Limits of Bempedoic Acid and Ezetimibe in Getting the Last Mile in Apo(b)

#1

Bempedoic Acid 180 mg and Ezetimibe 10 mg have brought my Apo(b) values into the mid-80’s. This drop is significant for me but my target for my age and profile is to reduce to 70.

I don’t want to migrate to a PCSK9 inhibitor at this point but perhaps there are other non-statin alternatives that can be taken in combination with Bempedoic Acid and Ezetimibe.

Does anyone have any experience increasing the dose or peak value of these two drugs, or adding another low side effect supplement to reduce my Apo(b) into the 70s? (Currently, I’m taking both in the evening with dinner.)

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#2

berberine, red yeast rice, astaxanthin, niacin and maybe natto could potentially work

#3

Thank you @Paul. I’m taking astaxanthin and natto but stopped berberine in favor of 850 mg. metformin with evening meal out of a slight concern that it could adversely affect gut bacteria. I see that berberine has a modest PSK9 inhibitory effect. Has it reduced your Apo(b)?

#4

I just started it at the beginning of March - have a blood test scheduled in April

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#5

I was reading your notes. By how much did rapa increase your eGFR? Did you do anything else to improve kidney function?

#6

went from 64 to 86
did nothing else

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#7

Berberine and swapping olive oil for canola oil brought my apoB from 74 mg/dl to 55 mg/dl. I had pain in my toe sometime at night (gout?), and sometimes in one of my hands though. Started using statins later instead.

Oat beta glucans work slightly, maybe garlic extract.

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#8

https://www.youtube.com/watch?v=5hiLY5oFprY&t=3201s at 30:40 Dr Attia ApoB 30-40

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#9

Thank you all for these suggestions. I will reintroduce berberine because I discontinued it before I began monitoring Apo(b) and retest in a few months to see how that works.

#10

A low dose statin (Atorvastatin 5 mg) every day dropped my ApoB from 68 to 48. I have switched to EOD but haven’t measured the effects yet.

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#11

FWIW: Replacing Bempedoic Acid with BrilloEZ (Bempedoic Acid 180 mg and Ezetimibe IP 10mg)

These are my latest lab results. Apo(b) is not included because these are free tests from my HCP.

I have been taking Atorvastatin 40mg and Bempedoic Acid for quite some time. Approximately 60 days ago, I began taking BrilloEZ (Bempedoic Acid 180 mg and Ezetimibe IP 10mg)

I am pleased with the results.

Dec. 9, 2024:

Mar. 25,2025:

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#12

I guess the most obvious interpretation is that some of your cholesterol was coming from recycling assimilation. Did you maintain the high dose of atorvastatin? Healthwise, it could be useful to see Apo(b) because there is occasionally discordance between LDL and Apo(b).

I’m chasing better numbers as well even though the evidence suggests that it may not be consequential to do so at our age. I still believe that evidence is contaminated with a high degree of variance in important variables when one is over 75.

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