My husband is very disciplined concerning his diet and exercise. That’s why the high Lp(a) result came as a shock. It’s all genetics.
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That’s great that he has that sort of self control. But I am wondering about the guidance to get LDL below 30 and the fact that he lowered his lp(A) so much when you supposedly can’t do that?
His LDL has always been low, so I’m not sure the goal is to push it to extremely low levels. The Praluent helped lower his Lp(a) ; he mentioned that the medication can reduce it by about one-third.
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I hope you don’t mind the questions, but I want to look into this Praluent, as my Lp(a) is high, and I had thought this was still experimental.
If the Praluent was prescribed specifically just to lower his Lp(a), and the LDL lowering is incidental, plus he already had low LDL, why would they also prescribe a statin lowering drug if the goal isn’t to get his LDL down to extremely low levels? I had thought an LDL of 70 was good enough, but it is the lower, the better?
Also, has he had an angiogram (the gold standard of checking your arteries) or a calcium scan? If so, have they shown any blockage? I’m assuming they would have had him take a calcium scan, that’s kind of a no brainer to do every 5-10 years, everyone should know what their Agatson score is. I’m curious if his is high, and that’s why they’re treating him so aggressively?
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My husband’s cardiologist recommended he get his LDL to less than 50. My husband’s brother’s LDL is now less than 20 (He’s taking Repatha, and my H just started taking repatha).
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Why are the cardiologists recommending that? Do they have serious risk factors?
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I feel like I’ve posted this before so sorry if it’s a repeat, but apparently for them it’s hereditary. BIL, who is and was in good shape, not overweight, exercised regularly, etc. had a CT calcium score of over 3000 and had 6 bypasses at age 59 or 60. Hs CT calcium score was 1300ish. H takes multiple drugs for heart issues, and is considered to have coronary artery disease, but he hasn’t had any bad heart related events.
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Even if you said it before, I have a two minute memory and sometimes confuse who said what! That sounds like good reasons to take the Repatha, for sure.
I may be paranoid, but my Lp(a) is 106, Agatston score is 17, and I’d wish to prevent anything from getting worse. Looking at insurance coverage, though, it sounds like there might be a problem getting Repatha or Praluent covered for high Lp(a) with no other issues, unless you have high LDL, are at the maximum dosage and can’t get it down any other way.
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Praluent and Repatha are not covered under our Medicare Part D plan. However, the maximum out-of-pocket cost this year is $2,100, which is much better than in previous years when there was no out-of-pocket cap and my husband had to take Praluent.
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The American Heart Association and American College of Cardiology now recommend adults get their LP(a) level checked at least once in their lifetime.
https://www.ahajournals.org/doi/10.1161/CIR.0000000000001423
3.4 discusses measurement of LP(a)
4.2.10 suggests more aggressive treatment if high LP(a) levels are found.
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Hey, how did the Zetia work out? Have they retested you lately? I am curious how much it lowers LDL.
My husband just got prescribed that. I was a little surprised, because his LDL is 87, but his Lp(a) is high.
I have genetically high LP(a) — 125 — and I take a low dose statin. My cardiologist wants to get my LDL below 50 and it’s at 56 right now (total cholesterol is 137. I have a calcium score of 0, and my blood pressure is well managed on a combo of lisinopril, Amlodipine and metoprolol, all small doses. But I am still worried about that 125 LP(a). I have an appointment with her in a couple of weeks and will retest my numbers. I’m going to ask about Praluent because I would love to see a 25-29 percent reduction in LP(a), even if that’s an “off label” use. I am only 51 but have a significant family history of heart disease.
@Wjs1107 is that in nmol, or in mg/dl? If it’s nmol, that’s barely high risk, and if we’re in competition, I have you beat by 2. 
Okay, this competition I don’t want to win.
I’d be curious to see what your cardiologist says. That is very low LDL, especially on a low dose statin. My cardiologist said what they do is increase your statin to the point where they can’t increase it any more, and then they start adding the other things. Seems like your doctor could raise your statin just a little bit and then you’d be below the 50. Statins do raise your Lp(a) a bit, so a better measurement would be if you had your Lp(a) tested before you started the statin.
The LP(a) 125 is nmol/L. I’ve had it tested 3 times. It was 99 in Jan 2024, 128 in June 2025, and 125 in Dec 2025. I’m trying to see when I started the statin. Looks like it was May 2025, which would make sense given the increased LP(a).
I think my curiosity about lowering LP(a) with Praluent is that the studies seem to be showing that even with very very low LDL, high LP(a) remains a high cardiac risk factor. If there’s a drug that can target LP(a) specifically, I want that drug.
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Just wanted to make sure you are aware of this:
What does the Part D cap not include?
This cap doesn’t apply to plan premiums or to drugs your Part D plan doesn’t cover. It also does not apply to out-of-pocket spending on Part B drugs.
Understanding the Medicare Part D cap - PAN Foundation
My new LDL on Zetia and Crestor is in the high 70s. Doc is inclined to leave it there.
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That sounds like a huge decline with the Zetia.
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