Bempedoic Acid or PCSK9i?

Starting APOB was 95 and Lp(a) was 40. Trigs low, HDL high.
Repatha (plus Ezitimibe 5 mg) got APOB to 43 and Lp(a) to 29.
Inflammation is now about 1.1.

But HbA1C went up to 5.8, Glucose has always been a little high. Insulin dropped to about 1. Decided to stop Repatha and do a washout. After two weeks Glucose and insulin starting to normalize. Really relieved about that and will retest in June.

So, considering Bempedoic Acid with Ezitimibe and not targeting the Lp(a) for now, just keep inflammation low and wait for the Pelacarsen or whatever gets here first, or

Or -Rechallenge with Repatha? may-be monthly instead of bi weekly?
or start BA + Ez?

Would welcome input on making this kind of tradeoff decision: optimal cholesterol reduction with some glucose elevation versus the BE which acts only on the liver.


Others will have much better feedback, but I’m just here to share that I asked my doc about ezetimibe and bempedoic acid. He felt we should just try ezitimibe for now because bempedoic is expensive and he hasn’t seen that it makes a huge difference. He doesn’t tend to shy away from things due to cost, so I do believe this has been his experience in his practice. He’s a brilliant guy. However, enough people here are taking it, I imagine it is well worth it for many (and I’m curious to see what they say!). FWIW, my cardiologists at UCSF are big fans of repatha. Have you considered going on metformin to offset the rise in glucose?

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Hi beth. Thanks for your message. I have been on Metformin for several years

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It does not have to be expensive if you get it from India. I used Laxminarayan Pharmaceutical to get 80 tablets of Bempedoic Acid with Ezitimibe (which they call BRILLO EZ) for $91. That includes everything, including shipping and an extra fee for using PayPal (WISE is likely cheaper). I have been on it for 10 days with no noticeable side effects. I will get bloodwork in about 5 weeks (when I see my cardiologist next) to guage its effectiveness. Everything else I have received from India has been the real thing, but as President Reagan said: “Trust, but verify.”


Empagliflozin 25 mg dropped my HbA1C to 5.2 from 6. No side effects for over 3 yrs. Washing all that glucose out of your system can only be good for you. Urinalysis shows glucose being excreted.


Repatha is going to lower your cholesterol more than Bempedoic Acid and Ezetemibe. Empagliflozin, Metformin and Akkermansia can reduce your HBA1C. I settled on BA and EZ, Metformin and Akkermansia and got to 4.9 HBA1C and a 65 LDL.

Repatha is a bit too far for me to go to lower my LDL further, but 65 may not be good enough for everyone else. However I wouldn’t mind lowering LDL even more.