#61

Have you considered adding Bempedoic Acid and/or Ezetemibe to bring down your LDL and ApoB? What are your current levels of LDL and ApoB?

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#62

Thx for these ideas! I am not familiar with bempedoic acid, but I shall google!

I had forgotten about ezetemibe, and I should re-ask my doctor about this.

At the time, because Iā€™m 100% WFPB and a little psycho about my diet, they told me my body is making cholesterol and itā€™s not what Iā€™m consuming, so there is not much that the ezetemibe can go after. But, I have a new cardiologist and it has been years since hearing that, so perhaps the thinking has changed. Maybe capturing some of the fat from nuts/etc, would only be helpful and make my diet even better.

Iā€™m on repatha and Apob is 65 and ldl is 60. I know Attia says have it below 50 but I donā€™t have much low hanging fruit left for lifestyle changes. Iā€™m willing to do what I need to do to get it below 50 but just not sure how.

Knowing I have a great diet, do you think one of those rxā€™s might still be helpful?

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#63

Hi Beth, ezetimibe still works to lower LDL even if you arenā€™t consuming cholesterol in the diet because it mainly works by inhibiting absorption of endogenously-created cholesterol in bile acids (i.e. cholesterol made by your own body):

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#64

With all the PCSK9i studies done over past 10+ years, I canā€™t imagine how they wouldnā€™t have seen a signal by now if there were one to see, especially if it were such a direct-acting mechanism with suppression of insulin secretion.

#65

I looked into the drug with great interest when I first saw it on the chart you posted. The problem is that itā€™s injection-only, expensive, and itā€™s a pretty significant immunosuppressant with risks of infection and a whole host of other potential side effects, which also happens to lower Lp(a) 30-40%.

Given that there are very specific drugs in the pipeline that lower Lp(a) 90+%, at least some of which are orally administered and highly specific for Lp(a) and with very little potential for side effects (fingers crossed), I donā€™t really see Actemra/tocilizumab as much of a viable option at this pointā€¦

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#66

Thanks Davin, wasnā€™t sure if the immune suppression is in bad territory or an ok ā€œrapa like territoryā€ when I saw it was approved for juvenile age groups too, but guess that some forms of arthritis can be very severe and perhaps worth those risks there even if perhaps not in Lp(a) contexts.

Unless there is a bit Lp(a) effect even at very small doses (like there is for Apo B from very small statin doses).

Injection doesnā€™t seem like a big hassle after having been on Repatha for a while now.

And seems the prices should fall a lot this year with eg the US FDA and EU EMA go aheads for two generics/biosimulars just at the end of last year.

The thing with the new Lp(a) meds are that while I agree that they are looking very promising they might be tough to get and very expensive for years even after they get approval in perhaps 2026? (and weā€™ll know less about long term effects in the beginning, so there are some unknown risks there too).

#67

There is here an interesting question as to what extent Lp(a) correlates with CRP. My CRP is particularly low at normally under 0.15mg/L (thatā€™s the best testing threshold) although the last result was 0.17mg/L. My Lp(a) has been lower than 5.2 nmoll/L (the testing threshold), but the last result was 8.2 which I think is around 20 mg/dL. (but I have not checked the conversion)

#68

Thanks Davin! And thanks @DeStrider ! Wow, this is all great news that there is something else I can do to help the cause!! I already eat air, so I was hoping not to restrict even more!

Iā€™ll call my doc today! Thank goodness for strangers in my ipad!!!

#69

@Beth Bempedoic Acid and Ezetemibe can be purchased quite cheaply from India just like Rapamycin.

#70

I appreciate that!! I have my first bottle of rapa that my doc called into my local pharmacy, but now that my head didnā€™t fall off, I do want to look at alternatives for my next bottle incase it saves a bunch of $

I have sirolimus 1mg pills.

#71

Iā€™m wrestling with CVD from apoB containing particles vs mitochondrial health. Iā€™m convinced that my statin is injuring my mitochondria (many things do). My statin is also reducing my apoB. Rapa should be helping my mitochondria via mitophagy even though it may increase LDL (and apoB?). CVD is caused by more than high apoB particle counts. I no longer want to force it lower it by way of damaging my mitochondria.

I am planning to drop the statin (Bempedoic acid on the way) and continue boosting my mitochondrial health (stop statin, GG, Urolithin A, MB, glutathione substrates) and other means of improving artery health (NO boosting, lower blood sugar, better sleep, lower AGEs in diet, lower Uric acid, gut health).

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#72

Insulin levels go up and down rapidly. It should be paired with your blood glucose. It should be done fasting in order to interpret. For example if you have a blood glucose of 110 and your insulin level is 80 ā€¦ you are insulin resistant but your sugar hasnā€™t gone off badly yet ā€¦ but this is pre-diabetes and lifestyle changes (wt loss, exercise, getting on a WFPBD, etc) will make a massive difference.
If you have a blood sugar of 130 and an insulin level of 7, you arenā€™t insulin resistant, but your pancreas is totally happy simply watching this ā€¦ and diet/exercise/wt loss will likely make little difference - pharmacotherapy is the only option.
What we want optimally, is a fasting glucose <80 and a insulin of <5-10. This is where your glucose level is good and you are insulin sensitive.
The C peptide is a longer term measure of your production of insulin, each time an insulin peptide molecule is made from pro-insulin, it is cleaved into a molecule of insulin and a c-peptide. This C-peptide stays around for a long time - so you can understand if your body is making a lot of insulin over 24 hours or little.
Hopefully that explanation helps.

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#73

One of the papers on the arthritis drug seemed to say that lowering IL-6 helped but not lowering a different form of inflammation - might have some clues

Re N=1, My crp has also always been low - over the last decade where I have more measurements of both it has been below the detection threshold of <0.2 and then <0.3 while my Lp(a) is medium to high at 60-110 nmol/L or 24-44 mg/dL if I understand the conversion math.

#74

Its a difficult one. Pleasingly I have just got in my blood test from Tuesday (it normally takes a week for this lab) Lp(a) is now below the threshold of 5.2 (nmol./L). I am having a bit of struggle with some of the kidney markers, however.

One of my problems is I walk a longish way to my sonā€™s school in the morning and evening which drives up creatinine. Hence it will inevitable drive up creatinine from when I drove him to school.

However, from a health perspective a bit more walking is good.

IL-6 is supposed to drive CRP.

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#75

Thereā€™s been so much discussion and concerns about Lp (a). Mine is suspiciously low - 9. However my CAC is horrible (about 300). My total cholesterol is borderline (207), and Apo B is 76 (down from 109 three mo ago after rosuvastatin/ezetimibe treatment). My point is that low Lp (a) doesnā€™t contribute to health in my situation.

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#76

@LaraPo Yes, in your case it seems important to work on Apo B (and inflammation and all the other things).

Itā€™s not that one is protected if one has low Lp(a). Itā€™s that one has an additional, independent risk factor if one has a high Lp(a).

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#77

I think part of the reasons is that there are many known and generally good options available to lower Apo B and inflammation, but nothing really really Lp(a) and as optimizers many of us (who donā€™t have low levels) would like to take control of that factor too

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#78

My memory is horrible, but if I recall, I THINK elevated lp(a) just shows a genetic/heredity disposition to have heart disease, but not that you wonā€™t have it without it. People with elevated lp(a) are just behind the 8 ball and have to try harderā€¦ does that sound familiar?

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#79

Iā€™d have a look at cystatin C-based GFR estimation for kidney function, which unlike creatinine isnā€™t affected by exercise, creatine supplementation or other potentially confounding variables. This is covered in another thread on the forum and of course isnā€™t related to Lp(a), just thought Iā€™d mention it.

#80

Hopefully this is where generics from India could help us out! :upside_down_face:

Even if Lp(a)-lowering effects could happen at lower doses, it only comes in a fixed 162mg pen or syringe, so youā€™d have to break that up into smaller doses while keeping them sterile to even try it. An even bigger barrier would be finding a willing prescriber to fill this Rx. If you check out epocrates.com and look up Actemra, youā€™ll see the dreaded Black Box warnings and Adverse Reactions. I just canā€™t imagine any provider sticking his/her neck out and risking it to prescribe this for Lp(a).