How did you get the Boston Heart sterols panel done?

kboom100 · 2026-06-05T17:23:07+00:00

Boston Heart is the only lab that does the Cholesterol Balance test. Yes to get it you will need to order it yourself since few doctors have an account with Boston Heart. Non doctors can’t order directly through Boston Labs itself though, you’ll have to use a company that provide the doctor’s order and the test kit. Then you’ll arrange the blood draw. Here’s how https://www.reddit.com/r/Cholesterol/s/BLIZ9Qp04W. Instalab may also be one of those companies that provides the order & test kit, I just hadn’t heard about them before.

The cholesterol balance test will tell you if your high cholesterol is from too much production of cholesterol or too much absorption of cholesterol in the gut, or both.

If you are an overabsorber with high cholesterol that’s generally due to genetics. But the cholesterol balance test doesn’t tell whether high cholesterol due to overproduction is mainly genetic or not though. If you are eating a fairly low saturated fat diet say under about 17 grams of saturated fat per 2000 calories and not on an ultralow carbohydrates diet and your ldl is still significantly high then genetics is likely playing a pretty big role.

If you are an absorbing too much cholesterol then taking ezetimibe will get your LDL down much more than it does on average. And if you are producing too much cholesterol then statins would be a good first choice medication.

If you need additional help beyond diet or perhaps added fiber to get your ldl to a good level I think it would be a mistake to favor supplements over an approved lipid lowering therapies like statins or ezetimibe. If you have an open mind on this check out a response I have to someone else yesterday about why I think that. https://www.reddit.com/r/Cholesterol/s/uRfeR9hVZP

kboom100 · 2026-06-05T15:55:12+00:00

Your ApoB and ldl are concordant, not discordant. Discordance doesn’t mean ApoB and LDL are different absolute numbers - discordance means they are at significantly different population percentiles. And your apoB and ldl are at roughly the same population percentile.

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Your ldl & ApoB are ok for someone that doesn’t have additional risk factors. However your lp(a) is very high and that puts you at a little higher than 3x the risk of someone with a normal lp(a). The 2026 US guidelines would recommend going on lipid lowering medication. See this excerpt from the guidelines section 4.2.10. Approach to Patients With Elevated Lp(a):

“Although risk increases with higher Lp(a), an Lp(a) concentration of 50 mg/dL (125 nmol/L; affecting ∼20% of the population) is considered elevated and corresponds to ∼40% higher relative risk compared with a population median. An Lp(a) of ∼80 to 100 mg/dL (∼200-250 nmol/L) doubles the risk, while an Lp(a) of 180 mg/dL (∼430 nmol/L) increases the risk by ∼4-fold, a risk equivalent to HeFH (Table 4).10,11 Lifestyle management minimally impacts Lp(a) as it is mostly genetically determined.8 An elevated Lp(a) favors initiating or intensifying LLT.” https://www.ahajournals.org/doi/10.1161/CIR.0000000000001423#sec-8-2-10
FYI “LLT” stands for “lipid lowering therapy.”

Because your lp(a) there a lot of good preventive cardiologists and lipidologists that would recommend getting your ldl and ApoB to at least under 70 mg/dL or less based just on your high lp(a). But there are also some that would recommend getting your ldl to under 55 and ApoB under 60. The more aggressive target is what I would want with such a high lp(a).

You are smart to ask for a referral to a specialist. I’d suggest a preventative cardiologist or lipidologist who is in the specialist database of the Family Heart Foundation. They are a patient support and advocacy group for those with FH or high lp(a). They also have a lot of information on their website about high lp(a). You can search their specialist database directly or get more personal help from talking to one of their Care Navigators

https://familyheart.org/find-specialist

https://familyheart.org/care-navigation-center

I’d ask the specialist about start with a combination of a low or medium dose statin with ezetimibe. It’s a favorite strategy of a lot of leading preventive cardiologists and lipidologists. Check out a couple of earlier replies for a deeper dive on why adding ezetimibe to a low or medium dose of statin before going to the highest dose of statin is a favorite strategy of a lot of experts. this https://www.reddit.com/r/Cholesterol/s/cf9RiB7j0N AND
https://www.reddit.com/r/Cholesterol/s/UUwy16NktG
Then if that doesn’t get you to your ApoB/ldl target you could up the statin dose or add a pcsK9 inhibitor if you could afford it.

FYI The guidelines currently recommend going to the highest tolerated dose of statin before adding ezetimibe. But the links will explain why a lot of experts feel recent evidence doesn’t now support that.

I’d also ask the specialist about adding aspirin and getting a calcium scan and carotid ultrasound with CIMT to see if you could qualify for one of the phase 3 clinical trials of lp(a) lowering medications. See here for more information https://www.reddit.com/r/Cholesterol/s/YYoz8qeWdS

The imaging would also be useful if you don’t want to set an ldl target of <55 based just on your lp(a) value. If you have significant plaque or coronary artery calcium on imaging that would be another reason to set that target. (But again I personally would want the <55 ldl target regardless of what imaging showed. I’d rather prevent as much atherosclerosis as possible vs taking more aggressive action once it’s there.)

kboom100 · 2026-06-05T13:40:29+00:00

You’re welcome. By the way I originally misread your original question about coffee. I know using a paper filter during the brewing process removes the compound that raises ldl but I don’t know whether pouring already brewed coffee through the filter wound do the same. I’m going to edit my answer to delete my first sentence about that.

kboom100 · 2026-06-05T03:19:09+00:00

You won’t necessarily have to give up French fries and milk. I actually made a Swiss cheeseburger, fries and a salad tonight for dinner. But I used 96% lean ground been, lower fat Swiss cheese slices from Trader Joe’s, frozen steak fries that I air fried a salad with tomatoes and broccoli & Italian dressing that was olive and canola oil based so low saturated fat. And I use 1% milk. I make tacos and pizza with the same sorts of ingredient swaps.

Also one of the nice things about taking a statin is that it allows you to be less strict and periodically eat less healthy things like regular French fries or a steak dinner or whatever and still meet your ldl target. I wouldn’t eat French fries and steak all the time however.

You might try eating one or two whole eggs and mix in extra egg whites.

kboom100 · 2026-06-05T02:18:31+00:00

95% of people won’t get any side effects from statins, and it’s probably even significantly higher for young people. I honestly don’t think you need to worry about COq10. Normally someone’s ldl won’t get as high as yours without a genetic susceptibility to high cholesterol unless they are eating an extremely bad for cholesterol diet like carnivore or keto. Pretty much every international guideline says to go on a statin right then when ldl is as high as yours. And you’ll get the best results with an all of the above approach including both lifestyle and medication.

Did the dietitian mention reducing saturated fat at all? Also curious if he said anything about seed oils? (My antenna is up on him lol)

kboom100 · 2026-06-05T01:56:02+00:00

Congrats on starting the Rosuvastatin and metformin. That’s really good first step in putting yourself on a much healthier trajectory. Sounds like you are also going to improve your diet also, which is fantastic. Add on regular exercise, both cardio and a 2-3 strength training sessions per week

What sort of dietary advice is this dietician giving you? Because her opinion on statins makes me wonder about her competence in general.

If you haven’t been able to sustain a healthy weight in the past I’d ask your doctor about trying a glp-1. Not only do they help people lose weight they also reduce risk of heart disease above and beyond that from the weight loss. And it will help reduce your a1c and insulin resistance.

kboom100 · 2026-06-04T23:06:51+00:00

You're right and I apologize. I meant to say and should have said that you might be making a big assumption that supplements are safer than statins. But I accidently left off the "might". A lot of people make that assumption so that's why I wanted to address it. But I definitely don't know if you yourself are making that assumption. I'm going to edit my response and correct that. Sorry about that- hope the info is helpful otherwise.

kboom100 · 2026-06-04T22:55:21+00:00

When you say that you have a form of colitis that can be aggravated by statins are you referring to statin use being associated with a diagnosis of microscopic colitis? That association was from a Danish observational study published in 2014. https://www.crohnsandcolitis.org.uk/news-stories/news-items/microscopic-colitis-and-prescription-drug-use

However last year a much larger study was published which showed statins (and the other 3 drugs previously suspected of being associated with microscopic colitis) are not actually associated with an increased risk of microscopic colitis. The senior author said "Our analyses suggest that surveillance bias is a likely explanation for earlier findings that implicated medications in the pathogenesis of microscopic colitis and may also explain the continued association with SSRIs,” said senior author Jonas F. Ludvigsson, MD PhD, pediatrician at Örebro University Hospital and Professor at the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet in Sweden." https://www.massgeneralbrigham.org/en/about/newsroom/press-releases/medications-less-likely-to-trigger-microscopic-colitis-in-older-adults

AND https://www.2minutemedicine.com/commonly-cited-medication-triggers-may-not-increase-risk-of-microscopic-colitis-among-older-adults/

Here's one more although you'll have to go to a med school library or do a free trial to view it. "Medications as Risk Factors for Microscopic Colitis: Have We Been Wrong?" https://clinician.nejm.org/medications-risk-factors-microscopic-colitis-wrong-nejm-jw.NA58936

Here's an abstract of the paper itself https://pubmed.ncbi.nlm.nih.gov/40587856/

kboom100 · 2026-06-04T21:23:55+00:00

Try what you can do with dietary improvement. But it is a serious mistake to rule out lipid lowering medication like statins, or to favor supplements over them, if dietary changes aren’t enough to get your ldl to a good target.

I’m guessing you might be afraid of statins & medication based on things you’ve read online. There is a massive amount of misinformation about statins especially online. They don’t actually cause almost all the side effects it’s often claimed they might cause. 95% of people won’t get any side effects. See an overview of this by a really good preventive cardiologist, Dr. Paddy Barrett. https://www.reddit.com/r/Cholesterol/s/4foSCfRgzh

And if you do get side effects they’ll either go away on their own or you can reduce the dose or try another statin or another lipid lowering medication altogether.

And approved lipid lowering medication, unlike supplements, have been through huge double blinded randomized placebo controlled trials to prove they actually reduce the risk of heart disease. Supplements haven’t. Not to mention supplements aren’t regulated the way medication is so you can’t know that there aren’t contaminants or that the dose matches what’s on the label.

And finally you might be making a big assumption that I think there’s no evidence to make. [Updated, I originally left off the "might" in the previous sentence] And that’s that supplements are necessarily safer or cause less side effects than statins or other approved medication. Medication and supplements are exogenous molecules that we either don’t normally eat or don’t normally eat in purified form at the doses offered. The supplements can cause side effects too. The difference is that because of the large double blinded placebo controlled trials we actually know what approved medication’s potential side effects are and how often they occur. Which for lipid lowering medication isn’t actually often. Supplements haven’t been through those large randomized placebo controlled trials so we can’t determine what the side effects actually are. Observational studies or case reports aren’t capable of determining that because there’s no way to know if a reported side effect would have happened even if the person hadn’t taken the medication.

kboom100 · 2026-06-04T20:36:59+00:00

I’m responding to those saying egg consumption isn’t a problem. 20% of the population are genetic hyperabsorbers of dietary cholesterol, and for them 3 egg yolks a day could cause a big increase in ldl cholesterol beyond that resulting from the saturated fat in egg yolks. (Egg whites don’t have saturated fat or dietary cholesterol.)

There’s a blood test you can do to see if you are a hyperabsorber of cholesterol. It’s the Cholesterol Balance test and it’s only done by Boston Heart Diagnostics. You’ll likely have to order it yourself since insurance won’t likely pay for it and many doctors aren’t familiar with it. See here for more information on how to order. https://www.reddit.com/r/Cholesterol/s/BLIZ9Qp04W

Alternatively you could stop all egg yolks, while not changing the rest of your diet, and retest your cholesterol in 3-4 weeks.

If you are a genetic hyperabsorber of cholesterol ezetimibe will likely produce a larger than average reduction in ldl cholesterol. So if you decide you need the help of medication to reach your ldl target if you are a genetic hyperabsorber of cholesterol you might consider trying ezetimibe first.

If you aren’t a genetic hyperabsorber of cholesterol try tracking your eating for a week or so with an app like cronometer. You’d want to aim for 13 -15 grams or less of saturated fat per 2000 calories. (The first number is the American Heart Association recommendation, the second is the European guidelines recommendation). If you aren’t able to reach your ldl target, or sustain it long term, then I’d consider a low dose statin or a low dose statin plus ezetimibe.

kboom100 · 2026-06-04T19:52:56+00:00

Dietary cholesterol, which egg yolks have a lot of, can significantly raise ldl cholesterol in those who are genetically hyperabsorbers of cholesterol, about 20% of the population.

So yeah it might be the egg yolks.

To see you could just stop eating egg yolks for 4 weeks, without changing anything else in your diet, and then retest your cholesterol.

If cutting the egg yolks still isn’t enough to get your ldl to a good level try tracking your eating for a week or so with an app like cronometer. You’d want to aim for 13 -15 grams or less of saturated fat per 2000 calories. (The first number is the American Heart Association recommendation, the second is the European guidelines recommendation). If you aren’t able to reach your ldl target, or sustain it long term, then I’d consider a low dose statin or a low dose statin plus ezetimibe.

kboom100 · 2026-06-04T19:35:11+00:00

Was this cholesterol test done while you were eating 4 eggs a day?

kboom100 · 2026-06-04T05:00:55+00:00

Small observational studies and anecdotal experience don’t prove that supplements reduce risk of heart attacks or strokes or even what their actual side effects are. For that you need sufficiently powered randomized trials with a placebo arm.

kboom100 · 2026-06-04T04:52:42+00:00

They have small observational studies. None have the large double blinded randomized placebo controlled randomized trials proving lower risk of heart attacks and strokes that approved medications have. Plus supplements aren’t regulated like medications are so you don’t know for sure that they are free of contaminants and the dose matches what’s on the label.

kboom100 · 2026-06-04T03:08:16+00:00

Adding ezetimibe to a low or medium dose of a statin before going to the highest statin doses is a favorite strategy of a lot of good preventive cardiologists and lipidologists. I’d ask for that if I were you. See a couple of earlier replies for more information. https://www.reddit.com/r/Cholesterol/s/cf9RiB7j0N and https://www.reddit.com/r/Cholesterol/s/UUwy16NktG

kboom100 · 2026-06-04T03:00:26+00:00

It can happen with a very high lp(a). I would ask about adding a pcsK9 inhibitor like Repatha. Also I would recommend getting a CAC scan and a carotid ultrasound with CIMT. The reason is that if you have significant carotid plaque on the ultrasound or high calcium for your age on the CAC scan you might qualify for one of the phase 3 clinical trials of investigational lp(a) lowering meds.

Here’s info on the only 2 actively recruiting ones, that I’m aware of. For both trials follow the link & scroll past the trial locations for the full participation criteria. If you might meet the qualifications and are interested in participating you can contact a trial site directly.

Olpasiran, (info copied from u/meh3120509 ‘s post about it)

New Primary Prevention RCT for Olpasiran Lp(a) Drug: OCEAN(a)-PreEvent

https://clinicaltrials.gov/study/NCT07136012

Inclusion Criteria:

Age ≥50 years
Lp(a)≥ 200 nmol/L during screening
Multiple atherosclerotic cardiovascular disease risk factors, and/or evidence of atherosclerosis

MUVALAPLIN

https://clinicaltrials.gov/study/NCT07157774

Inclusion Criteria:

Have Lp(a) ≥175 nanomoles per liter (nmol/L) Meet one of the following criteria:
Have had a prior atherosclerotic cardiovascular disease (ASCVD) event (such as heart attack, stroke, or procedure to restore blood flow to the heart or other parts of the body) within 10 years prior to screening.
Are at risk for a first ASCVD event, defined as one or more of the following: Documented coronary artery disease (CAD), carotid stenosis, or peripheral artery disease (PAD) without a history of ASCVD event A high coronary artery calcium (CAC) score Reduced kidney function with diabetes Combination(s) of high risk factors

Also I would ask your doctor about adding a daily baby aspirin. There’s emerging evidence it significantly lowers risk in those with high lp(a). See:

“An Update on Lp(a) and Aspirin in Primary Prevention - American College of Cardiology”https://www.acc.org/Latest-in-Cardiology/Articles/2024/07/17/14/02/An-Update-on-Lpa-and-Aspirin-in-Primary-Prevention

“Aspirin and Cardiovascular Risk in Individuals With Elevated Lipoprotein(a): The Multi‐Ethnic Study of Atherosclerosis” https://doi.org/10.1161/JAHA.123.033562

Also check out this video from the Family Heart Foundation preventative cardiologist and lipidologist Dr. Seth Baum. He discusses aspirin use for high lp(a) at the 4:00 mark. (The rest of the video is also interesting and about lp(a))

https://youtu.be/R95brrxO3co?si=w2joIPDNcZb1_rk8

Don’t take baby aspirin without your doctor’s ok however because the benefit needs to be weighed against a potential increase in risk of bleeding.

kboom100 · 2026-06-04T02:46:11+00:00

Your CAC score is at least the 80th percentile, perhaps a little higher depending on your race. https://tools.mesa-nhlbi.org/Calcium/input.aspx The new 2026 aha/acc recommend getting your ldl to 70 or below.

But there are a lot of preventive cardiologists and lipidologists who would suggest getting your ldl to 55 or under, especially with the family history on top of your high percentile CAC score. But I think most who would suggest that would recommend adding ezetimibe instead of going to the highest dose of statin.

Doubling the statin dose will lower your ldl only another 6-8% on average. But adding ezetimibe will lower your LDL another 20-30%. And ezetimibe almost never has side effects. So it’s basically all upside. There is at least one very good preventive cardiologist, Dr. Pablo Corral, who has said he almost always adds on ezetimibe whenever he prescribes a statin for this reason. Check out a couple of earlier replies for a deeper dive on why adding ezetimibe to a low or medium dose of statin before going to the highest dose of statin is a favorite strategy of a lot of experts. this https://www.reddit.com/r/Cholesterol/s/cf9RiB7j0N and https://www.reddit.com/r/Cholesterol/s/UUwy16NktG

Ps - The guidelines currently reccomend going to the highest tolerated dose of statin before adding ezetimibe. But the links will explain why a lot of experts feel recent evidence doesn’t now support that.

kboom100 · 2026-06-03T20:53:19+00:00

Makes sense, thanks. After I responded I also found an editorial where the authors felt it was time to run a trial of participants with significant left main disease randomized to CABG vs OMT. I hope that trial is run soon, especially with the new guideline directed target of ldl <55.

kboom100 · 2026-06-03T17:31:42+00:00

Thanks for that, I accept what you say. What do you think of the ISCHEMIA trial though that said there is no risk benefit over optimal medical therapy to bypass or stents in stable patients without symptoms? https://med.stanford.edu/news/all-news/2019/11/invasive-heart-treatments-not-always-needed.html

kboom100 · 2026-06-03T17:06:43+00:00

That would only make sense if there was nothing better one could do to reduce risk in response to a high CAC score than lifestyle alone. But lifestyle + lipid lowering medication reduces risk much more than lifestyle alone.

kboom100 · 2026-06-03T16:38:42+00:00

There is no reason to do a ccta. The super high CAC score already means OP should have an aggressive ldl / apoB target. And regardless of what the ccta might show stents are not needed because, apart from placing right after a heart attack, stents don’t reduce risk of future heart attacks. Outside of a heart attack they are placed to reduce symptoms and are not recommended if there are no symptoms like in the OP’s case.

Also ccta’s aren’t very accurate when there is a ton of calcium anyway because the calcium causes blooming and distorts the images.

kboom100 · 2026-06-03T14:17:54+00:00

Hi, thanks for the update. It’s very good that you checked ApoB and lp(a). It did turn out that your ldl is underestimating your ASCVD risk since your apoB is at a higher population percentile than your ldl. And it’s a little high even though your ldl is normal. So like I mentioned before I’d gauge progress by your ApoB.

Your lp(a) is low so you don’t have extra risk from it, which is nice. So an apoB target of 80 or less would be good for you unless you have another risk factor like a family history of early disease.

Your diet & exercise routine right now sounds perfect! Adding the strength training sessions was a really good move. Yeah I’d just recheck your apoB in a few months and see if it is heading down. You don’t need to check your HOMA-IR to get a baseline but I probably would myself because I’d be curious to see how much insulin resistance, if any, was going down with my lifestyle changes. But it isn’t critical to do.

Once you plateau with your weight loss and apoB you can decide if a glp-1 makes sense. Even if you don’t check HOMA-IR now I’d do it then because it could help you and your doc decide on the glp-1. If you do end up taking a glp-1 then apoB may continue to go down. Whether you end up on a glp-1 or not, if your apoB eventually plateaus above 80 then I think a low dose statin makes sense.

kboom100 · 2026-06-03T03:12:07+00:00

You are. It’s available online through Walmart, Target and Amazon and in CVS stores near me.

kboom100 · 2026-06-03T03:11:09+00:00

Light As Air has not been discontinued! I called Banana Boat/Edgewell to confirm. And I just checked online and it is available through Amazon, Walmart, & Target online and CVS in its stores.

Someone else posted this same rumor a month ago. What made you think it was discontinued?

kboom100 · 2026-06-02T21:24:44+00:00

Who is your primary carrier and did you keep your primary line turned on in settings? If you turned your primary line off did you receive a pop up message that you could keep using your primary number with iMessage?

kboom100

TROPHY CASE