Lower (sub-20) LDL is better for cardiovascular health- see new paper below. I tried Repatha only (no Rosuvastatin) and my LDL went from 18 to 78. My cardiologist said that Repatha is intended for use with statins, not instead of statins. Went back on Rosuvastatin and my LDL went back down to sub-20.
https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.122.063399
wow…that is certainly a counterintuitive results of going on Repatha and LDL going up…
I have been on Crestor and Zetia and my LDL has been 60 to 70. i have started Repatha and just took my second monthly dose…i plan to test my lipids next week sometime and see what my results are.
but wow…shocked your LDL went from 18 to 78…on the other hand…standing pat with 18 LDL is not the worse thing in the world too!
I am hoping to get my LDL down to that level…I am just curious do you also track your ApoB?
I should clarify that before starting any treatment my LDL was 195 and ApoB was 200. Started taking Repatha and Rosuvastatin, resulting in a LDLc of 7. No ApoB measurement. Stopped the Repatha (continued Rosuvastatin) and LDLc went to 78. No ApoB measurement. Went back on Repatha plus Rosuvastatin and LDLc went to 19 and ApoB to 35.
My fasting glucose has been high (92) even with Metformin and a keto diet, and my H-A1c has crept up to 6.1, so I just started Canagliflozin, a SGLT2 inhibitor, plus Acarbose.
I don’t know what kind of diet you have, but for people like me that have a low carb diet and are keto adapted , fasting glucose doesn’t tell us much. That’s why these days, I go straight to the source and just get a fasting insulin test. If you’re worried about your glucose levels and generally eat low carb, I would recommend a fasting insulin test.
Hi, thanks for the suggestion. I was on keto but am now on a Mediterranean maintenance diet after getting to my target weight. I do have a few fasting insulin measurements, and they fall between 4.3 and 6.6. Bill Falloon at the LEF recommends <5 to 7.0, so that’s optimal. However, he suggests A1c of 5.0-5.4, and mine was 6.1, up from 5.7 a few years ago. That plus my fasting glucose being high worries me, thus adding the SGLT2 inhibitor and acarbose.
Very hopeful, will report results. My breath ketone levels have gone up to about 4 times previous levels since I started canagliflozin, so that’s a good sign.
Has anyone here tried lupin protein isolate as a PCSK9 inhibitor from a natural source? There’s loads of papers on the subject and actual (small) human trials but I only found one lupin reference in this forum’s search.
Supposedly (from the papers) a 20-30 per day of lupin protein can possibly lower LDL by 10-15%.
I dont understand this. Could you elaborate on why?
I was under the impression that high glucose is PER SE problematic, bc it causes pathological changes, including blood vessell damage, contributing to atherosclerosis.
Specifically, why would insulin sensitivity matter, except in so far as its helpful in keeping glucose down? Is there some other way in which its beneficial?
Actually, some people only take Repatha. One of the most noted lipidoligists, Thomas Dayspring, can’t tolerate statins or Zetia. I believe in this series of videos he also explains why raising LDL isn’t a problem. It’s a great series nonetheless. He also did a 4-part podcast with Peter Attia.
I misremembered. Statins raise LPa. Not wonderful, but not a problem or reason to discontinue statins. He said nothing about APK9 raising LDL.
I have high ApoB and LDL-C numbers. Unfortunately I have do not tolerate statins well even at low doses (muscle pain) and have further statin related concerns related to my APOE (3/4) status.
I would love to get a PCSK9 prescription and am willing to pay out of pocket. So far I have been unable to find a doctor to write me a prescription or schedule a CT Angiogram (I have CAC score of zero but remain concerned based on my APOE status, high LDL-C and ApoB numbers and the possibility of non calcified plaque that my CAC score is missing).
Can anyone that has been successful in getting a rx (in the US) share the name of their doctor?
I don’t see why insurance companies should dictate the rules for prescriptions being written, especially in cases where the patient is willing to pay out of pocket.
Its pretty inexpensive from the India vendors, and no prescription required (around 83 rupees to the USD)
High insulin levels cause inflammation which in turn is the ultimate cause and a major risk factor in atherosclerosis. On the other hand, high insulin levels probably cause less damage than high blood sugar.
CT Angiograms have fairly high radiation dose so doctors might be reluctant to prescribe it unnecessarily : Have you tried getting a CIMT Ultrasound (lower resolution and cost than CT Angiogram, but no radiation) or MRI Angiogram (higher resolution and cost than CT Angiogram, but also no radiation)? I would try the CIMT Ultrasound first (around $275 without insurance) and if it shows something (in the Carotid Artery), follow up with a MRI Angiogram (around $600 without insurance) to see how bad it is.
Repatha appears to have refrigeration requirements. I am not sure how to ensure they will be followed to ensure efficacy.
Thanks. I like your idea of seeking other tests. Hopefully my PCP will agree despite my CAC score of 0.
Ah yes - no guarantees that anything from India has been kept in refrigerated storage. But perhaps given the price differential it may be worth a test - and check cholesterol afterwards to see if it worked or not…
From the repatha website:
Storage of Repatha:If removed from the refrigerator, the Repatha SureClick autoinjector should be kept at room temperature at 68°F to 77°F (20°C to 25°C) in the original carton and must be used within 30 days.
I, like you, am pro-active for health. Get your LDL to 20 mg/dL.
See: Circulation. 2023;147:1192-1203. Conclusions: Long-term LDL’s 20mg/dL was associated with lower risk of cardiovascular outcomes with no significant safety concerns.
I prevailed with my cardiologist to get Repatha, he was thankfully in agreement after seeing 50% blockage in the ccat scan. First attempt for insurance coverge was denied; however, his office made an appeal and the denial was reversed. Probably a routine occurrence. You could try to get a consult with a cardiologist who is also a lipidologist and would advocate for you.
Anyway, Repatha caused me to have an extremely runny nose 7 days after the first dose; I took an antihistamine and it stopped this side effect and the runny nose issue was gone. Good luck.
This issue of how low to go on LDL/APOB has been discussed ad nauseam in this thread already: Rapamycin and risk of cardiovascular disease
But yes… going too low doesn’t seem to be much of a risk (though using multiple medications to get there may incur some risk)
I take only Repatha, no statin. Took the Statin very briefly, just until I could get on Repatha. After about 6 months on Repatha, Lp(a) went from 40 to 29 mg/dl. LDLC went from 124 to 69 and APOB went from 95 to 70. That’s low enough for me, I think. Was reading that very low LDL can increase risk of hemorrhagic stroke. Everything is a tradeoff. Interestingly the Repatha also decreased my very high HDL from 125 to 119 which is good news, though might be noise?
Do you take Repatha as suggested, every two weeks, 140mg?
Why did you decide for Repatha?
