indeed, the benefits in terms of protection from CVEs for LDLc concentrations < 20 mg/dL are even more marked[9] and should not scare clinicians nor patients, certainly up to concentrations not exactly equal to zero but at least equal to or higher than 12.5 mg/dL.[2]
@AnUser @L_Hayes @Virilius - have we discussed those two refs in the past:
What are your thoughts on the consultations of the paper that @adssx shared?
Actually, now that I have an LDL of 66, I would like to get it down to about 50. What would be the next best treatment to add on top of Bempedoic Acid + Ezetemibe to get it down to that figure?
Just polling our experts for their current opinions. 
PCSK9 inhibitor such as Repatha or Praluent
Do you know your Apo B?
Unfortunately, in Hong Kong, the ApoB test is quite expensive. I’ll do it this summer when I am in the USA. LDL is a good proxy for me.
@Davin8r Great idea, but a PCSK9i is a little too costly and inconvenient. I don’t think it’s worth it at my cholesterol levels.
I should say an inexpensive and convenient way to lower my LDL further.
You could try a citrus bergamot supplement. I’d say berberine, but that has a lot of caveats and I’m sure you’re already familiar w/it.
Alpha cyclodextrin. It actually does help fix lipids. Beta doesn’t but alpha does. Take a small dose with meals.
I think the Endothelial to mesenchymal transition that drives this relates to a failure of differentiation. The higher levels of methylation imply fewer genes being expressed (or being expressed at a lower frequency) that would fit with the idea that atheroslcerosis is a disease of aging partially caused by genomic failure and partially caused by lipids.
You want a 25% reduction. I think that rosuvastatin 2.5 mg or atorvastatin 5 mg could do the job. If these doses are not sold in HK, you can split larger doses, or you can buy smaller doses from India. Here they found a 39% reduction in LDL for rosuvastatin 2.5 mg. AstraZeneca even found a 34% LDL reduction for rosuvastatin 1 mg in the original 2001 paper. So rosuvastatin 1 mg or atorvastatin 2.5 mg might be enough!
Did you ever start a Apo B lowering protocols - if so what does it look like, if not what are your considerations?
Other that adding a statin or PCSK9i, your best bet are supplements and cleaning your diet I guess.
How much cardio exercise do you get in an average week? Does could help take down risk.
What are your thoughts on reducing LDL/ApoB to as low as possible, even close to 0?
Thanks, but I am statin intolerant. I guess I need to rely on diet and exercise for additional gains until something new comes along.
An LDL of 66 isn’t too bad. 
Not saying you should, have you historically tried very small almost micro doses of a statin(s)? The dosages in @adssx example show a remarkable bang for the buck even low dose.
(Similarly you could eg do just one fifth of PCSK9i dosage which while not free would be substantially different than the high full dosages).
How exactly would you do this? It comes in a pre-packaged syringe, doesn’t it? You’re saying do partial injections over a period of a few months? Interesting idea.
I think someone mentioned that they did it a while back here on the forum, but can’t remember who.
I have to wonder if this is a good idea… its basically “reusing” the needle, which seems like a very bad idea. Perhaps some of the medical professionals here can comment on this idea… spreading out a Repatha injection over a few months for those who want to lower their cholesterol a bit more, but not suffer the full monthly cost of Repatha’s full dose.
@DrFraser @Dr.Bart Any thoughts on how this could be done in a safe manner?
No I don’t think that person reused the needle, I think (s)he extracted the solution and did smaller injections (assumably with different needles)
… is there a way to search the forum with google or something and not the built in search function that only seems to understand extract words and not synonyms and same meaning with different words?
I just searched on Repatha and found it here: Statin usage and Desmosterol - #35 by ben_nichols
You are right. Put it into new sterile vials, and then use one at a time. I guess that would likely work fine. Its a great idea, it seems. @ben_nichols how has this worked out for you. What type of needles do you use for this?
