A year on statin and more data TIA for any input

#1

Hi everyone,

Have always had high cholesterol average 215 total, 115 LDL but since HDL and triglycerides good, ratio was always good and that’s what my doc went by. After 8 months on rapa total 248 LDL162 so stopped Rapa and numbers back to total 212 LDL 115, but, by then I’d heard about ApoB and asked for it - 126. I posted here and got lots of advice, thank you. I decided to go with 5mg Crestor. A year or so later Total 174 LDL 88. (She forgot to do APOB that time.) I decided to see if 2.5mg kept it lowered and recently got results - total 173 LDL 75, so even that small amount lowered it slightly more! ApoB 69 from 126. She also did an LPa - 65. I’m 72 calcium score was 0 at 71. Am aware it doesn’t show soft plaque and 15% chance it’s wrong but still encouraging.

I have chronic fatigue/fibromyalgia so it’s hard for me to know if something is making it worse, but one reason I went to 2.5 is I thought I had more fatigue, but that was after being on Crestor for many months the previous months no extra fatigue which confused me but recently read about a man who had no fatigue for many months then quite bad. Lately now even on 2.5mg the fatigue has been so bad and leg muscles weak. I have decided to stop Crestor for 3 weeks to see if I can figure this out.

My questions -

If I determine Crestor is not the problem, do you think my current numbers are ok at 173 total, LDL 75 and ApoB 69.

If not would you add ezetimibe?

If so would you try the ezetimbe/bempedoic acid and how much?

What do you think of the LPa being 65? When I first saw the normal level was discouraged that this put me at higher risk even above borderline but then noticed the next group starts at 180 so maybe 65 isn’t so bad?

Would you suggest getting another CAC in case first a mistake? I can’t do the CLEERLY now as too fatigued to commit to an hour drive up etc.

I see my doctor Thursday she’s pretty good about my taking info to her and acting on it so just thought I’d see if anyone here has any further input. Thank you!

#2

You’re making great progress, so thats good news.

My personal belief is that we want to go with the research on this topic:

we can use intensive lipid-lowering therapy to mechanically halt plaque progression . The data shows that when LDL is driven below 70 mg/dL ( <1.8mMol/L), and ideally lower, plaque growth stops, and the risk of rupture drops near zero. See this study: The Coronary Plaque Progression Paradigm: Why Your "Low Risk" Score Might Be Lethal. and all the Cardiovascular 2025 discussion here: Cardiovascular Health 2025

You might try different statins to see how they affect you. I was on atorvastatin and move over to pitavastatin (due to lower risk of glucose/insulin disregulation) and was also taking bempadoic acid and ezetimibe. My LDL was in the mid-40s with all three, but I’ve run out of bempadoic acid, and with my switch over to the less effective statin (pitavastatin) and just the ezetimibe - and its still in the same range plus or minus a few points. I’d definitely recommend ezetimibe - it seems like a side effect free, low cost option for most people to help get down to the level where you can be confident that you are halting plaque prevention.

Doing another CAC without clearly AI analysis doesn’t seem to add a lot of value in my thinking. The key issue is soft plaque and another CAC isn’t going to tell you much without the Cleerly analysis.

Did rapamycin help your CF at all? Did you go back on it, or still off?

On the issue of LP(a) levels - I’m not sure there is a ton that you can do on that right now - see this thread, and new medications may be available soon for LP(a): CVD and high Lp(a) levels