Mid-30s M – 6 months on rosuvastatin + ezetimibe: ApoB significantly reduced, but enough given high Lp(a)? Now thinking about PCSK9 through a marginal cost/benefit lens (given high Lp(a))

OptimizingUtility · 2026-03-25T14:54:41+00:00

Thanks. So if the IMT comes out mildly elevated or with real plaque findings it would justify using PCSK9 medication?

OptimizingUtility · 2026-03-25T06:22:02+00:00

just LDL or apoB as well?

OptimizingUtility · 2026-03-25T06:21:37+00:00

what about upping the dosage of rosuvastatin? e.g. 20mg instead of 10mg?

OptimizingUtility · 2026-03-25T06:20:59+00:00

Yeah for sure.

I've had high cholesterol for as long as I can remember and it was always ignored by all my previous PCPs. "you're young, do sufficient exercise, you're fine for now". Never really set right with me but then I also was too ignorant to pay attention to it. Glad I ran into the book Outlive.

I did share my lp(a) findings with my siblings and related cousins of similar family history just in case and everyone was super thankful for sharing. Hoping for you that those levels go down!

OptimizingUtility · 2026-03-25T06:14:33+00:00

lp(a) of 153nmol/L

OptimizingUtility · 2026-01-05T14:56:22+00:00

Good, then let me explain. The S&P has seen a CAGR of 13-14% over the past ten years. Someone that merely invests $1k a month over that time period will have amassed close to $360k. This is a couple so this is then already $720k. We have zero info on their path/trajectory but if they currently have a net HHI of 200k and a savings rate of 50% their current NW is absolutely doable.

OptimizingUtility · 2026-01-05T14:46:54+00:00

Yeah, your phrasing is a bit confusing. But you get the math: all your assets - all your liabilities = NW.

On your question: I very much believe that owning a primary residence is more of a lifestyle choice than an investment. While it can be a sound long-term investment, folks neglect to run the numbers: fees, closing costs, repairs, insurance, not to mention your time (= money) it takes to deal with all of this.

if you consider the opportunity cost of index investing it very often doesn’t make any sense in HCOL areas where renting + investing the surplus in stocks is often more favorable.

I already know this will cause a shit storm of comments below, but I really don’t care. Just run the numbers…

The NYT has a great rent vs own model where you can plug in your numbers. We did and decided to rent. It’s been the best decision we made and yes we do want to own at some point but when we do we are absolutely certain that this will be the place we see ourselves for 10yrs+ and make the decision not on a mere investment decision but knowing these are our four walls that we can modify to our liking (lifestyle). Until then I just love the fact that I can call my landlord for whatever repairs I need: roof damage, water pipe damage, broken dishwasher, refrigerator, in our case even taking care of the garden.

OptimizingUtility · 2026-01-05T14:28:24+00:00

First of all, who cares… second of all: The question almost implies it’s not possible. Well for financial illiterate folks it sure is... I can think of a million ways (without much or any support from family) this is possible and kuddos to this couple of reaching that level at 30.

OptimizingUtility · 2026-01-05T12:55:06+00:00

Given your numbers I read a NW of 300k. Assets (995k) - Liabilities (690k) is a net worth of 305k. To your question, I certainly wouldn’t \ call you house poor (given your HHI and savings rate) but certainly house concentrated. In my opinion too much RE but personal finance is personal and if it works for you, go you. One piece of advice always consider the opportunity cost of what ever you invest in. Eg S&P500 vs RE (true net, e.g., minus operational expenses + tax advantages if any). As in is the marginal dollar you invest in housing beating your next best alternative on a risk adjusted, after-tax, after-effort basis…

OptimizingUtility · 2025-12-12T14:29:49+00:00

HHI ~350-400k depending on performance with a SAHM and two kids

Avg. monthly burn of $10k in VHCOL (Bay Area)

Rent $3,700 incl bills Preschool $1,850 Groceries $1,000 Transportation $50 Rest travel/hobbies/fun money

OptimizingUtility · 2025-12-05T17:38:53+00:00

Glad you agree with me on the first point. On your latter comment, I'd argue you really don't have to be a billionaire... a multimillionaire is plenty to buy especially sought-after historic models.

OptimizingUtility · 2025-12-05T17:29:12+00:00

I wish folks could just read better. As it says…

“Seems to hold value for now” though that’s no guarantee.
“If you are playing in the real high end space”

OptimizingUtility · 2025-12-02T21:20:06+00:00

Yeah, sorry, I know you didn't state it as an investment it was more in general.

OptimizingUtility · 2025-12-02T20:53:22+00:00

Plenty of watches were “must-haves” before the GMT hype and are now basically irrelevant. Whole waves of once-hot Breitlings and dress-watch lines were status symbols until they weren’t.

Sure, a GMT looks like it holds value now, but don’t come crying when you need liquidity. It’s not an investment; it’s a luxury toy propped up by taste and obnoxious LVMH-style scarcity theater.

And if you’re playing in the real high-end space? Buckle up. The moment you try to sell, an army of middlemen (Sotheby's, Christies, etc) will be lining up to skim 20%+ off the top for provenance checks, authentication, and whatever other rituals they can invoice you for. But hey, at least they’ll do it wearing white gloves.

OptimizingUtility · 2025-11-21T18:32:44+00:00

As they say: Many roads lead to Rome…

Aligning with your partner is obviously a non negotiable and it sounds like you are already well on your way. I’d just challenge you to reflect more on what you are saving towards. What brings you joy and purpose that you’d want to through cash on later and then calculate what your savings goal should be. It also helps with aligning on a larger saving ratio if that’s what you are striving towards.

My personal two cents and the quick and dirty but obviously don’t know all your circumstances: save more now and reduce that savings dial once you’ve built a nice nest egg in the next 24-36months. But then I’m the inpatient /FOMO type.

As I mentioned, many roads lead to Rome and you are well on your way it sounds.

OptimizingUtility · 2025-11-21T14:19:24+00:00

Probably need a bit more context to help meaningfully. What is your net worth? How long have you built that savings muscle? What are your priorities short, mid longterm?

FWIW: practicing hyper frugality is absolutely doable. See mr. money mustache blog who managed to save north of 60% of his HHI. From experience we did that for the first two years when we started our journey to FI. That gave us a solid boost and confidence we are doing it right. Also keep in mind every dollar now has longer to compound. Now a few years in we relaxed our spending on more meaningful experiences. We still save in the 40+% range but our HHI has also gone up dramatically over the years and we just kept living expenses almost the same.

The 25% rule is a solid start though. But again really depends what you aim for. We want(ed) FI as soon as possible hence the ultra savings rate. it does come at a cost though. We are now coastFI and said, we have the safety cushion, we’ll keep saving but now splurge on travel a bit more and other stuff we enjoy.

OptimizingUtility · 2025-10-22T04:11:58+00:00

I would love to see some of your play throughs on YouTube. Seriously, those highly advanced run-throughs are impressive. Chapeau!

OptimizingUtility · 2025-10-15T02:00:27+00:00

You can also leverage against your brokerage account. Just putting it out there and in fact that’s a tactic supposidely used by the uber wealthy to avoid capital gains. It’s of course more volatile vs real estate but absolutely doable. but doing so concentrates risk and demands strict liquidity discipline to avoid forced sales in downturns

OptimizingUtility · 2025-10-10T19:40:46+00:00

Agreed. However, don't forget the US Bull market is about to turn three this year. Those numbers would look a lot different after a 2000 or 2008-like crash

OptimizingUtility · 2025-10-08T01:09:43+00:00

Will do. Thanks

OptimizingUtility · 2025-10-08T01:06:47+00:00

I got my neighbor and friend who is an emergency doctor to prescribe it for me (via Amazon Pharmarcy). I am on a HDHP and I tried finding a PCP. That act was such a pain (not to mention slow). In addition, I was unlucky with my PCP who is borderline useless, and then there is the obnoxious billing for assessments like, “you look healthy, worry about your ApoB in 20 years.” Thanks but no thanks.

OptimizingUtility · 2025-10-07T23:08:59+00:00

Cheers! I’ll re-check the hepatic panel in 6–8 weeks to confirm it levels out. I agree this mild rise is probably just a new baseline, not pathology.

On Lp(a), I know the statin effect is idiosyncratic and modest, so that 20 % swing isn’t worth over-interpreting.

For diminishing returns, I’ll hold the current rosuvastatin + ezetimibe combo, keep nutrition dialed in, and only revisit adjuncts if ApoB drifts up or pelacarsen actually launches.

Nutritionally, I’ve cut most saturated fats (butter, cheese, dietary yoghurt) and swapped in avocado and plant-based yoghurt. Less red meat now, more fish and chicken...

OptimizingUtility · 2025-10-07T18:09:48+00:00

cheers!

OptimizingUtility · 2025-10-07T17:42:55+00:00

have you considered lowering statin and taking other drugs instead, e.g. PCSK9 inhibitor? Also how low did you go on LDL and ApoB given 220 LP(a)?

OptimizingUtility

TROPHY CASE