg)?

Currently taking 1g of AAS and will start taking an ARB (Losartan), but at a low dosage (25mg per day) and check blood pressure levels for a week to ensure they do not go to low. Then maybe up the dosage to 50-100mg, depending on the blood pressure results.
I wouldn't personally use an ARB (or any elective drug) when not on cycle unless you have a pre-existing issue that needs it. Just do your best to live a healthy lifestyle as much as you can off-cycle and you should be fine.

As for when to start, AAS appear to induce the RA system (renin-angiotensin) pretty substantially even at relatively low doses (eg around 30% at just 160mg/wk). So bascally any dose over physiological/TRT and I'd introduce it, but for TRT at genuinely physiological doses you'll be fine without.

As mentioned above, guidance on aspirin has been changed recently. But not because it doesn't work. Rather, because in vulnerable (ie generally elderly) populations, the risk of bleeding can potentially outweigh any beneficial anticoagulant effect.

For your typical AAS using bodybuilder, the risk of severe bleeding on a low dose is rather smaller (especially given the high haemoglobin levels AAS tends to cause). But if you have an ulcer or had a gastrointestinal bleed before, you may want to exercise caution or possibly avoid altogether.

If you do decide to use, go with the lower dose 75mg (or 81mg) if you can find it, and again, if otherwise healthy, I'd personally only use while on cycle, not off-cycle. Though actually I don't use aspirin myself and instead rely on keeping my Hb levels in check and using the ARB and other supps and staying well hydrated, but it is still an option if you're the cautious type.

Regarding Losartan, 100mg is unlikely to lower your blood pressure excessively (and these days, you can't really have 'too low' blood pressure as long as you're not developing hypotensive symptoms like dizziness). But by all means work your way up if you feel more comfortable doing that.
 
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TrenE

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Thanks for your detailed answers. You are helping me alot.

You mentioned in another thread that Telmisartan COULD be beneficial compared to Losartan because of his additional PPAR-γ agonism. But am I right that you would NOT make the general recommendation for using Telmisartan over Losartan as you personally also take Losartan?

Studies which I have found with an ARB and nandrolone always used Losartan.

 
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