The title of this document sums it up:
"LDL Cholesterol Management Simplified in Adults – Lower for Longer is Better: Guidance from the National Lipid Association"
Getting cholesterol as low as possible, for as long as possible.
The best lipid lowering protocol is the one that you’re willing to adhere to. It’s “time on target” that’s as important as absolute reduction. Because once you get it low enough to stop progression of plaque, the next goal is to minimize the damage already done. Low enough LDL will regress plaque. Literally pulling it back out of your arteries. But that’s only possible with the “freshest” plaque. Once that’s gone, the next benefit of very low LDL is to “suck” the inflammatory goo out of the plaque that’s not removable. That transforms the remaining plaque from unstable (likely to break off causing a heart attack), to dry, “mummified”, hardened plaque that’s still there but poses little risk.
We know from the huge, ongoing, long term Repatha studies, the first capable of achieving ultra low LDL, that there’s no “floor” level of these benefits, down to single digits. It’s also put to rest the theories of potential harms from ultra low LDL. Theres no indication whatsoever they exist.
The lower you get LDL the better off you’ll be. The limits are cost and what meds you can use without side effects becoming an issue.
Ideally, Repatha / Eze / Statin is the best stack, with the best results. But 2, or even 1 of any of them is significantly better than none.
On all three I’m down from 140 to 24.
Repatha and Eze are a potent combo, and great particularly for those fearful of statins who would otherwise let their high cholesterol go untreated. The only caveat is that inflammation is a major CVD (and general health) risk factor (makes “pimples” grow under plaque, which can make a piece more likely to break off and cause a heart attack). Statins have uniquely potent anti-inflammatory effects, 50% reduction of systemic inflammation, that other classes of lipid drugs don’t offer.
