u/Over_Consequence_865

Anyone else not see much LDL lowering when adding Ezetimibe to Rosuvastatin?

After 6 months of ONLY 5 mg Rosuvastatin, my LDL dropped from 140 to 76.

I have FH, high LP(a), and familial history of early cardiac events/death, so doctor said my LDL needs to be below 55. Added 10 mg of Ezetimibe 3 months ago.

LDL 76 -> 69

I’m bummed. Diet is very clean (less than 10 g of sat fat, etc.). I am lean, exercise a lot, don’t drink or eat junk, etc., etc., etc.

Is this tepid response typical with FH? Should I increase dose of Rosuvastatin (despite studies showing most lowering comes with 5 mg dose)? Is it time for Repatha? Just frustrated because there are not many other levers I can pull.

I posted last week about having an elevated A1c. Basics (full details are included in original post):

Retired pro long distance runner.

Still doing 20 miles per day, but mostly walking due to severe osteoarthritis in knee. Body weight lifting.

Lean, moderately muscular.

Wore a CGM - results normal with normal rises in BG and optimal return to baseline, including during a carb tolerance test.

Fasting BG: 60-75

After many great responses, I sought further testing to verify that my elevated HbA1c was an anomaly - the “athlete paradox”.

Results: Fasting insulin: 2.8 HOMRA-IR = .5 Fructosamine: 211

Thank you to everyone who took the time to reply and suggest the extra testing that needed to be done.

Edited to add: Per multiple suggestions, I have scheduled a fasting insulin test on Friday. Thank you to everyone who took the time to respond.

Hello all! I’ve been down the rabbit hole on this topic, and while there is some info, the evidence is conflicting, so I’m curious if anyone has found an answer or a doctor who knows how to address this issue.

Context:

• Former professional long distance runner. No one tested my a1c, so I have no data from those years.

• HBa1c has consistently been between 5.6 - 5.8 since I started testing 7 years ago.

• Currently (retired from pro running) still doing 20 miles per day, but mostly walking due to severe osteoarthritis in right knee. No intention of returning to high mileage running.

• Lean, moderately muscular (daily body weight lifting protocol).

• After retiring from pro running, dropped most simple carbs and now eat a primarily WFPB diet with limited lean chicken, fish, etc. due to Familial Hypercholesterolemia which is being treated with low dose statins (these have NOT affected my a1c).

• Liver function tests always normal.

• Fasting glucose 60-75.

• Wore a CGM and data showed normal spikes and optimal return to baseline.

• Did a “carb tolerance test” while wearing the CGM and results were top 1% (excellent).

GP is still very concerned about elevated a1c and believes the “athlete paradox” is BS. Trying to decide if I just ignore the issue after all this testing, or if I should probe further.

Thank you in advance for any of information anyone can provide.

Edited to add: 58 Female. Hello all. I follow this community, and appreciate all of the info everyone posts.

Synopsis: Family history of CAD.

Father had first heart attack at 55. Five more followed (stented each time). Finally agreed to a quintuple bypass.

Grandfather dropped dead at 60 from a heart attack/stroke.

All of my siblings have had elevated cholesterol since we started testing (30s). We are all athletes (runners, cyclists, CrossFit). All thin. No other health issues.

High lipoprotein a (140).

6 months ago: Total cholesterol was 224. LDL was 140. Calcium score - 86.4.

Prescribed 5 mg Rosuvastatin and daily baby aspirin. Spent the last 6 months moving towards a more WFPB diet. Removed alcohol completely.

Today: Total cholesterol 154. LDL 76.

Doctor is adding Zetia (ezetimibe). Goal is to get my LDL below 55 because of family history and calcium score.

Will continue the mostly WFPB diet and retest in 6 months.