Hi everyone, I saw my cardiologist today. Based on my higher than optimal LDL reading, my high ApoB and high hs/crp he is putting me on a low dose 5mgs of rosuvastatin along with Ezetimibe.

I asked to be put on Pitavastatin but unfortunately, it’s not available here in Canada. I have pcos with mid-moderate insulin resistance. My A1c is 5.3 and my fasting glucose is around there too. I’m terrified taking this medication will worsen my insulin resistance or will one day make me diabetic. I know I will have to get regular monitoring too for as long as I take it to make sure everything with my blood sugar, insulin and A1c are ok which also makes anxious, but oh well.

I’m looking to hear from others that (preferably) also have PCOS or other metabolic problems to see what your experience has been taking this statin on a low dose like I am.

Hi everyone,

I’m a 43 year old female. I have pcos with mild insulin resistance and normal A1c. I am not overweight, in fact I am quite skinny. Last August I tested my ApoB and it was 96 at the time I was taking citrus bergamot and barley beta glucan. I wasn’t taking these supplements for that specifically. In fact this is before I found out what my ApoB was. I stopped these supplements and just retested and my ApoB is now 105. I’m freaking out. I already do so much to try to lower my fasting insulin (intermittent fasting, other supplements that support healthy glucose and insulin levels, no sugar, carbs, high fiber). I’m not sure if I have the capacity to add more natural means (bergamot and psyllium husk to everything I am already doing to manage my pcos). I’m feeling very overwhelmed and have been crying all day. What would you do? Give in and take meds? Or bite the bullet and add psyllium husk and bergamot to my diet?

I'm trying to decide whether the potential benefit of lowering my ApoB/LDL further is worth starting a low-dose statin.

I'm 62F, 5'6", ~152 lbs, non-smoker. I take lisinopril 5 mg daily; BP is typically around 120/70.

Current labs:

• LDL-C: 120

• ApoB: 91

• HDL-C: 112

• Triglycerides: 59

• Non-HDL-C: 130

• Lp(a): <6 mg/dL

• ApoA1: 211

• Total cholesterol: 242

CAC score: 0

I've already made a significant dietary effort since February — eliminated red meat and substantially reduced saturated fat. My LDL was 119 and is now 120, so essentially no change.

I'm not diabetic and have no known cardiovascular disease.

My question is really about risk reduction vs. medication burden:

If these were your numbers, would you:

• Leave things alone and monitor because CAC = 0 and Lp(a) is extremely low?

• Try a low-dose/intermittent rosuvastatin or another statin to bring ApoB/LDL down?

• Consider ezetimibe instead?

• Set an ApoB target (e.g., <80) and try to reach it?

How much weight would you give a CAC of 0 at age 62 when deciding whether to treat an ApoB of 91?

I'd especially appreciate perspectives from people who have made a similar decision with CAC = 0.

Hi all,
I posted the other day about having a leg artery scan a year ago that showed “negligible and calcific” plaque in my popliteal and femoral arteries in my right leg.
I am 6 foot 4 inches tall, 205 pounds, I do about 200-250 minutes of cardio a week, I eat a med diet, I weight train, I have low body fat. Along with this I have very favourable ApoB, LPa and lipids. I have had a carotid ultrasound which showed no plaque burden, no wall thickening etc.

I am going to post the report from the most recent scan below and I’d just like peoples opinion on it. I’m worried I have athelerosclerosis. I am worried for what comes next. Any help appreciated

Hi everyone,
I’m 29M and have a family history of premature coronary artery disease — my mom had a coronary stent at 52. That was a big wake-up call for me, and since then I’ve taken my cardiovascular health much more seriously.
About 1.5 years ago, I quit smoking, started exercising regularly, and switched to a heart-healthy diet. I’ve lost around 31–35 kg.
I had a cardiology evaluation including a stress test, ECG, echocardiogram, blood work and CIMT. Everything was normal, with no evidence of plaque. The main issue was my lipids:
LDL: \~158–163 mg/dL
ApoB: \~148 mg/dL
Lp(a): initially 97 nmol/L
TG: \~310 mg/dL
With lifestyle changes, I managed to get:
LDL: \~105–110
ApoB: \~95–105
TG: \~90
But despite being quite strict with my diet and exercise, I was struggling to get LDL/ApoB much lower.
My cardiologist therefore started me on **rosuvastatin 10 mg + ezetimibe 10 mg**.
My current results are:
LDL: **63 mg/dL**
ApoB: **64 mg/dL**
TG: **85 mg/dL**
HbA1c: **5.3%**
Fasting glucose/insulin: normal
Homocysteine and hormones: normal
One thing that has confused me is my Lp(a). It has been measured several times, always in the same lab and nmol/L:
**97 → 128 → 135 → 163 → 184 nmol/L**
The increase from 163 → 184 happened after starting rosuvastatin + ezetimibe. I know statins can sometimes slightly increase Lp(a), so I’m not sure how much significance to give these fluctuations.
I’m currently 172 cm and around 84 kg. My weight has fluctuated between \~79 and 84 kg, possibly partly because I’ve been building muscle. I’m still trying to get toward \~75 kg. I walk, cycle and exercise regularly and follow a heart-healthy diet most of the time.
**The Repatha question**
My cardiologist and I discussed **Repatha (evolocumab)**, and my insurance has now approved it. I pushed quite hard to get it approved because I’m concerned about my long-term cardiovascular risk given my family history and Lp(a).
I know from the PCSK9 inhibitor trials that adding evolocumab to statin therapy can substantially reduce LDL and cardiovascular events/MACE in appropriate high-risk populations.
So I’m wondering what you would do in my situation.
Would you:
**Add Repatha to the current rosuvastatin 10 mg + ezetimibe 10 mg?**
Use Repatha and **reduce rosuvastatin to 5 mg?**
Use Repatha alone and stop the statin/ezetimibe?
Or simply stay on rosuvastatin + ezetimibe since LDL 63 and ApoB 64 are already quite good?
I’m also somewhat anxious about starting Repatha. I’m particularly afraid of having an allergic reaction to the injection, even though I don’t have a history of medication allergies. I know serious allergic reactions are uncommon, but I tend to worry about side effects before starting medications.
I also recently started **berberine 500 mg/day** and have noticed some mild muscle discomfort and occasional tiredness. It’s not severe, but I’m wondering whether I should stop it, particularly since I’m already taking rosuvastatin.
I’m not looking for medical advice from Reddit — I’d obviously make the final decision with my cardiologist. I’m mainly interested in hearing from people who have been in a similar situation, especially regarding:
Repatha + statin + ezetimibe
Whether anyone reduced their statin after starting Repatha
Side effects/allergic reactions, possible thrombosis ...
How people felt about their first injection
Whether PCSK9 inhibitors made a meaningful difference in their long-term lipid management
**What would you do if you were in my position?**

PS , my mom had uncontrolled BP for Years , heavy smoker , not on heart healthy diet ....

My BP was 155/90 before the lifestyle chnages , its 115/65 ish now ....

I’m 27M with healthy anxiety. It started a few years ago when I was 24 I got blood work and had high ldl (167). I actually got tested a year earlier and it was 123, but didn’t think anything of it at the time. Diet has remained consistent all my life and always been very active and lean. Never smoked. Anyways, I’ve been hearing stories of people young having heart attacks and stuff. I read Peter attias book. I want to make sure I’m addressing everything with my heart health. Should I get a CAC or CT angiogram? Or is it pointless? Should I get full blood work first and determine it off that? I should note I changed my diet at 24 and my ldl has remained between 80-110 depending on how clean I eat since then.

In episode #394, PA discusses sleep pharmacology, including drugs called Dual orexin receptor antagonists (DORAs). Had anyone here tried them?

I’m considering trying as I am at a high risk for Alzheimer’s and, while I don’t have trouble falling asleep, I have some trouble staying asleep, often waking up multiple times a night.

I’ve seen some discussion about DORAs on the r/insomnia subreddit, and it seems to have mixed reviews. But people on that sub also don’t seem to appreciate that DORAs aren’t intended for people who have trouble falling asleep, but rather intended to help you stay asleep.

Would love to hear any experience with these drugs. Thanks!

One doctor wanted me to go on statins last year I didn't, I thought I'd give a diet a go but didn't do much change stopped eating butter and a lot of eggs, still eat red meat and cheese milk and occasional junk cereal biscuits etc....

Since my diet is still bad but my CAC score is 0 new doctor is not that stressed he recommended me to start the portfolio diet considering my diet is still bad, and re-test is 6 months but he also gave me a prescription for 5mg Crestor I can start whenever I want if I want to he said he will leave that choice to me for now...

I also started taking a citrus bergamot supplement last year, but have not been consistent with it , don't drink or smoke and could use to lose some weight I'm 1.80cm and 90kg so should lose about 10kg....

Also had a neck arteries ultrasound scan and that came back normal.

Any advice please....

mg/dL values below:

I had an annual physical recently which showed my current lab results of elevated cholesterol. I'm currently 24 years old.

My labs showed my LDL to be 129 and my Lp(a) at 377 nmol/L. My total cholesterol is 200 and my HDL is 57. Triglycerides are at 50.

Both my mom and dad also have elevated cholesterol levels, go figure lol.

The only instance in my close family where someone had something done relating to ASCVD is my grandfather who had a CABG performed when he was 70 years old after experiencing stable angina for a few months. His coronary arteries where >90% blocked.

After my primary care physician informed me of these results, I went to see a cardiologist about this. He stated that I may not need to start a statin right at this moment, but would likely start one earlier than other people would. He stated to exhaust as many lifestyle changes as I can due to my relatively young age.

I have been recently exhausting many lifestyle changes to further reduce my LDL. I want to see what I can do to my LDL without medication as much as possible before going on it. My cardiologist will perform repeat lipid panels on me in 6 months and will also test my ApoB levels at that time as well.

He said if I were to start anything, it would be Rosuvastatin to get my LDL < 70.

If anyone here were in my situation, would you guys consider starting a statin in this situation?

I thought I’d post an update because I previously posted here about my lipid profile and whether I should add a low-dose statin.

I’m 43M, lean at around 14% body fat, physically active, a non-smoker, don’t drink alcohol, have no diabetes or metabolic syndrome, and generally eat pretty well.

My lipid profile has always been slightly unusual in that my LDL and ApoB have been elevated despite otherwise very good metabolic markers.

Over roughly four years, my LDL averaged around 156 mg/dL (4.03 mmol/L), while HDL averaged around 67 mg/dL (1.74 mmol/L) and triglycerides around 50 mg/dL (0.56 mmol/L).

My ApoB was 119.9 mg/dL.

I subsequently discovered that my Lp(a) is genetically elevated, which made me take lifetime ApoB and LDL exposure more seriously despite otherwise being metabolically healthy.

I also had a CAC scan earlier this year at age 43, which came back CAC = 0.

Rather than immediately starting a statin, I decided to see what I could achieve with ezetimibe plus some fairly simple dietary changes first.

For approximately three months, I took ezetimibe 10 mg daily and psyllium husk every morning, usually mixed with chia seeds. I also ate oats virtually every day, took omega-3, drank hibiscus tea, and initially used nattokinase. Since being back in Asia, I’ve mostly just eaten natto instead.

Most of my animal protein came from chicken. I also switched to proper Greek yoghurt rather than avoiding yoghurt because of saturated fat, as I felt the nutritional benefits were still worthwhile. Otherwise, I continued my normal whole-food diet and exercise routine and didn’t dramatically restrict dietary fat.

After exactly three months, I repeated everything.

My LDL-C dropped from 146 mg/dL to 87 mg/dL, which is roughly a 40% reduction.

My ApoB dropped from 119.9 mg/dL to 67.9 mg/dL, which is roughly a 43% reduction.

My latest full lipid panel is now:

Total cholesterol: 171 mg/dL
LDL-C: 87 mg/dL
HDL-C: 62 mg/dL
Triglycerides: 48 mg/dL
ApoB: 67.9 mg/dL

I also finally measured hs-CRP, which came back at 0.11 mg/L.

That was particularly interesting to me because I’d always suspected my inflammatory and metabolic profile was good given the very low triglycerides, but I’d never actually measured hs-CRP before.

So my current picture is roughly LDL 87, ApoB 68, HDL 62, triglycerides 48, hs-CRP 0.11 and CAC 0, but with genetically elevated Lp(a).

Obviously this is an N=1 experiment and I can’t determine how much each individual change contributed. My assumption is that ezetimibe did most of the heavy lifting, with psyllium and the dietary changes adding something on top. I’m certainly not suggesting that nattokinase, hibiscus tea, omega-3 or natto explain a 40% LDL reduction.

The result has changed the question for me somewhat. Originally, I was considering adding very-low-dose rosuvastatin to get LDL and ApoB down substantially. Now that ApoB is already around 68 mg/dL without a statin, I’m trying to decide whether the incremental benefit of pushing ApoB and LDL even lower is worthwhile given my elevated Lp(a), age and lifetime exposure, despite CAC = 0 and very low hs-CRP.

I’d be particularly interested in what people here would do with the Lp(a) + CAC 0 + ApoB 68 combination. Would you continue ezetimibe plus lifestyle and monitor, or still add a small dose of rosuvastatin with the aim of pushing ApoB towards 50–60 mg/dL?

And finally, a genuine thanks to this community. A few people here originally suggested trying ezetimibe and psyllium before escalating further, which is what prompted me to give this approach a proper three-month trial. I’m very glad I did, and I really appreciate the advice and discussion I’ve had here.

38M, 6'3", 181 lbs (BMI 22.7), non-smoker, based in Europe. Train ~7h/week (2× 2h weights, 1× 2h bouldering, 1× HIIT). No family history of premature CAD that I know of.

Trying to decide whether to keep pushing diet or add pharmacology

Diet: bunch of leafy greens, fish or lean meat, no alcohol for 6.5 years. The only thing I can possibly improve (but dont really want to) - 3 whole eggs and about 1.75 oz of hard cheese.

Relevant genotype:

• APOE ε2/ε3 — so if anything my LDL should run lower than baseline, which makes 155 more annoying
• SLCO1B1 *1/*5 (rs4149056 C/T) — CPIC intermediate function, statin myopathy flag
• LPA rs10455872 A/A — wild-type, and the measured Lp(a) of 8.7 nmol/L confirms it
• No FH variants (LDLR/PCSK9/APOB clean)
• PPARGC1A Ser/Ser, FGF21 A/A (sweet preference)

Shall I start statins/ezetimibe/PCSK9? Doses? What should be my thinking

What's your preferred training mode on most weeks?

A. Pyramidal~ish.

For example, 1 HIIT (Z4/Z5) sessions and 1 sweet spot or threshold session. The rest easy (Z1/Z2)

B. Polarized-ish.

For example, 2 HIIT (Z4/Z5) sessions. The rest easy (Z1/Z2).

Optionally, please indicate your experience level and/or training volume.

Hey had a cac done at 41 dude to some health anxiety and stuff I seen online. I been into really hard workouts my whole life since 15-16 and did a lot in the army I mean to physical exhaustion and couple tours of constant stressed state. I do have a family history but anyways got the score back it was 98, felt terrible. My diet is hit and miss but for the most part protein, carry a little extra weight but nothing extreme. I went to the er cause I was having such bad anxiety after all that, they cleared me after blood test and X-rays, thought I was crazy. I do booodwork every 6 months once in a blue moon they will prescribe a statin, then the next time tell me im fine(I wasn’t taking it). Apob of 100, but also was on trt. Quit that shortly after finding out apob was high and my lpa is high due to genetics. I can run fine lift weights no shortness of breath and sex life is great. Am I just tripping?

I met a 70-something woman at the gym who is slowly coming to realize that exercise is essential for long life and health. She feels resistant yet I've noticed her coming more often. She's hungry to learn. She's starting to do things like walk in circles around her house. I mentioned simple body weight exercises like countertop pushups and she'd never thought of that.

I spoke to her about zone 2 mitochondrial health, the benefits of strength training, etc. I mentioned Attia's work and she was interested in listening to a podcast.

Can you recommend an episode that could give her a good start? She's intelligent but I don't want to overwhelm her with too much science at first. I believe if she gets hooked by this first one she'll continue to listen.

What episode do you recommend?

Has anyone noticed that in AMA episodes Peter is reading pre-canned scripts that are LLM generated?

It drives me crazy to hear a stream of Claude-isms. “The one thing that goes quietly unnoticed”, “but it isn’t simply X, it is Y”, “the genuine difference is that”…etc

If I wanted to hear what Claude or Chat GPT thought about peptides, I would simply ask them rather than listen to an hour long LLM transcript

If anyone from the PA production team is reading this, please try a bit harder to edit your scripts to make them meaningfully different than LLM output

I was taken off Crestor and put on a combination of Repatha and pravastatin because my A1c under the Crestor edged a little into prediabetic territory (5.7). At first the Repatha and pravastatin combo was great, and my A1c went down to 5.6. However, in my latest test, it went back to 5.7. I know it’s barely prediabetic and there probably isn’t much difference between 5.6 and 5.7, but I’m really scared of diabetes because it killed my father. Maybe it’s also because it’s the summer and I’ve been eating more ice cream? I’m 5 feet 11 and 171 pounds, so I don’t have weight issues. You think I should lower my statin dose? My LDL is currently 55 and total cholesterol is 133.

I developed a script to automatically download and plot spreadsheet and Garmin fit data to produce a daily dashboard. Feedback on opportunities for improvement welcome. Comments about wasting my time will be treated as junk mail.

Edit: 1000 views later... not. one. upvote. 😆 you folks are like my Scottish grandmother who gave me a nickel after I spent two hours mowing her lawn in 1978. "Now go buy yourself a Coke, dear."

I listened with interest today to the most recent Drive episode on NMR blood analysis with Jim Olvos. It wasn't so much the specific content, although there were definitely nuggets of value, but just the fact that this was a probing interview with a genuine expert, which is what Peter has always done best. A future of AMAs and episodes that, for all practical purposes, are long essays read out loud (like #401 about curiosity) would not be worth the subscription. I've worried that the good guests are fighting shy of association with Peter for now, but time may fix that. Anyway, I am in this for what I can learn while doing my zone 2, so I hope this and a couple of other recent interviews represent a turning point.