I’ll be discussing that with my lipidologist at my appt. next month. After looking at my elevated LDL he prescribed rosuvastatin 5mg. I have been on the rosuvastatin for a month before the CardioIQ was done. The med did drop the LDL from 113 to 72.
I’m experiencing pronounced fatigue not felt before. Could that be a side-effect of even this small a dose of the med?
Low dose Rosuvastatin caused immense fatigue and muscle soreness for me. I felt 20 years older. It was horrible.
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for me, Atorvastatin had an immediate effect on muscle aches. I switched to Rosuvastatin, and thought I was good but over time (7-8 months) my muscle power dropped off (muscle aches were minimal). I thought i was just getting old but stopping statins all together resolved it. On Bempadoic Acid / Ezetimibe now. No issues so far. Lp(a) was very low all along (<8.4).
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Thanks for sharing
Anyone look at the ones in bold here
Other therapies lower lipoprotein(a) …. include the CETP (cholesteryl ester transfer protein) inhibitor anacetrapib, antibody-based inhibitors of PCSK9 (proprotein convertase subtilisin kexin type 9), and drugs, such as mipomersen and lomitapide, that directly affect the hepatic secretion of apoB-containing lipoproteins.
Where did they find this - can you share more info?
Does that actually lower Lp(a) or it may lower the risks of having Lp(a) (without affecting the Lp(a) levels)?
I just got my blood work back a couple of days ago. My LPa went up from 148 to 150, so the baby aspirin made no difference. I was under the impression that it should have gone down, but perhaps it just reduced the risk of Mace in spite of elevated LPa. Maybe. We hope. I visit the cardiologist again on April 1st. No joke.
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There is some published data that aspirin can very slightly lower Lp(a), but not enough to make a difference in itself. The anti-platelet effect is what’s supposed to help lower risk of coronary events in those with high Lp(a). I can’t handle aspirin, so I’m on clopidogrel and hoping that I’m getting the same if not better protection I’d get from aspirin 
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Wow yeah, that’s similar to my family. I found my sky high LDL-C (200+) through a random blood test. Then we learned my mother also had it, and her brothers all died years ago from heart attacks.
But there are plenty of cases out there of familiar hypercholesterolemia patients having strokes and heart attacks in their 30’s. So it’s absolutely correct that your daughter needs to bring down both LDL-C and the Lp(a). If she can sort them out at 19, she should be absolutely fine. In fact, she may end up better off than “normal”
Maybe. Around 3-5% of patients can’t tolerate statins. For me, I have zero negative effects, and Rosuvastatin even cleared up my fatty liver. Luckily there are plenty of other options nowadays.
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Just got my latest test results: (on Crestor, Ezetimibe + Repatha)
LDL-C = 32 mg/dl
HDL-C = 65 mg/dl
Trigs = 38 mg/dl
Lp(a) = 85 mg/dl
Urgh. These new drugs can’t come quickly enough.
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I hear you. I also have sky high Lp(a), about 3x yours 
I’m awaiting the results from my blood tests, should have them in about a week.
Re: rosuvastatin and ezetimibe - what doses?
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Are you serious? I legit didn’t know it could do that high. Note: mine is 85 mg/dl (not nmol/L). In a recent study I saw (https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.069556) they used 50mg/dl to stratify “high” and “low” Lp(a) 
I’m taking 10mg Rosuvastatin and 10mg Ezetimibe every day. And inject Repatha 140mg one per month.
Fingers crossed for safe and effective medications to deal with our Lp(a) ASAP.
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Sadly, yes. That said, there’s some new thinking in some quarters, that the Lp(a) situation is highly complex, and while the particle may be much more atherogenic than plain LDL, there’s some indication that there is some conditionality involved too, where it may end up not being particularly involved in plaque progression under some circumstances. FWIW, I had a CAC done at age 65 1/2, and my score was zero. Now, it’s possible that my arteries are riddled with soft plaque, but it’s still a surprising score to me, as I have had life long high LDL (165-185 mg/dL), and have only been on atorvastatin 10mg/day for about 5 years (and btw. not very effective, last October my LDL was 146 mg/dL, TC 240).
Anyhow, your LDL has been crushed at 32. Lp(a) is nasty, but fortunately it’s not a big component numberwise of your blood lipids, it’s dwarfed by LDL, so if you crush LDL, the Lp(a) is small change. Of course, the danger of Lp(a) is the calcification of the valve leaflets, so yeah, good drugs against it can’t come soon enough.
And your rosuvastatin is not very high intensity, so you don’t need more at 32mg/dL.
I’m awaiting my results. Right now, as of the past 6 months I’m on 4 mg/day of pitavastatin. Depending on what my lipid panel shows, I intend to push my LDL to below 60 mg/dL at least, or lower. For that I’m looking to 180 mg/day of bempedoic acid, and ezetimibe 10 mg/day… hopefully that will be enough.
But lipids lowering is only one CV therapy. I think, depending on the rest of your physiology, metabolic biomarkers, you may want to add a SGLT2i like empagliflozin that’s cardioprotective, perhaps an ARB, like telmisartan to keep your BP firmly below 120 SYS. Maybe additional therapies - rapamycin can be cardioprotective. Point being, you can’t just look at lipids. There is a lot more we should be doing to keep the CV system working, it impacts the brain too. Work in progress.
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FWIW I asked my cardiologist about LPa last visit about 5 months ago and whether I should be tested. He said the meds I’m taking (statin, aspirin and ARB) are pretty much what I’d take if they found my LPa abnormal, so not to worry too much about it.
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Mostly right, with a couple of caveats. First, it’s true, as long as you bring your ApoB/LDL low enough. If you have little Lp(a), you have a little bit more leeway, depending on other risk factors (such as the presence of plaque). But if you have high Lp(a), you really must crush your ApoB/LDL. If you can do it with just a statin, great. But many people can’t - we are talking LDL well below 60 mg/dL. Here’s the second factor, PCSK9i enters the picture, both because they can help you reach your ApoB/LDL target, and because they can slightly lower Lp(a), by about 20% (whereas statins tend to raise it).
Bottom line, if you are below 60 mg/dL on just a statin, aspirin, and ARB, fine. But if not, I do think more can and should be done. I’m not a doctor and not offering medical advice, but if it were me, I’d get a second opinion in that scenario (of LDL above 60).
And sure, the ARB and aspirin can control other risk factors, like high BP, but ApoB/LDL is the biggest factor for MACE by far. It’s critical to get that under control.
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Thanks for that information.
My LDL hangs around 60 on 5mg crestor. The doc seemed pretty happy about being on 5mg and lipids staying pretty low. Definitely a balancing act.
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You’re probably very similar to me; heterogenous familial hypercholesterolemia (HeFH). Though fortunately I’ve caught it relatively early (at 32 years old). Mine was the same as you describe, where a statin alone had very little effect, but combined with Ezetimibe it was very effective. (I did also try Ezetimibe monotherapy which was also not very effective).
IMO, with your age and lifelong LDL of >160mg/dl, you should have a positive calcium score if you built plaque. I feel it’s very unlikely that you’d have all soft plaque and nothing calcified at 65yo.
As for whether I’ve built any plaque, I’m going to find out with a CTA next week… fingers crossed.
Yeah, this is definitely a valid viewpoint, and I shared this until recently. However, according to the PESA study, you can still build plaque with “low” LDL-C of 60mg/dl. If your Lp(a) is indeed high, it’s an argument to take ApoB even lower, and to perhaps be more aggressive with other risk factors (blood pressure targeting 100-110 rather than 120 etc).
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I just added Ezetimibe 10 mg with my Crestor 10 mg. Hoping for a 20% reduction in ApoB. Lp(a) is not a problem for me. My numbers are on Crestor alone are:
LDL-C = 48 mg/dl
HDL-C = 62 mg/dl
Trigs = 53 mg/dl
Lp(a) = 10.5 mg/dl
ApoB = 68 mg/dl
Will report back in 2 months. Calcium score is 23. 78 yo. male
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Those are great numbers, and I’m going to guess your ApoB goes below 50 mg/dl with addition of Ezetimibe
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