Neo
#128
@lsutiger how is your Lp(a) nowadays after your meet with Dr. Sam T?
Davin8r
#129
That is pretty crazy, Neo, but tracks with my experience. No, I never found out either but I’m guessing it must be that they’re presumably getting more accurate at the testing (but if so, what does this say about previously published studies?). Nothing I’ve done seems to have put a dent in Lp(a), Repatha included, so I’ve given up that angle and am focusing on ApoB and inflammation. I recently did a battery of the latest/greatest tests for arterial inflammation related to CVD and they were all nice and low, so that’s something at least. I’m seeing patients at the moment, but I can post the tests I took when I get home.
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What kind of CRP values do you have/are aiming for?
Neo
#132
Mine are always under the measurement threshold, so not sure what one should aim for if higher. The threshold at Quest was .2 then they increased it to .3 and now recently it is below .2 again.
My Sedimentation Rate Westergreen Test or ESR tend to = 2, does anyone know if that can/should be lower?
Perhaps @John_Hemming knows as he thinks about inflammation a lot and also measures it a lot on think.
4 Likes
Neo thanks for the question. I just had another appointment with Dr. Tsimikas. I started Repatha in March and my LPa went from 130 to 58. It has stayed in the upper 50s. The plan is to stay on Repatha until the new meds that lower LP’s to single digits are on the market. Let me know if you have further questions.
3 Likes
Davin8r
#134
Wow! Wish I had that kind of response. I’ve been on Repatha for years, and Lp(a) is higher than ever. Maybe my immune system has made antibodies to the Repatha and it’s no longer doing as much.
I have not looked at ESR that much. Mine has been low when measured. I dont know if it goes below 2 much
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Wow. I was not aware that our immune system could make antibodies for a particular med and thus the med no longer works. I did labs again around a week ago and I hope that is not the case with my LPa when I get the numbers back hopefully tomorrow.
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Davin8r
#138
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Neo
#139
@Davin8r Do you know if (a) one can test for those antibodies/ such a reaction and (b) switching to another PCSK9i would be different ending to not have the continued immune response?
Davin8r
#140
I don’t know of a way to test for antibodies to Repatha outside of the research setting, unfortunately. Since Praluent is not on my insurance formulary, I can’t switch to it from Repatha without a compelling reason. At least my inflammation is low 
2 Likes
Davin8r
#141
Temporal variability of Lp(a) in clinically stable patients: Implications for cardiovascular risk assessment
https://www.sciencedirect.com/science/article/abs/pii/S0025775324004007
Ok, finally the research is catching up to my own experience.
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I have quite a few values that vary a lot.
Neo
#143
With no approved drugs to lower lipoprotein(a) concentrations, it is promising that at least five drugs in development lower concentrations by 65–98%, with three currently being tested in large cardiovascular endpoint trials. This Review covers historical perspectives, physiology and pathophysiology, genetic evidence of causality, epidemiology, role in familial hypercholesterolaemia and diabetes, management, screening, diagnosis, measurement, prevention, and future lipoprotein(a)-lowering drugs.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01308-4/abstract
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amuser
#144
Started Repatha 8/15, and here are the results (minus LP(a) which I expect back Friday) after one month :
Considerable drop in vldl/trigs, rise in hdl. But no change in ldl.
And that’s a personal record high for Apo-B.
No statin involved.
We’ll see what LP(a) is, but these results are not encouraging. Anybody else had a similar experience? Any reason to expect another month or two of usage will turn things around?
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Davin8r
#145
Wow that is SO strange. Lately I’ve been wondering if my Repatha is doing anything (have been on it for years). Lp(a) has only gone up over time, and LDL/ApoB are low, but I’m also taking ezetimibe and bempedoic acid and doing whole foods plant based diet.
It did occur to me that I may have developed neutralizing antibodies to the drug over time, but that would seem unlikely for you since you just started it.
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Neo
#147
What dosing schedule are you on and when in the cycle did you take the blood test
Since people usually take this once every 2, 3 or 4 weeks the pattern of your blood markers will be a drop and then a climb and then another drop (typically from a slightly better leve)l and a climb back and so on.
My cardiologist suggested 3 months as good duration to have the lows and new peaks both tech there general new better levels
He also suggested taking the measurement around one week after the injection and then do that consistently each time one does blood work in the future to be able to compare.
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