38M, apoB 107 / LDL 155 / HDL 83 / Lp(a) 8.7 diet-only or start statins & ezetimibe?
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
u/strygah — 6 days ago