#82

Laron’s Syndrome is often associated with higher LDL but lower risk. Lower T3 levels can increase LDL. Rapamycin also can inhibit LDL-R expression

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#83

This is the use case for metformin
Off target effects of statins on geranylgeraniol are scary

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#84

What alternatives are you thinking of to keep LDL cholesterol low to prevent a lot of atherosclerosis and its consequences?

#85

Like I said, metformin to reduce LDL. It’s less risky than statins. There a reason metformin + rapamycin synergize

Metformin in patients with and without diabetes: a paradigm shift in cardiovascular disease management | Cardiovascular Diabetology | Full Text)%20%5B45%5D.

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#86

From personal experience, Metformin (500 mg daily) did nothing to reduce my LDL. It did reduce my HBA1C though, and I am now at my target of 5.4. Bempedoic Acid + Ezetemibe reduced my LDL by about 45%.

Why would you think Metformin will reduce LDL?

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#87

I appear to have had zero improvement in my LDL/ApoB from adding bempedoic acid to my Repatha+ezetimibe. I’m even wondering if the med I got from India (“Brillo EZ”) is fake…

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#88

My father takes Brillo EZ and I take Brillo + Ezetemibe. Both were bought from Jagdish. We both had 45% drops in our LDL after taking them.

Repatha and Bempedoic Acid are synergistic. Your LDL should have dropped an extra 30%. What is your LDL currently?

Also, you may be taking double the recommended dose of Ezetemibe as Brillo EZ is Bempedoic Acid + Ezetemibe. If you take that and Repatha + Ezetemibe you are double dosing.

#89

I stopped my regular ezetimibe Rx when I started the Brillo-EZ. LDL was 33 in Feb 2023, 58 in Nov 2023, back to 33 in Feb 2024, and 45 as of this week. I started the Brillo-EZ in January. So, maybe it helped drop it from 58 to 33, but doesn’t explain why it went up 12 points over the last 3 months and why I had LDL of 33 a year ago before I was ever even taking bempedoic acid. I expected to get it down lower than I’ve ever seen it with this med combo.

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#90

My LDL went from 65 before Rapa to 120 after Rapa. BA + Ezetemibe brought it back down to 65. My guess is you are experiencing something similar.

Also, it’s a lot harder to drop below 33!

#91

Are you testing around the same day post PCSK9i injection?

#92

I hadn’t considered that, but I don’t think it should matter since I’m at steady-state drug concentration after being on Repatha for over a year now.

#93

nexlizet can be sourced cheaply at an Indian pharmacy

#94

My cardiologist did think it would matter - even if you have “steady stated out” of the most extreme part of the saw tooth, there can still be a meaningful amount of saw tooth if you only are dosing every 2 or 4 weeks.

He recommended that I do my cholesterol testing around day 7 or so post injection and then keep cholesterol testing consistent with that to be comparable.

Going forward it might be valuable for you to consider something like that.

You could also see if any of the clinical studies quantified how big the saw tooth effect is to help understand how much it might have impacted your past data.

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#95

I was told that Indian retailers aren’t allowed to sell branded Nexlizet or Nexlitol, which is why I got the generic. Is this not true?

#96

Just updating you as I just got retested. Unfortunately not apples to apples as it was a fasting cholesterol test.

Total cholesterol 101mg/dl
HDL 32 mg/dl
LDL 51 mg/dl
Triglycerides 88mg/dl

So triglycerides being lower is expected as it was a fasting test, LDL got a slight bump and HDL also went up (probably in response to higher LDL). Almost certainly not significantly different as you get some inter-test variance. At the time of the test I was taking 12mg rapamycin per fortnight. Bodyweight was not significantly different between tests. My diet did not change.

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Rapamycin Dose in 20s/30s (+lipid side effects)
#97

What are you currently taking for your cholesterol now?

#98

Atorvastatin (20mg), Bempadoic acid (180mg), and ezetimibe (1/4 to 1/2 a 10mg tablet).

LDL-C (and APO-B) now down around 60. No apparent side effects of the medications.

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#99

good stuff. do you get all these mediations from india too? and if you don’t mind me asking how old are you? thanks!

#100

The statin I get from my regular doctor, but he wouldn’t support the more aggressive approach, so I went offshore for the bempadoic acid and ezetimibe - and click on my profile (image) to learn more about me.

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#101

I have very recently stumbled upon this discussion which happen to be most relevan to me since i have a CAC score of 259. Combined medication of Rosuvastatin 20mg + Ezetimibe 10 mg brought my LDL from 149 to 53, TChol 203 to 127 and TriG from 73 to 55. Starting with those numbers i started to take Rapamycin 6 months ago, my protocole is 6 mg a week, 5 months on 1 month off. I took another blood test on the last week of the fifth month for which i will get the result next wednesday, i expect an increase of about 15 to 20 % in my numbers, if not it will be a pleasant surprise. This being said, my concern was more with the apparent contradictions in some studies with the fact that rapamycin elevate ldl-c, total cholestrerol and at the same time be beneficial for atherosclerosis. After inquiring with very helpful AI tool call “Consensus” that filters all relevant studies link to your inquiry, the conclusion of his apparent cntradiction is:
While rapamycin elevates LDL and total cholesterol, its potent anti-atherosclerotic effects, such as reducing inflammation and stabilizing plaques, can provide overall cardiovascular benefits. The use of cholesterol-lowering drugs alongside rapamycin can help manage its dyslipidemic side effects, making it a viable option for treating atherosclerosis in certain patient populations.

Here is the link that includes all relevant studies:

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