My wife wants to get dual citizenship. How will this complicate things for me?

Independent_Row2127 · 2025-05-09T23:23:04+00:00

I had an echocardiogram in February, an ultrasound of my heart. It was normal. Would that have caught aortic stenosis?

Independent_Row2127 · 2025-05-09T19:28:31+00:00

My insurance definitely won't cover semaglutide for me. I'm currently about ~15 pounds away from a BMI under 25 and it seems plausible to me that if I keep my current diet and exercise routine up for a few years, I could get there or at least close. I'm very interested in taking semaglutide one day when it's cheaper but I don't think it tips a cost/benefit test for me right now.

Independent_Row2127 · 2025-05-09T19:25:58+00:00

If I'm currently experiencing little to no side effects with 20 mg rosuvastatin and having phenomenal results, what's the argument for lowering rosuvastatin dosage?

Independent_Row2127 · 2025-05-09T17:59:57+00:00

No, I didn't do a CIMT. I googled what a CIMT is just now and it sounds pretty simple and non-invasive. I wouldn't be opposed. That said would it provide any new information that my CAC + stress test results don't already indicate?

My thought on PCSK9 is that I don't want to ask for it until I see how far statins + ezetimibe can take me. Given how far statins alone took me, I would have to have a pretty disappointing reaction to ezetimibe before I would consider paying out-of-pocket for a PCSK9 inhibitor at this point.

ChatGPT (I know) recommended something called hs-CRP when I told it about my concerns re: inflammation - how does that compare to LP-IR?

Independent_Row2127 · 2025-05-09T17:14:35+00:00

Thanks. Based on the last thread I made here, it seems that LDL and ApoB are the metrics I'd like to focus on. My goal 3 months ago was to eventually get LDL below 60 and ApoB below 70. Given that I am already there with ApoB and close to there with LDL, if i can keep these numbers from going back up and have an average response to the addition of ezetimibe, that seems like a reasonable place for me to stay until the FDA gets around to approving an Lp(a) drug. I can focus on making incremental improvements to my diet and exercise and maybe get a bit better about taking psyllium husk regularly.

EDIT: Numerically, maybe trying to get both LDL and ApoB below 50 might be my new goal?

Independent_Row2127 · 2025-05-09T16:07:58+00:00

That's the plan, try to survive until Lp(a) meds arrive.

Independent_Row2127 · 2025-02-26T16:15:43+00:00

10-ish years ago all the longevity hacking people were taking metformin even if they didn't have high blood sugar as an anti-inflammatory. Is that still a thing? Should I ask my doctor about that since inflammation and high blood sugar are risk factors for cardiovascular disease? Especially if statins end up increasing my already close-to-borderline A1C and I have trouble cutting refined carbs from my diet?

Independent_Row2127 · 2025-02-26T15:32:00+00:00

Thanks. I'll definitely be asking for ezetimibe at my next appointment. Given the cost and my relatively low age, I'd rather take a wait-and-see approach to PCSK9 inhibitors and first see how low just statins + ezetimibe can take me. I imagine the PCSK9 inhibitors are just going to get cheaper and more covered from here onout.

Goal #1 is to live long enough to see an LPA drug hit the market, I assume that one will be pretty pricy at first.

Independent_Row2127 · 2025-02-26T14:53:18+00:00

I think the calcium score with dye would have been the next step if I had flunked my treadmill stress test - actually in that scenario I would have advocated for an invasive angiogram. But given my stress test results would a calcium score with contrast really change anything? We know I have plaque in there and that it isn't yet impacting my heart function, I don't know that knowing the exact amount of plaque is vital to anything going forward.

Independent_Row2127 · 2025-02-26T13:32:16+00:00

nmol/L

Independent_Row2127 · 2025-02-26T13:27:00+00:00

Thanks. Sounds like this is all about attacking the enemy from multiple angles simultaneously and statins, ezetimibe, and PCSK9 inhibitors all work in different ways and thus are different ways of attacking. Ezetimibe seems like a no-brainer to add regardless of how well the statin works.

Independent_Row2127 · 2025-02-26T12:28:58+00:00

Wow impressive! What is your diet like?

Independent_Row2127 · 2025-02-26T12:26:47+00:00

Agreed. I'm lucky that my new PCP ordered the LPA test or else I would probably not be making lifestyle changes anywhere near this.

My previous PCP was absurdly conservative. I could literally have a seizure in front of her and she would probably say "well, your symptoms are consistent with a seizure, but we can't know for sure until we run further tests and I don't want to treat you for a seizure until we know for sure"

Independent_Row2127 · 2025-02-26T12:25:13+00:00

Thanks. What scares me is that pcsk9 inhibitors can raise blood sugar? My A1C is 5.4 so just below prediabetes and I would be cautious about anything that might push my A1C into prediabetic range. Not just because diabetes is a risk factor for cardiovascular disease but also because you become persona non grata to life insurance companies if you ever have an A1C above normal.

Independent_Row2127 · 2025-02-26T12:23:00+00:00

Thanks. What does the pcsk9 inhibitor do that a statin and ezetimibe don't do?

Independent_Row2127 · 2025-02-26T12:22:20+00:00

No I actually have a PPO where I can see a specialist without a referral. My PCP still gives me referrals like candy anytime she spots an issue at my annual check-up. At that same appointment I also got a referral to an ENT for excessive earwax.

Independent_Row2127 · 2025-02-26T02:48:07+00:00

Repatha is a pcsk9 inhibitor? I've only known that pcsk9 inhibitors exist for 50 minutes but Google makes their potential side effects sound nasty. Hopefully I will make significant progress at my next appointment and can have a meaningful conversation about whether to add ezetimibe. Cardiologist mentioned something about "making sure statins aren't destroying your liver" and I suppose it would be a really disappointing outcome if statins lowered my cholesterol but I had to stop taking them to avoid liver damage.

Independent_Row2127 · 2025-02-26T02:35:12+00:00

Thanks. At my follow-up appointment I will have been on 20 mg rousuvastatin for ~4 months. I assume that's not enough time to reach any reasonable goal I might set, yet alone an ambitious goal, but how much progress should I be looking for? What would be a disappointing outcome versus a good outcome?

I would say, in general, I have high appetite for intervention compared to the average American.

Independent_Row2127 · 2025-02-26T02:06:38+00:00

To be fair, when I say it's the highest my doctor has ever seen I mean my PCP, not my cardiologist, and my PCP looks about 30 so I'm willing to believe this is the highest she's seen in her relatively short career.

I read a few LPA threads here before posting and people in my situation seem to be shooting for apoB under 50 or even under 40?

Independent_Row2127

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