lowest LDL without using a PCSK9 inhibitor?

I’ve seen people get into the upper 20s, starting from 90-100, using a statin and ezetimibe, or statin+ezetimibe+bemp acid.

Ezetimibe is the main wildcard that can create a much bigger drop than expected. This is because the “transporter” that moves cholesterol from the gut into blood is present in some people at much higher levels than than others. Eze loads this transporter with “blank loads”, so they can’t carry cholesterol. For these folks the LDL drop can be huge.
 
I’ll just mention here if anyone in US does want Repatha, get a prescription from your doctor or telehealth, and get a coupon code from goodRx for your pharmacy.

Amgen lowered the price for cash payers from $700/mo to $239 (lowest in the world). If you DO go through your insurance policy get a “copay card” from Repatha.com and your price will be $15/mo with Repatha picking up the rest. If you’re uninsured, and your household income is less than 3x the poverty level (ie $50k for 1 person, higher for multiple), you can get Repatha for free.

They had been selling direct but decided to work through GoodRx instead.


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As someone pointed out, even if you only use 1, instead of 2 pens a month, you’ll still get most of the benefit at half the cost.

Finally, this is the only way at the moment to put a big dent in Lp(a), dropping it by ~30%.
 
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