#1

45yo male, generally very fit & healthy except sky-high lp(a) levels and recently discovered a 70% blockage (soft plaque) in an artery (D2).
Started Rapamycin in October. Have been alternating 9mg / 13mg weekly (following Bryan Johnson published protocol before he discontinued).

Medications to manage CVD risk:

  • 20mg Rousuvastatin once daily
  • 10mg Ezetimibe once daily
  • 400mg Bezalip Retard once daily
  • 100mg Aspirin once daily

Medications for longevity:

  • 9mg / 13mg Rapamycin alternating once weekly
  • 100mg Acarbose with meals 3x daily

Supplements:

  • Protein
  • Lithium Orotate 10mg daily
  • CoQ10 200mg daily
  • Omega-3 Fish Oil (1800mg EPA/120mg DHA) x3 daily
  • Astaxanthin 6mg daily
  • Vit B12 3000mcg daily
  • Nattokinase 12,000 FU daily

The Liver Function and CBC both threw up some ā€˜out of rangeā€™ / potentially concerning numbers.

This is the first time Iā€™ve tested them since starting Rapamycin. Iā€™m wondering if these look normal? Or if Iā€™m perhaps overdoing it?

If I were to adjust my dose, I would probably prefer to keep the dose high and move to once fortnightly rather than lower the dose and have higher frequency. I am keen to cross the blood brain barrier as I have a family history of neurodegenerative diseases.

Soemthing else weird that Iā€™ve noticed - I have always had high Bilirubin. Since a kid Iā€™ve always been told I have Gilberts Syndrome. This is the first time in my life I have had a ā€œnormalā€ Bilirubin number.

CBC
Haemoglobin: 143 g/L ( 130 - 175 )
Haematocrit: 0.42 ( 0.40 - 0.52 )
MCV: 89 fL ( 80 - 99 )
MCH: 30 pg ( 27 - 33 )
RBC: 4.77 x 10e12/L ( 4.30 - 6.00 )
Platelets: 254 x 10e9/L ( 150 - 400 )
WBC: 4.3 x 10e9/L ( 4.0 - 11.0 )
Neutrophils: 1.9 x 10e9/L ( 1.9 - 7.5 )
Lymphocytes: 1.9 x 10e9/L ( 1.0 - 4.0 )
Monocytes: 0.5 x 10e9/L ( 0.2 - 1.0 )
Eosinophils: 0.2 x 10e9/L ( 0.0 - 0.5 )
Basophils: 0.0 x 10e9/L ( 0.0 - 0.2 )

Liver Function
Bilirubin: 22 umol/L ( < 25 )
Alkaline phosphatase: 67 U/L ( 40 - 110 )
GGT: 7 U/L ( < 60 )
ALT: 38 U/L ( < 45 )
Protein: 64 g/L ( 66 - 84 ) L
Albumin: 41 g/L ( 32 - 48 )
Globulin: 23 g/L ( 25 - 41 ) L

Folate
Folate: 38.3 nmol/L ( 5.0 - 45.0 )

Lipids
Fasting status: Fasting
Cholesterol: 2.1 mmol/L ( < 5.0 )
Triglyceride: 0.5 mmol/L ( < 2.0 )
Cholesterol (HDL): 1.25 mmol/L ( > 1.00 )
Cholesterol (LDL) (calculated): 0.5 mmol/L ( < 3.4 )
Cholesterol (total/HDL): 1.7 ( < 4.5 )

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High Total Cholesterol (over 300)
#2

What a wake up call. I would up your dosing on Ezetimibe to 25 mg daily. Keeping glucose low, lowers inflammation in arteries possibly preventing anymore hard plaque from being inflammed and turning soft, while possibly preventing your soft plaque from forming a clot. Good Luck, andkeep 500-600 mg aspirin handy in case of an event.

#3

Am I missing something? His ldl is 19.3 mg/dl. Why would he need to increase zetia?

#4

SGDL2 Inhibitors reduce glucose levels in blood from the kidneys. High glucose=higher inflammation= turns hard plaque to soft in arteries = possible clot to brain or heart. Ldl?

#5

Has the Bezalip helped with your Lp(a) or have you not retested it subsequently? I donā€™t know what you call sky high (mine is 188 in US units and I would call that sky high). I am asking because I have some Fenofibrate on order.

Your LDL, HDL and Trigs look fantastic to me.

Only other thing I am trying to reduce Lp(a) which is not on your list is Nicotinic acid (Niacin). I have been taking it at 3g per day for 6 months and plan to retest Lp(a) after 12 full months.

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#6

May I ask how you found the 70% blockage and the high Lp(a)?

#7

Thanks. I had my lp(a) and ApoB tested at the same time, but need to wait about a week for those results (theyā€™re sent to another lab). When I get those back, Iā€™ll be able to let you know the impact Bezalip has had (itā€™s the only meaningful change Iā€™ve made since last tested).

I am planning to start Niacin this week. Itā€™s effect should become apparent fairly quickly, so I intend to re-test after using for ~1 month.

Something else I have tried, which didnā€™t work for me, was Leqvio. It made virtually no difference to my lp(a) levelsā€¦

My lp(a) levels when last tested were 1174 mg/L and anything above 300 is considered high.

#8

I recently read Outlive by Peter Attia, which led me to Rapamycin and also led me to the concept of aggressively testing for long-term diseases. For me, 1st cab off the rank was cardiovascular. A blood test indicated high cholesterol generally and particularly high lp(a) levels. Based on this I decided to have a CT Angiogram (incl contrast) which is how my 70% plaque blockage was found. I have a calcium score of zero, so itā€™s unlikely to have been found any other wayā€¦

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#9

Agreed. At this stage, I have no plans to increase my Ezetimibe prescription.

#10

Thanks. I particularly appreciate the suggestion of keeping 500-600 mg aspirin handy in case of an event. Itā€™s pretty cheap insurance! Whilst I hope I never need it, Iā€™ve placed some in my car and a few other places, just in caseā€¦

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#11

How do you have blockage with calcium score of zero. ( calcium in heart and arteries?)

#12

Itā€™s a soft plaque which hasnā€™t hardened (calcified) yet. The reason I wanted a CT Angiogram was because I knew the other tests Doctors wanted to suggest first (stress test, calcium score) could potentially miss quite a lot. I can run a marathon, so would always do well on a stress test. And Iā€™m fairly young (45), so itā€™s possible for me to have soft plaques which havenā€™t had enough time yet to harden and progress into calcified plaqueā€¦

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#13

I know someone who is a very prominent doctor in my area who has a zero calcium score who had a major heart attack caused by a soft plaque rupture. Itā€™s unusual but sometimes there is no correlation between calcified plaque and unstable plaque. Thank God KiwiGuy was able to get his doctor to order the CTA!

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#14

Are you taking the Aspirin and CoQ10 at the instruction of your Cardiologist? Does he know your taking Natto?

#15

Wow, thatā€™s really useful information about Leqvio, thank you. I have been hounding my GP about PCSK9 inhibitors but without any luck so far. Do you intend to try Repatha at some point too?

I look forward to hearing about your latest Lp(a) results when they come in, good luck with those.

You might want to leave it a bit longer for retesting after starting Niacin. The only reason I say this is because it took me a good 4 to 6 weeks to build up to the 3g per day. The flushing effect from Niacin is not that pleasant and it takes the body a while to get used to it, even starting at just 500mg. I also found it helped taking the Niacin with food and just after the low dose Aspirin. If you donā€™t experience the flushing effect then double check youā€™ve got the right type of Niacin. I made the rooky mistake of trying Niacinimide at first and wondered why I wasnā€™t getting any flushing. It has to be Nicotinic Acid.

#16

Yes. The CoQ10 is because I am taking Statins. The Aspirin is to reduce odds of a heart attack or stroke. And theyā€™re well aware of everything I am taking (incl. Natto & Rapamycin).

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#17

Leqvio (or another PCSK9 inhibitor) should probably work for you (it has for many others!). It just didnā€™t work for me. My first choices were to try Repatha or Praluent. Unfortunately neither are available to purchase in New Zealand. On paper, Leqvio is quite promising, so I may give it another shot.

Niacin - yes, Iā€™ll take time to build up and have purchased the correct type.

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#18

Any concern about combining aspirin and natto? Too much anticoagulant?

#19

No concerns from the Docs. Natto & Aspirin work on slightly different clotting pathways. I was the one who was most concerned / questioning. Theyā€™ve said if I like, I can just take an aspirin every 2nd day, or 2 out of every 3 days (the aspirin I am on is enteric coated, so canā€™t be split).

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#20

Maybe itā€™s a NZ thing but Iā€™ve never seen 100mg Aspirin before. Baby Aspirin is usually one quarter of a standard single Aspirin so 75mg (UK) or 81mg (USA) IME.

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