r/repatha

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 ....

Prior numbers from 29 May:

201 total
121 Triglycerides
56 HDL
125 LDL

New numbers from yesterday

119 total
101 Tri
48 HDL
51 LDL

For those who traveled in the US with Repatha: do you bring the box or bring just the pen? Do you tell the TSA beforehand that you have it, or only if they ask?

I'm thinking about buying a pouch that keeps it cool (75 F / 23 C). Has anyone used something like that?

Thanks

Hi! I’ve been lurking in this sub for a while because I knew Repatha was essentially my only option. I’m a 33F who found out a couple of years ago that I have FH. Because I also have Dermatomyositis, statins were never an option for me.

I’m generally super sensitive to medication (whether it’s actual side effects or just my anxiety triggering a response), but I’m proud to say I went through with my first injection today despite my brain telling me not to. Six hours in, and I’m feeling pretty good. I took it out of the fridge about 2.5 hours beforehand, and the injection itself barely registered on the pain scale (though I know everyone is different there).

For the first couple of hours, I felt a little floaty, had a dry mouth, and a mildly scratchy throat. I can't stress enough that this could very well have been my mind playing tricks on me, but as of right now, all I feel is a little bit tired. We’ll see what tomorrow brings, but so far, so good and I’d much rather handle some minor side effects than risk major cardiac events before 60, which has been the trend for all the men in my family.

I just wanted to share this to offer a little reassurance to anyone in a similar boat: don't let the negative experiences you read on Reddit or elsewhere (which really only represent a fraction of people) dissuade you from making an important health choice. And before anyone eats me up, I’m definitely not trying to minimise the experiences of those who did have a rough time.

So I finally jumped in and took my first dose. Actually had my second dose this week. Didn’t notice any side effects. I lift heavy weights and exercise pretty hard. I haven’t noticed anything related to that so far.

But at the end of last week I developed a dry unproductive cough. There’s basically a tickle constantly in the back of my throat. That’s been happening for maybe 4 or 5 days now.

Just curious if this is related and if anyone has experienced such effects.

Thanks for your input.

So I had to get an angiogram done a couple weeks back. It came back that I have 50% stenosis in my ostial LAD. They put me on Crestor and it was awful. My cardiologist ran some genetic testing and it turns out I am intolerant to all statins. Something about the way I process them and makes them build up in my system and causes terrible side effects.

He switched me to Repatha. I’m nervous about trying it. Unfortunately, I read too much on here about side effects and that has me anxious.

Most people I read with this medication are just trying to lower their cholesterol and I don’t find a lot of accounts of people with actual LAD stenosis, and their stories with this medication. I know this medication is powerful. Will lower your LDL but will it still give me plaque stabilization if I’m not on any statin and just Repatha?

I guess I’m looking for some positive feedback on this medication in my current situation.

Thanks!

Finally got my cardiologist appointment after 9 months of waiting and he said what I thought he would. I’m 50, both grandfathers died of heart attacks at 55 and 63, my dad has been on statins his whole life and now has Alzheimer’s at 88. My brother has taken statins since he was 30. My lp(a) is 109.4 and my cholesterol has dropped from 267 to 206 in the last 6 months.
The doctor suggested Repatha after trying 3 different statins. I’m a little worried about the needle and doing it every 2 weeks. What do you all think?

I posted quite a while back and received excellent feedback, which included several comments recommending a PCSK9 inhibitor for my LP(a) of 226 nmol/L. I really appreciated the input as it made me a better advocate for myself. I FINALLY just got a prescription for Repatha after first being prescribed Atorvastatin 20 mg, increasing to 40 mg, then adding in Ezetimibe - which did not move the needle at all. My current LDL-C is ‘good’ (53) per normal standards, but my preventative cardiologist is now in sync with being more aggressive and getting it and my ApoB (70) as low as possible. 69 YO female and almost three years into this journey of trying to lower stubborn ApoB and LDL-C. Will test all again in a few months. Any other advice is always appreciated.

My mother is 55 and had an MI at 53, followed by one stent. She is currently doing well, her blood pressure is controlled, and her EF is 61%.
She is currently taking rosuvastatin 20 mg + ezetimibe 10 mg, along with bisoprolol 7.5 mg, Co-Valsartan 12.5/160 mg and aspirin 100 mg.
Her latest blood tests show LDL-C 49 mg/dL, ApoB 55 mg/dL, non-HDL 66 mg/dL, triglycerides 90 mg/dL and HDL 45 mg/dL. However, her Lp(a) is **185 nmol/L**.
Her LDL and ApoB are already very well controlled, but I’m concerned about the elevated Lp(a), especially given that she has already had an MI at a relatively young age.
I’m wondering whether it would make sense to discuss **Repatha (evolocumab)** with her cardiologist despite her LDL already being below 55 mg/dL. From what I understand, PCSK9 inhibitors can lower Lp(a) by around 20–30% in addition to lowering LDL, and there is outcome data in people with established cardiovascular disease.
Would you consider Repatha on top of the statin + zetia in this situation, or would you stay with rosuvastatin + ezetimibe because her LDL and ApoB are already excellent?
We’re also currently working on weight loss, diet and exercise to improve her HbA1c, which is 5.74%.
I’d especially appreciate experiences from people with high Lp(a) and previous MI who have used Repatha, particularly if their LDL was already below 55 mg/dL.
Fasting Glucose and Insulin, Homa IR , Homocysteine ,ALT , AST , Creatinine , eGFR all perfect .Thanks

Would you consider Repatha for my mother despite LDL being 49 because of high Lp(a)?

My mother is 55 and had an MI at 53, followed by one stent. She is currently doing well, her blood pressure is controlled, and her EF is 61%.
She is currently taking rosuvastatin 20 mg + ezetimibe 10 mg, along with bisoprolol 7.5 mg, Co-Valsartan 12.5/160 mg and aspirin 100 mg.
Her latest blood tests show LDL-C 49 mg/dL, ApoB 55 mg/dL, non-HDL 66 mg/dL, triglycerides 90 mg/dL and HDL 45 mg/dL. However, her Lp(a) is \*\*185 nmol/L\*\*.
Her LDL and ApoB are already very well controlled, but I’m concerned about the elevated Lp(a), especially given that she has already had an MI at a relatively young age.
I’m wondering whether it would make sense to discuss \*\*Repatha (evolocumab)\*\* with her cardiologist despite her LDL already being below 55 mg/dL. From what I understand, PCSK9 inhibitors can lower Lp(a) by around 20–30% in addition to lowering LDL, and there is outcome data in people with established cardiovascular disease.
Would you consider Repatha on top of the statin + zetia in this situation, or would you stay with rosuvastatin + ezetimibe because her LDL and ApoB are already excellent?
We’re also currently working on weight loss, diet and exercise to improve her HbA1c, which is 5.74%.
I’d especially appreciate experiences from people with high Lp(a) and previous MI who have used Repatha, particularly if their LDL was already below 55 mg/dL.
Fasting Glucose and Insulin, Homa IR , Homocysteine ,ALT , AST , Creatinine , eGFR all perfect .Thanks