lowest LDL without using a PCSK9 inhibitor?

[BigChungusRX]

Lp(a) additive risk is linear with Lp(a) level (higher levels = higher risk). The hazard ratio at 140 nmol/L is 1.3-1.5 (30-50% increased risk) depending on what study we're looking at. The researchers gave us a handy dandy table to tell us how much we need to lower LDL to mitigate the risk of elevated Lp(a):

Lp(a) (nmol/L)	Δ Lp(a) vs median (nmol/L)	Lp(a) percentile	HR for MCVE due to ↑Lp(a)	LDL‑C reduction starting age 30 y (mg/dL)	40 y (mg/dL)	50 y (mg/dL)	60 y (mg/dL)
320	300	99	2.56	≈46	≈54	≈66	≈89
270	250	97.5	2.19	≈39	≈46	≈58	≈73
220	200	93.5	1.87	≈31	≈35	≈46	≈58
170	150	90	1.60	≈23	≈27	≈35	≈43
120	100	82.5	1.37	≈15	≈19	≈23	≈31
70	50	75	1.17	≈8	≈8	≈12	≈15
20	ref.	50	ref.	ref.	ref.	ref.	ref.

If I’m reading this right, my LPA is 144 nmol/l. This chart is saying I should be at 15mg/dL LDL? Or am I reading this wrong?

 

[deadbeef]

If I’m reading this right, my LPA is 144 nmol/l. This chart is saying I should be at 15mg/dL LDL? Or am I reading this wrong?

15 reduction. If you normally have ldl of 100, you'd need to lower to 85 to make up for your lp(a).

 

[EnhancedPhysio]

the important thing is that your LDL is already so low, so congratulations, therapy was clearly successful!

Thanks, I appreciate it.
It's taken many years to get to this point. I still can't believe I'm tolerating therapy so well after trying literally every other drug on market. Even Nexletol caused my CK to go high out of range with severe muscle aches.

How They Work (Mechanism of Action)

• Leqvio (siRNA): Uses RNA interference (RNAi) to target the liver, preventing it from producing the PCSK9 protein in the first place.
• Repatha (Monoclonal Antibody): Directly binds to the PCSK9 protein in the bloodstream, blocking it from binding to LDL receptors.
• Result: Both methods allow more LDL receptors on the surface of liver cells to remain active, which removes more "bad" cholesterol from the blood.

 

[EnhancedPhysio]

the important thing is that your LDL is already so low, so congratulations, therapy was clearly successful!

Great info thank you.

 

[just some dude]

Thanks, I appreciate it.
It's taken many years to get to this point. I still can't believe I'm tolerating therapy so well after trying literally every other drug on market. Even Nexletol caused my CK to go high out of range with severe muscle aches.

How They Work (Mechanism of Action)

• Leqvio (siRNA): Uses RNA interference (RNAi) to target the liver, preventing it from producing the PCSK9 protein in the first place.
• Repatha (Monoclonal Antibody): Directly binds to the PCSK9 protein in the bloodstream, blocking it from binding to LDL receptors.
• Result: Both methods allow more LDL receptors on the surface of liver cells to remain active, which removes more "bad" cholesterol from the blood.

I’m familiar with the intolerance to the other 3, but what was the issue with Repatha?

 

[EnhancedPhysio]

I’m familiar with the intolerance to the other 3, but what was the issue with Repatha?

Same thing as before with statins, severe muscle aches, fatigue and elevated CK muscle enzymes. I tried every 3 weeks instead of 2, then 4 weeks and still didn't help.