Lp(a) increased 25% after 3mths on Repatha & Ezetimibe
Just got the last of the labs in and I'm really confused and concerned. Prior to trying a statin, (Sep 2025 to mid Jan 2026, 5mg of Rosuvastatin), then Ezemtimibe and Repatha, my Lp(a) this past yr had been 250 to 290 nmol/L.
I just did labs for my recent 3 mth treatment eval of Repartha/Ezem
(21 Jan to 14 Apr) and here are the results -
ApoB - 115 to 88 mg/dl, started at 154 prior to Zepbound in Apr 2025
Total Cholesterol - 197 to 165 mg/dl
LDL-C - 153 to 97 mg/dl, started at 205 prior to Zepbound in Apr 2025
HS-CRP - 4.3 to 4.5 mg/L, been steady at 4.3 until now
Lp(a) - 289 to 367 nmol/L, been 280s until now
CAC score - 21
Having read many, many articles, research papers, etc., I thought I'd see lower results on the LDL-C and hoped for a bit of a drop in the Lp(a) but was concerned to see the Lp(a) increase by 25%.
I'm 72F, a TIA at 42, no other heart issues, but fam history of heart attacks, strokes, etc., and until the last couple years had never heard of ApoB nor Lp(a). Never prescribed anything for cholesterol but did go on Rosuvastatin but couldn't tolerate the lowest dose. Memory issues and muscle cramping.
I've lost 50lbs this past year, eat very well, mostly cruciferous veggies, 4 oz of protein once or twice a day, no carbs much to speak of and the only fat comes from my baked Salmon and a bit of butter (9g).
I'm limited on exercise due to other health issues, but do try strength training.
Has anyone else on Repatha and Ezemtimibe noticed an increase in their Lp(a)? Am I an anomaly? I did try searching the sub, but didn't find any comments describing similar results.
I see my PCP on the 28th and was going to ask about adding Nexletol to the current treatment plan in hopes of reducing the LDL-C further. I really don't want to try a statin again. The memory piece was maddening for me. Since stopping the statin, I'm back to myself again.
Thoughts?