3-month update: LDL 146 → 87 mg/dL and ApoB 120 → 68 without a statin
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.