This is the sort of situation where ApoB and Lp(a) would be useful measurements.
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Wish I could tell you. This wasn’t a test I ordered from a lab. This was a test I got as a routine yearly physical at UCLA, and for some reason they decided this year to just do the bare bones old style blood test where the lipid panel is just the TC/LDL-C/HDL/TRG, and so on for the rest of the biomarkers. Not even fasting insulin. I was shocked when I got the results. Assholes. Again I’ll have to go get my own labs much sooner than planned just to get my data (originally was going to get my next labs Feb. 2026). Standard medical care is continuing to be useless despite my paying for insurance at UCLA for decades. Back to doing my own labs, getting my own tests and drugs and ignoring the useless establishment.
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Ah, that’s too bad. My apoB is about 2/3 of my LDL, so if you’re like me, your apoB might already be below mg/dL.
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My ApoB usually runs about 8-10 mg/dL higher than my LDL so this is interesting to hear.
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ApoB is like $12 at Goodlabs… Its easy to get a test anytime: [REFERENCE] Master list of all places to get blood tests - #24 by RapAdmin
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When assessing ASCVD risk, I’d start by measuring the full lipid panel plus ApoB and ApoA1, later on, you can often track risk using good proxies (especially ApoB). It’s essentially about how your body prefers to transport cholesterol: more via ApoA1 (HDL) usually means lower risk, more via ApoB (LDL, VLDL, etc.) means higher risk. In my case, ApoA1 is much higher than HDL-C, and ApoB is about just shy of 2/3 of LDL-C, which suggests relatively fewer ApoB particles for a given LDL-C. But the key is still the absolute ApoB level and overall clinical context.
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I wouldn’t use a PCSK9 inhibitor purely for primary prevention or “longevity hacking”. They have its role in ASCVD risk reduction in clearly high-risk situations. Based on current MR data, HMGCR (statins) looks possibly better for combined cardiovascular and dementia outcomes, but if I had to bet mechanistically on a longevity leaning lipid target, I’d pick CETP inhibition (obicetrapib) while we wait for definitive outcome data.
My ApoB typically runs at the same level as my LDL or a few points lower. My ApoB is 58 and LDL is 64 the last time I checked. Before that, both had been 48.
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Personally, I think a “small amount of everything” approach would be great. Low dose statin + ezetimibe + PCKSK9i (can go off-label, monthly injections to save money and reduce dosage), then add your BA or CETP inhibition to taste. Then you’re hitting multiple pathways without really running into side effects which come with high doses.
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And, daily D3. I have been taking this supplement since Covid.
Common vitamin (D3) could protect some heart attack survivors, study shows
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This article talks about a study of LDL-C in ischemic stroke survivors and MACE risk. Takeaway seems to be lower is better. What blows me away is that they had 666 patients in an LDL-C < 20mg/dL group!
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Mine was 22 mg/dL when checked yesterday! The only difference in my routine is that now I’m on branded Nexlizet (bempidoic acid+ ezetimibe) instead of the generic version from India. I was always skeptical that I was getting any significant effect from the generic, and now I’m even more skeptical. My LDL has never been this low.
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I use GoodLabs to record all of my lap results. I had Labs at Quest, Labcorp and CPL (Texas based). I now use them for my labs as well much lower cost.
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It’s fantastic, because it shows that clinicians are finally acting and they aren’t “scared” to just obliterate LDL-C levels.
Go back 9 years ago, I went to my family doctor, aged 30, with an LDL-C of 220mg/dl, and she told me I didn’t need to do anything. She even pulled up the QRisk 10 year calculator and said my risk was 1% so I should stop worrying. I told her that I do plan to live for longer than 10 years, and she looked at me as if I was insane.
I found a better doctor and now I’m formally diagnosed with familial hypercholesterolemia and I’m on 3 medications, and my LDL-C rarely goes above 30mg/dl. And I’ve been encouraging my friends and family members to get aggressive with LDL-C lowering too.
However, things are not perfect and not all doctors understand this. A colleague of mine, (aged around 41) had a routine health check, came back with LDL-C of 210mg/dl, and a calcium score of 330. His doctor reluctantly prescribed 10mg Crestor, got his LDL-C down to 100 and said that was good enough…
So basically, the more studies we have like this, showing that LDL-C of 20 is safe, and actually beneficial, the faster we can all access good quality healthcare.
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More on this research:
Heart attack risk halved in adults with heart disease taking tailored vitamin D doses
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Very Low LDL correlates to lower risk of stroke study finds.
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Super interesting.
85% of the study population were below 40ng/ml at the start of the trial. They were supplemented up to a range of 40-80ng/ml (which is a very wide range IMO). 52% of participants needed more than 5000IU per day to achieve 40ng/ml.
The weird part is this:
Researchers found that tailored vitamin D doses did not significantly reduce the primary outcome of death, heart failure hospitalization or stroke; however, supplementation appeared to be beneficial for preventing heart attack specifically.
So it reduced heart attacks, but not deaths. The problem is that the study is pretty small (630 participants, 2 groups over 4 years), so the number of events is small. And non-fatal MI is much more common than stroke or fatal MI. If you wanted to see a reduction in deaths you’d either need a massive effect size, or a much larger study population.
The big limitation for members of this forum is that these patients were pretty unhealthy, all of them had diagnosed heart disease, and many had already had nonfatal MI. So the applicability to healthy people in preventing MI is not totally clarified by this study.
But IMO, this is still a very encouraging signal that we should aim to keep our Vitamin D levels above 40ng/ml.
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I measure my 25OHD every week and normally try to keep it well above 100 UK units (which is 40ng/ml). I made a mistake and let it drop a bit low a few months ago and had a few niggly aches so I think there clearly is a threshold around that point. I took it up using 25OHD and the aches went.
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