Background: 41M with CCTA detected mild soft plaque detected 25-49% stenosis, no clinical symptoms, passed echo and stress tests, exercise 5 days a week. No known CAD in my family but have some high cholesterol in family (I suspect there may be some CAD in my family, just haven’t tested for it).
Started atorvastatin 20 mg after my CCTA. Switched to 20 mg Rosuvastatin to see if it would help more. Results:
- Baseline before statins: 130s LDL on bad diet, 100s LDL on good diet. Lp(a) 21 nmol/L. HDL 60s, Trigs 50s.
- After 12 weeks 20 mg atorvastatin: 53 LDL. No material changes to HDL or Trigs.
- After 8 weeks 20 mg Rosuvastatin: 64 LDL. HDL went up a little to mid 60s. No impact on trigs.
My questions are:
Should I switch back to atorvastatin? Or is this just noise? My diet was “militant” during the atorvastatin timeframe and probably just “very good” during the Rosuvastatin timeframe.
Should I add zetia or jump straight to adding repatha? Cardiologist is ok with either but leans zetia. I can’t decide. Getting to 30s with repatha seems better given I’m only 41, but I’m also slightly worried about decades of injecting a monoclonal antibody where I’m not aware of super long term studies yet (correct me if wrong). But I feel like zetia would probably only get me to mid 50s LDL and I think I want lower.