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I had a heart attack this weekend... (1 Viewer)

I'm doing great and I appreciate you asking. I'm getting used to the new diet and having to take a bunch of medication (3 statins, 2 blood thinners, a beta-blocker and the Omega-3 fatty acid horse pills). The thing is, once you determine that there's a new reality, that's exactly what it becomes. I haven't really had any major cravings for red meat or sweets, which I have pretty much sworn off because I have to. I was never a huge drinker but I have cut that down as well (1 drink/week). I have lost 15 pounds and on target for more. I'm still walking 4 miles every day.

I guess the biggest change is my own mindset on how I want the rest of my life to go. With my dad passing away at 79 in November and me having a heart attack in February, my priorities have changed. I have always focused on a work-life balance and have never gone overboard with my commitment to my career (some would call me "aloof"), my thoughts are really starting to drift towards early retirement. I just turned 55 this week and it wouldn't make me sad to put in two more good years and call it quits. Granted the stock market needs to stabilize a bit before I feel comfortable with doing that, but I think it's doable. We'll see.

I convinced my brother and my sister to visit the cardiologist and get their calcium artery score. My brother came back and said his looks fine however, he does need to medicate with statins to get his cholesterol lower.

Overall, so far, so good!
 
Last edited:
It's been about two months since my STEMI (ST-elevation myocardial infarction) so I had my 2nd follow-up visit with the cardiologist to see how my recovery has been going. I had a lipid panel done last week to check on current numbers and I have to say, those statins really do the trick. Yes, my diet has had some impact but there is no way I would have seen this type of improvement from diet changes alone.

Lipid Panel Standard
Blood PanelsRange
4/10/2025​
% change​
2/2/2025​
% change​
10/4/2024
Cholesterol Totals<200 mg/dl
69​
-64%​
191​
-22%​
245
Triglycerides<150 mg/dl
45​
-78%​
202​
-33%​
301
HDL Cholesterol>= 40 mg/dl
39​
-15%​
46​
15%​
40
LDL Cholesterol<100
17​
-84%​
105​
-34%​
159
Non HDL Cholesterol<130
30​
-79%​
145​
-29%​
205
CHOL/HDLC Ratio<5.0
1.8​
-57%​
4.2​
-31%​
6.1​

As a point of reference, I started on a statin (Rosuvastatin) in October 2024 after a previous lipid panel and appointment with my previous cardiologist. I saw some mild improvement between October and February when I had my STEMI. Truthfully, this was a result of statins alone, as I justified taking a statin as a reason that I didn't necessarily have to change my diet. That's what the meds were for. Yes, stupid logic, but that's man-logic. LOL.

I had a lipid panel on 2/2/2025 during my hospital stay and then again last week. The difference is staggering. I am actually going to reduce my statin dosage slightly as my LDL is significantly lower than it has to be. The range listed above is standard (>100) for someone that doesn't necessarily have the genetic or medical history that I have. My cardiologist wants mine to be closer to 50 as anything lower has no material effect, so there is some room to work with. He is going to halve my current dosage of Atorvastatin (Lipitor) and expects the LDL score to move up to the 35-40 range. It's impressive how precise they can be with those calculations.

In addition to Lipitor, I am also taking Repatha (a PCSK9 inhibitor) and Ezitimibe (Zetia) to help lower the LDL, cholesterol and triglycerides.

I did ask how I could increase my HDL (good cholesterol and should be higher than 40), and my doctor indicated that at this point, increased exercise was the only way as I had already made improvements to my diet and lifestyle changes (limited alcohol consumption/non-smoker, lost 20 pounds). In addition to my daily 4-mile run/walks, I will start incorporating some resistance training to see if I can increase that number between now and mid-July when I have another lipid panel and follow-up.

Between the beginning of January and this week, I am down about 19 lbs. I was at 246 and am now at 227. I'm targeting 220 and seeing where we can get to after that. I'm already noticing that I'm probably closer to a 36 than a 38 in my waist and have had a few people comment that I'm looking like I lost some weight, so that's a positive sign.
 
Last edited:
It's been about two months since my STEMI (ST-elevation myocardial infarction) so I had my 2nd follow-up visit with the cardiologist to see how my recovery has been going. I had a lipid panel done last week to check on current numbers and I have to say, those statins really do the trick. Yes, my diet has had some impact but there is no way I would have seen this type of improvement from diet changes alone.

Lipid Panel Standard
Blood PanelsRange
4/10/2025​
% change​
2/2/2025​
% change​
10/4/2024
Cholesterol Totals<200 mg/dl
69​
-64%​
191​
-22%​
245
Triglycerides<150 mg/dl
45​
-78%​
202​
-33%​
301
HDL Cholesterol>= 40 mg/dl
39​
-15%​
46​
15%​
40
LDL Cholesterol<100
17​
-84%​
105​
-34%​
159
Non HDL Cholesterol<130
30​
-79%​
145​
-29%​
205
CHOL/HDLC Ratio<5.0
1.8​
-57%​
4.2​
-31%​
6.1​

As a point of reference, I started on a statin (Rosuvastatin) in October 2024 after a previous lipid panel and appointment with my previous cardiologist. I saw some mild improvement between October and February when I had my STEMI. Truthfully, this was a result of statins alone, as I justified taking a statin as a reason that I didn't necessarily have to change my diet. That's what the meds were for. Yes, stupid logic, but that's man-logic. LOL.

I had a lipid panel on 2/2/2025 during my hospital stay and then again last week. The difference is staggering. I am actually going to reduce my statin dosage slightly as my LDL is significantly lower than it has to be. The range listed above is standard (>100) for someone that doesn't necessarily have the genetic or medical history that I have. My cardiologist wants mine to be closer to 50 as anything lower has no material effect, so there is some room to work with. He is going to half my current dosage of Atorvastatin (Lipitor) and expects the LDL score to move up to the 35-40 range. It's impressive how precise they can be with those calculations.

In addition to Lipitor, I am also taking Repatha (a PCSK9 inhibitor) and Ezitimibe (Zetia) to help lower the LDL, cholesterol and triglycerides.

I did ask how I could increase my HDL (good cholesterol and should be higher than 40), and my doctor indicated that at this point, increased exercise was the only way as I had already made improvements to my diet and lifestyle changes (limited alcohol consumption/non-smoker, lost 20 pounds). In addition to my daily 4-mile run/walks, I will start incorporating some resistance training to see if I can increase that number between now and mid-July when I have another lipid panel and follow-up.

Between the beginning of January and this week, I am down about 19 lbs. I was at 246 and am now at 227. I'm targeting 220 and seeing where we can get to after that. I'm already noticing that I'm probably closer to a 36 than a 38 in my waist and have had a few people comment that I'm looking like I lost some weight, so that's a positive sign.
This is great to hear. I wouldn’t worry about raising HDL. Studies have shown repeatedly that there is no connection between raising your HDL and preventing heart attacks and strokes.
 
It's been about two months since my STEMI (ST-elevation myocardial infarction) so I had my 2nd follow-up visit with the cardiologist to see how my recovery has been going. I had a lipid panel done last week to check on current numbers and I have to say, those statins really do the trick. Yes, my diet has had some impact but there is no way I would have seen this type of improvement from diet changes alone.

Lipid Panel Standard
Blood PanelsRange
4/10/2025​
% change​
2/2/2025​
% change​
10/4/2024
Cholesterol Totals<200 mg/dl
69​
-64%​
191​
-22%​
245
Triglycerides<150 mg/dl
45​
-78%​
202​
-33%​
301
HDL Cholesterol>= 40 mg/dl
39​
-15%​
46​
15%​
40
LDL Cholesterol<100
17​
-84%​
105​
-34%​
159
Non HDL Cholesterol<130
30​
-79%​
145​
-29%​
205
CHOL/HDLC Ratio<5.0
1.8​
-57%​
4.2​
-31%​
6.1​

As a point of reference, I started on a statin (Rosuvastatin) in October 2024 after a previous lipid panel and appointment with my previous cardiologist. I saw some mild improvement between October and February when I had my STEMI. Truthfully, this was a result of statins alone, as I justified taking a statin as a reason that I didn't necessarily have to change my diet. That's what the meds were for. Yes, stupid logic, but that's man-logic. LOL.

I had a lipid panel on 2/2/2025 during my hospital stay and then again last week. The difference is staggering. I am actually going to reduce my statin dosage slightly as my LDL is significantly lower than it has to be. The range listed above is standard (>100) for someone that doesn't necessarily have the genetic or medical history that I have. My cardiologist wants mine to be closer to 50 as anything lower has no material effect, so there is some room to work with. He is going to half my current dosage of Atorvastatin (Lipitor) and expects the LDL score to move up to the 35-40 range. It's impressive how precise they can be with those calculations.

In addition to Lipitor, I am also taking Repatha (a PCSK9 inhibitor) and Ezitimibe (Zetia) to help lower the LDL, cholesterol and triglycerides.

I did ask how I could increase my HDL (good cholesterol and should be higher than 40), and my doctor indicated that at this point, increased exercise was the only way as I had already made improvements to my diet and lifestyle changes (limited alcohol consumption/non-smoker, lost 20 pounds). In addition to my daily 4-mile run/walks, I will start incorporating some resistance training to see if I can increase that number between now and mid-July when I have another lipid panel and follow-up.

Between the beginning of January and this week, I am down about 19 lbs. I was at 246 and am now at 227. I'm targeting 220 and seeing where we can get to after that. I'm already noticing that I'm probably closer to a 36 than a 38 in my waist and have had a few people comment that I'm looking like I lost some weight, so that's a positive sign.
This is great to hear. I wouldn’t worry about raising HDL. Studies have shown repeatedly that there is no connection between raising your HDL and preventing heart attacks and strokes.
I'm a sales guy, I like numbers. I want to win!!!

If anything, trying to achieve a higher HDL involves positive and healthy changes, so I don't see the downside in trying.
 
It's been about two months since my STEMI (ST-elevation myocardial infarction) so I had my 2nd follow-up visit with the cardiologist to see how my recovery has been going. I had a lipid panel done last week to check on current numbers and I have to say, those statins really do the trick. Yes, my diet has had some impact but there is no way I would have seen this type of improvement from diet changes alone.

Lipid Panel Standard
Blood PanelsRange
4/10/2025​
% change​
2/2/2025​
% change​
10/4/2024
Cholesterol Totals<200 mg/dl
69​
-64%​
191​
-22%​
245
Triglycerides<150 mg/dl
45​
-78%​
202​
-33%​
301
HDL Cholesterol>= 40 mg/dl
39​
-15%​
46​
15%​
40
LDL Cholesterol<100
17​
-84%​
105​
-34%​
159
Non HDL Cholesterol<130
30​
-79%​
145​
-29%​
205
CHOL/HDLC Ratio<5.0
1.8​
-57%​
4.2​
-31%​
6.1​

As a point of reference, I started on a statin (Rosuvastatin) in October 2024 after a previous lipid panel and appointment with my previous cardiologist. I saw some mild improvement between October and February when I had my STEMI. Truthfully, this was a result of statins alone, as I justified taking a statin as a reason that I didn't necessarily have to change my diet. That's what the meds were for. Yes, stupid logic, but that's man-logic. LOL.

I had a lipid panel on 2/2/2025 during my hospital stay and then again last week. The difference is staggering. I am actually going to reduce my statin dosage slightly as my LDL is significantly lower than it has to be. The range listed above is standard (>100) for someone that doesn't necessarily have the genetic or medical history that I have. My cardiologist wants mine to be closer to 50 as anything lower has no material effect, so there is some room to work with. He is going to halve my current dosage of Atorvastatin (Lipitor) and expects the LDL score to move up to the 35-40 range. It's impressive how precise they can be with those calculations.

In addition to Lipitor, I am also taking Repatha (a PCSK9 inhibitor) and Ezitimibe (Zetia) to help lower the LDL, cholesterol and triglycerides.

I did ask how I could increase my HDL (good cholesterol and should be higher than 40), and my doctor indicated that at this point, increased exercise was the only way as I had already made improvements to my diet and lifestyle changes (limited alcohol consumption/non-smoker, lost 20 pounds). In addition to my daily 4-mile run/walks, I will start incorporating some resistance training to see if I can increase that number between now and mid-July when I have another lipid panel and follow-up.

Between the beginning of January and this week, I am down about 19 lbs. I was at 246 and am now at 227. I'm targeting 220 and seeing where we can get to after that. I'm already noticing that I'm probably closer to a 36 than a 38 in my waist and have had a few people comment that I'm looking like I lost some weight, so that's a positive sign.
Wow that is super impressive amigo. Those are some low low #’s. Repatha really helps with LDL. I’m like you - finally got HDL in green with the last blood test. Always high 30’s and finally got low 40’s. Your LDL and triglycerides are super low. Well done. How much did you change your diet?
 
It's been about two months since my STEMI (ST-elevation myocardial infarction) so I had my 2nd follow-up visit with the cardiologist to see how my recovery has been going. I had a lipid panel done last week to check on current numbers and I have to say, those statins really do the trick. Yes, my diet has had some impact but there is no way I would have seen this type of improvement from diet changes alone.

Lipid Panel Standard
Blood PanelsRange
4/10/2025​
% change​
2/2/2025​
% change​
10/4/2024
Cholesterol Totals<200 mg/dl
69​
-64%​
191​
-22%​
245
Triglycerides<150 mg/dl
45​
-78%​
202​
-33%​
301
HDL Cholesterol>= 40 mg/dl
39​
-15%​
46​
15%​
40
LDL Cholesterol<100
17​
-84%​
105​
-34%​
159
Non HDL Cholesterol<130
30​
-79%​
145​
-29%​
205
CHOL/HDLC Ratio<5.0
1.8​
-57%​
4.2​
-31%​
6.1​

As a point of reference, I started on a statin (Rosuvastatin) in October 2024 after a previous lipid panel and appointment with my previous cardiologist. I saw some mild improvement between October and February when I had my STEMI. Truthfully, this was a result of statins alone, as I justified taking a statin as a reason that I didn't necessarily have to change my diet. That's what the meds were for. Yes, stupid logic, but that's man-logic. LOL.

I had a lipid panel on 2/2/2025 during my hospital stay and then again last week. The difference is staggering. I am actually going to reduce my statin dosage slightly as my LDL is significantly lower than it has to be. The range listed above is standard (>100) for someone that doesn't necessarily have the genetic or medical history that I have. My cardiologist wants mine to be closer to 50 as anything lower has no material effect, so there is some room to work with. He is going to halve my current dosage of Atorvastatin (Lipitor) and expects the LDL score to move up to the 35-40 range. It's impressive how precise they can be with those calculations.

In addition to Lipitor, I am also taking Repatha (a PCSK9 inhibitor) and Ezitimibe (Zetia) to help lower the LDL, cholesterol and triglycerides.

I did ask how I could increase my HDL (good cholesterol and should be higher than 40), and my doctor indicated that at this point, increased exercise was the only way as I had already made improvements to my diet and lifestyle changes (limited alcohol consumption/non-smoker, lost 20 pounds). In addition to my daily 4-mile run/walks, I will start incorporating some resistance training to see if I can increase that number between now and mid-July when I have another lipid panel and follow-up.

Between the beginning of January and this week, I am down about 19 lbs. I was at 246 and am now at 227. I'm targeting 220 and seeing where we can get to after that. I'm already noticing that I'm probably closer to a 36 than a 38 in my waist and have had a few people comment that I'm looking like I lost some weight, so that's a positive sign.
Wow that is super impressive amigo. Those are some low low #’s. Repatha really helps with LDL. I’m like you - finally got HDL in green with the last blood test. Always high 30’s and finally got low 40’s. Your LDL and triglycerides are super low. Well done. How much did you change your diet?
I haven't had any red meat, i.e., beef or pork, since the beginning of February. I am eating a vegetable-heavy diet with some chicken and fish thrown in. A lot of lentils. I have greatly reduced my consumption of anything with added sugar or processed food. I eat a good bit of fruit but no ice cream/candy/pastries/sweets, etc. I have tried a few of the Beyond Meat products and have been pleasantly surprised. A lot of whole grains like brown rice and quinoa. No or very low dairy. I use fat-free creamer or oat milk for my coffee and vegan cheese substitutes (still experimenting here to find one I like). Plenty of nuts like almonds, pistachios, pecans and walnuts, cashews, macadamias and hazelnuts. It's a little easier that my wife has fully bought into a similar diet, so she will find different recipes that fit with what we allow ourselves to eat.

Next month I'm on a two-week business trip to San Diego, Barcelona and Monte Carlo so it's going to be challenging but in this day and age, there are plenty of options for someone that is vegan so while I may not be able to be as strict, I think I can stick with my "approved" food pretty easily.
 
It's been about two months since my STEMI (ST-elevation myocardial infarction) so I had my 2nd follow-up visit with the cardiologist to see how my recovery has been going. I had a lipid panel done last week to check on current numbers and I have to say, those statins really do the trick. Yes, my diet has had some impact but there is no way I would have seen this type of improvement from diet changes alone.

Lipid Panel Standard
Blood PanelsRange
4/10/2025​
% change​
2/2/2025​
% change​
10/4/2024
Cholesterol Totals<200 mg/dl
69​
-64%​
191​
-22%​
245
Triglycerides<150 mg/dl
45​
-78%​
202​
-33%​
301
HDL Cholesterol>= 40 mg/dl
39​
-15%​
46​
15%​
40
LDL Cholesterol<100
17​
-84%​
105​
-34%​
159
Non HDL Cholesterol<130
30​
-79%​
145​
-29%​
205
CHOL/HDLC Ratio<5.0
1.8​
-57%​
4.2​
-31%​
6.1​

As a point of reference, I started on a statin (Rosuvastatin) in October 2024 after a previous lipid panel and appointment with my previous cardiologist. I saw some mild improvement between October and February when I had my STEMI. Truthfully, this was a result of statins alone, as I justified taking a statin as a reason that I didn't necessarily have to change my diet. That's what the meds were for. Yes, stupid logic, but that's man-logic. LOL.

I had a lipid panel on 2/2/2025 during my hospital stay and then again last week. The difference is staggering. I am actually going to reduce my statin dosage slightly as my LDL is significantly lower than it has to be. The range listed above is standard (>100) for someone that doesn't necessarily have the genetic or medical history that I have. My cardiologist wants mine to be closer to 50 as anything lower has no material effect, so there is some room to work with. He is going to halve my current dosage of Atorvastatin (Lipitor) and expects the LDL score to move up to the 35-40 range. It's impressive how precise they can be with those calculations.

In addition to Lipitor, I am also taking Repatha (a PCSK9 inhibitor) and Ezitimibe (Zetia) to help lower the LDL, cholesterol and triglycerides.

I did ask how I could increase my HDL (good cholesterol and should be higher than 40), and my doctor indicated that at this point, increased exercise was the only way as I had already made improvements to my diet and lifestyle changes (limited alcohol consumption/non-smoker, lost 20 pounds). In addition to my daily 4-mile run/walks, I will start incorporating some resistance training to see if I can increase that number between now and mid-July when I have another lipid panel and follow-up.

Between the beginning of January and this week, I am down about 19 lbs. I was at 246 and am now at 227. I'm targeting 220 and seeing where we can get to after that. I'm already noticing that I'm probably closer to a 36 than a 38 in my waist and have had a few people comment that I'm looking like I lost some weight, so that's a positive sign.
Those numbers are awesome!

While HMG CoA reductase inhibitors (AKA “statins”) are the gold standard in lipid lowering, the PCSK9 inhibitor is doing a lot of the work to achieve your uber low LDL.

Also, I’m not sure the bolded is accurate. As I mentioned earlier, there are longevity gurus who suggest lowering LDL as low as possible, period. There’s also some evidence for arterial plaque regression all the way down to an LDL of 20, though how meaningfully that extra bit impacts clinical outcomes, including vascular mortality, is unclear.
In 144 patients with baseline LDL-C levels less than 70 mg/dL, evolocumab treatment, compared with placebo, was associated with favorable effects on the change in PAV (−1.97% vs −0.35%; between-group difference, −1.62% [95% CI, −2.50% to −0.74%]; P < .001). In this subgroup, the percentage of patients with regression of PAV for evolocumab compared with placebo was 81.2% vs 48.0% (between-group difference, 33.2% [95% CI, 18.6% to 47.7%]; P < .001). A LOESS plot showed a linear relationship between achieved LDL-C level and PAV progression for LDL-C levels ranging from 110 mg/dL to as low as 20 mg/dL
PAV = percent atheroma volume, the change in size of the artery clogging plaque

IMO it’s more accurate to say we don’t know the optimal LDL. The US just changed their guidelines from a target 70 to 55, and I wouldn’t be surprised if it drops even lower over time.

Also, great job with your diet!

ETA Comment on another study looking at really low LDL:
A recent meta-analysis published in JAMA Cardiology suggests that it is both safe and effective to lower LDL below 70 mg/dL. The authors reviewed a large database of CVD patients with LDL levels averaging 70 mg/dL or less at the start of the studies. On average, there was a 20% drop in CVD risk seen for every 39 mg/dL drop in LDL cholesterol. In other words, a drop in LDL from 70 mg/dL down to 31 mg/dL was associated with 20% fewer CVD events such as heart attack or stroke.

The benefit was consistent regardless of the medications used to lower cholesterol. The JAMA Cardiologymeta-analysis looked at studies in which LDL was lowered with a statin drug, which works by lowering LDL production in the liver, or with a different type of medication, including ezetimibe (Zetia), which interferes with absorption of LDL from the intestine, or PCSK9 inhibitors, newer injectable medicines that increase uptake of LDL from the bloodstream into the liver. The drop in CVD risk was in line with previous studies of patients who started with LDL levels around 130 mg/dL, and saw a drop in CVD events of about 22% for every 39 mg/dL drop in LDL.

In this study, there was no increased risk of adverse outcomes (including muscle aches, liver dysfunction, new onset of diabetes, cancer, and bleeding strokes), even when LDL was lowered to as low as 20 mg/dL. Although statin medications themselves have been linked to side effects, especially at high doses, it appears that extremely low LDL concentrations are not responsible for side effects.

In other words, lowering LDL beyond our previous target of 70 mg/dL appears to be not only safe but beneficial, in patients with CVD.
 
Last edited:
It's been about two months since my STEMI (ST-elevation myocardial infarction) so I had my 2nd follow-up visit with the cardiologist to see how my recovery has been going. I had a lipid panel done last week to check on current numbers and I have to say, those statins really do the trick. Yes, my diet has had some impact but there is no way I would have seen this type of improvement from diet changes alone.

Lipid Panel Standard
Blood PanelsRange
4/10/2025​
% change​
2/2/2025​
% change​
10/4/2024
Cholesterol Totals<200 mg/dl
69​
-64%​
191​
-22%​
245
Triglycerides<150 mg/dl
45​
-78%​
202​
-33%​
301
HDL Cholesterol>= 40 mg/dl
39​
-15%​
46​
15%​
40
LDL Cholesterol<100
17​
-84%​
105​
-34%​
159
Non HDL Cholesterol<130
30​
-79%​
145​
-29%​
205
CHOL/HDLC Ratio<5.0
1.8​
-57%​
4.2​
-31%​
6.1​

As a point of reference, I started on a statin (Rosuvastatin) in October 2024 after a previous lipid panel and appointment with my previous cardiologist. I saw some mild improvement between October and February when I had my STEMI. Truthfully, this was a result of statins alone, as I justified taking a statin as a reason that I didn't necessarily have to change my diet. That's what the meds were for. Yes, stupid logic, but that's man-logic. LOL.

I had a lipid panel on 2/2/2025 during my hospital stay and then again last week. The difference is staggering. I am actually going to reduce my statin dosage slightly as my LDL is significantly lower than it has to be. The range listed above is standard (>100) for someone that doesn't necessarily have the genetic or medical history that I have. My cardiologist wants mine to be closer to 50 as anything lower has no material effect, so there is some room to work with. He is going to halve my current dosage of Atorvastatin (Lipitor) and expects the LDL score to move up to the 35-40 range. It's impressive how precise they can be with those calculations.

In addition to Lipitor, I am also taking Repatha (a PCSK9 inhibitor) and Ezitimibe (Zetia) to help lower the LDL, cholesterol and triglycerides.

I did ask how I could increase my HDL (good cholesterol and should be higher than 40), and my doctor indicated that at this point, increased exercise was the only way as I had already made improvements to my diet and lifestyle changes (limited alcohol consumption/non-smoker, lost 20 pounds). In addition to my daily 4-mile run/walks, I will start incorporating some resistance training to see if I can increase that number between now and mid-July when I have another lipid panel and follow-up.

Between the beginning of January and this week, I am down about 19 lbs. I was at 246 and am now at 227. I'm targeting 220 and seeing where we can get to after that. I'm already noticing that I'm probably closer to a 36 than a 38 in my waist and have had a few people comment that I'm looking like I lost some weight, so that's a positive sign.
Those numbers are awesome!

While HMG CoA reductase inhibitors (AKA “statins”) are the gold standard in lipid lowering, the PCSK9 inhibitor is doing a lot of the work to achieve your uber low LDL.

Also, I’m not sure the bolded is accurate. As I mentioned earlier, there are longevity gurus who suggest lowering LDL as low as possible, period. There’s also some evidence for arterial plaque regression all the way down to an LDL of 20, though how meaningfully that extra bit impacts clinical outcomes, including vascular mortality, is unclear.
In 144 patients with baseline LDL-C levels less than 70 mg/dL, evolocumab treatment, compared with placebo, was associated with favorable effects on the change in PAV (−1.97% vs −0.35%; between-group difference, −1.62% [95% CI, −2.50% to −0.74%]; P < .001). In this subgroup, the percentage of patients with regression of PAV for evolocumab compared with placebo was 81.2% vs 48.0% (between-group difference, 33.2% [95% CI, 18.6% to 47.7%]; P < .001). A LOESS plot showed a linear relationship between achieved LDL-C level and PAV progression for LDL-C levels ranging from 110 mg/dL to as low as 20 mg/dL
PAV = percent atheroma volume, the change in size of the artery clogging plaque

IMO it’s more accurate to say we don’t know the optimal LDL. The US just changed their guidelines from a target 70 to 55, and I wouldn’t be surprised if it drops even lower over time.

Also, great job with your diet!

ETA Comment on another study looking at really low LDL:
A recent meta-analysis published in JAMA Cardiology suggests that it is both safe and effective to lower LDL below 70 mg/dL. The authors reviewed a large database of CVD patients with LDL levels averaging 70 mg/dL or less at the start of the studies. On average, there was a 20% drop in CVD risk seen for every 39 mg/dL drop in LDL cholesterol. In other words, a drop in LDL from 70 mg/dL down to 31 mg/dL was associated with 20% fewer CVD events such as heart attack or stroke.

The benefit was consistent regardless of the medications used to lower cholesterol. The JAMA Cardiologymeta-analysis looked at studies in which LDL was lowered with a statin drug, which works by lowering LDL production in the liver, or with a different type of medication, including ezetimibe (Zetia), which interferes with absorption of LDL from the intestine, or PCSK9 inhibitors, newer injectable medicines that increase uptake of LDL from the bloodstream into the liver. The drop in CVD risk was in line with previous studies of patients who started with LDL levels around 130 mg/dL, and saw a drop in CVD events of about 22% for every 39 mg/dL drop in LDL.

In this study, there was no increased risk of adverse outcomes (including muscle aches, liver dysfunction, new onset of diabetes, cancer, and bleeding strokes), even when LDL was lowered to as low as 20 mg/dL. Although statin medications themselves have been linked to side effects, especially at high doses, it appears that extremely low LDL concentrations are not responsible for side effects.

In other words, lowering LDL beyond our previous target of 70 mg/dL appears to be not only safe but beneficial, in patients with CVD.
Good info Term. What was bolded may not have been my cardio's exact words, just paraphrasing on my part. I'll take the above commentary into consideration.
 
It's been about two months since my STEMI (ST-elevation myocardial infarction) so I had my 2nd follow-up visit with the cardiologist to see how my recovery has been going. I had a lipid panel done last week to check on current numbers and I have to say, those statins really do the trick. Yes, my diet has had some impact but there is no way I would have seen this type of improvement from diet changes alone.

Lipid Panel Standard
Blood PanelsRange
4/10/2025​
% change​
2/2/2025​
% change​
10/4/2024
Cholesterol Totals<200 mg/dl
69​
-64%​
191​
-22%​
245
Triglycerides<150 mg/dl
45​
-78%​
202​
-33%​
301
HDL Cholesterol>= 40 mg/dl
39​
-15%​
46​
15%​
40
LDL Cholesterol<100
17​
-84%​
105​
-34%​
159
Non HDL Cholesterol<130
30​
-79%​
145​
-29%​
205
CHOL/HDLC Ratio<5.0
1.8​
-57%​
4.2​
-31%​
6.1​

As a point of reference, I started on a statin (Rosuvastatin) in October 2024 after a previous lipid panel and appointment with my previous cardiologist. I saw some mild improvement between October and February when I had my STEMI. Truthfully, this was a result of statins alone, as I justified taking a statin as a reason that I didn't necessarily have to change my diet. That's what the meds were for. Yes, stupid logic, but that's man-logic. LOL.

I had a lipid panel on 2/2/2025 during my hospital stay and then again last week. The difference is staggering. I am actually going to reduce my statin dosage slightly as my LDL is significantly lower than it has to be. The range listed above is standard (>100) for someone that doesn't necessarily have the genetic or medical history that I have. My cardiologist wants mine to be closer to 50 as anything lower has no material effect, so there is some room to work with. He is going to halve my current dosage of Atorvastatin (Lipitor) and expects the LDL score to move up to the 35-40 range. It's impressive how precise they can be with those calculations.

In addition to Lipitor, I am also taking Repatha (a PCSK9 inhibitor) and Ezitimibe (Zetia) to help lower the LDL, cholesterol and triglycerides.

I did ask how I could increase my HDL (good cholesterol and should be higher than 40), and my doctor indicated that at this point, increased exercise was the only way as I had already made improvements to my diet and lifestyle changes (limited alcohol consumption/non-smoker, lost 20 pounds). In addition to my daily 4-mile run/walks, I will start incorporating some resistance training to see if I can increase that number between now and mid-July when I have another lipid panel and follow-up.

Between the beginning of January and this week, I am down about 19 lbs. I was at 246 and am now at 227. I'm targeting 220 and seeing where we can get to after that. I'm already noticing that I'm probably closer to a 36 than a 38 in my waist and have had a few people comment that I'm looking like I lost some weight, so that's a positive sign.
Those numbers are awesome!

While HMG CoA reductase inhibitors (AKA “statins”) are the gold standard in lipid lowering, the PCSK9 inhibitor is doing a lot of the work to achieve your uber low LDL.

Also, I’m not sure the bolded is accurate. As I mentioned earlier, there are longevity gurus who suggest lowering LDL as low as possible, period. There’s also some evidence for arterial plaque regression all the way down to an LDL of 20, though how meaningfully that extra bit impacts clinical outcomes, including vascular mortality, is unclear.
In 144 patients with baseline LDL-C levels less than 70 mg/dL, evolocumab treatment, compared with placebo, was associated with favorable effects on the change in PAV (−1.97% vs −0.35%; between-group difference, −1.62% [95% CI, −2.50% to −0.74%]; P < .001). In this subgroup, the percentage of patients with regression of PAV for evolocumab compared with placebo was 81.2% vs 48.0% (between-group difference, 33.2% [95% CI, 18.6% to 47.7%]; P < .001). A LOESS plot showed a linear relationship between achieved LDL-C level and PAV progression for LDL-C levels ranging from 110 mg/dL to as low as 20 mg/dL
PAV = percent atheroma volume, the change in size of the artery clogging plaque

IMO it’s more accurate to say we don’t know the optimal LDL. The US just changed their guidelines from a target 70 to 55, and I wouldn’t be surprised if it drops even lower over time.

Also, great job with your diet!

ETA Comment on another study looking at really low LDL:
A recent meta-analysis published in JAMA Cardiology suggests that it is both safe and effective to lower LDL below 70 mg/dL. The authors reviewed a large database of CVD patients with LDL levels averaging 70 mg/dL or less at the start of the studies. On average, there was a 20% drop in CVD risk seen for every 39 mg/dL drop in LDL cholesterol. In other words, a drop in LDL from 70 mg/dL down to 31 mg/dL was associated with 20% fewer CVD events such as heart attack or stroke.

The benefit was consistent regardless of the medications used to lower cholesterol. The JAMA Cardiologymeta-analysis looked at studies in which LDL was lowered with a statin drug, which works by lowering LDL production in the liver, or with a different type of medication, including ezetimibe (Zetia), which interferes with absorption of LDL from the intestine, or PCSK9 inhibitors, newer injectable medicines that increase uptake of LDL from the bloodstream into the liver. The drop in CVD risk was in line with previous studies of patients who started with LDL levels around 130 mg/dL, and saw a drop in CVD events of about 22% for every 39 mg/dL drop in LDL.

In this study, there was no increased risk of adverse outcomes (including muscle aches, liver dysfunction, new onset of diabetes, cancer, and bleeding strokes), even when LDL was lowered to as low as 20 mg/dL. Although statin medications themselves have been linked to side effects, especially at high doses, it appears that extremely low LDL concentrations are not responsible for side effects.

In other words, lowering LDL beyond our previous target of 70 mg/dL appears to be not only safe but beneficial, in patients with CVD.
Good info Term. What was bolded may not have been my cardio's exact words, just paraphrasing on my part. I'll take the above commentary into consideration.
Yeah, it’s somewhat of a grey zone, but everything I’ve seen suggests lower is better. What you risk are side effects/toxicity from the meds, which your doctors will certainly be monitoring. So the question is, are the incremental cardiovascular benefits worth the risk? Cost and insurance coverage are also considerations, of course.
 
It's been about two months since my STEMI (ST-elevation myocardial infarction) so I had my 2nd follow-up visit with the cardiologist to see how my recovery has been going. I had a lipid panel done last week to check on current numbers and I have to say, those statins really do the trick. Yes, my diet has had some impact but there is no way I would have seen this type of improvement from diet changes alone.

Lipid Panel Standard
Blood PanelsRange
4/10/2025​
% change​
2/2/2025​
% change​
10/4/2024
Cholesterol Totals<200 mg/dl
69​
-64%​
191​
-22%​
245
Triglycerides<150 mg/dl
45​
-78%​
202​
-33%​
301
HDL Cholesterol>= 40 mg/dl
39​
-15%​
46​
15%​
40
LDL Cholesterol<100
17​
-84%​
105​
-34%​
159
Non HDL Cholesterol<130
30​
-79%​
145​
-29%​
205
CHOL/HDLC Ratio<5.0
1.8​
-57%​
4.2​
-31%​
6.1​

As a point of reference, I started on a statin (Rosuvastatin) in October 2024 after a previous lipid panel and appointment with my previous cardiologist. I saw some mild improvement between October and February when I had my STEMI. Truthfully, this was a result of statins alone, as I justified taking a statin as a reason that I didn't necessarily have to change my diet. That's what the meds were for. Yes, stupid logic, but that's man-logic. LOL.

I had a lipid panel on 2/2/2025 during my hospital stay and then again last week. The difference is staggering. I am actually going to reduce my statin dosage slightly as my LDL is significantly lower than it has to be. The range listed above is standard (>100) for someone that doesn't necessarily have the genetic or medical history that I have. My cardiologist wants mine to be closer to 50 as anything lower has no material effect, so there is some room to work with. He is going to halve my current dosage of Atorvastatin (Lipitor) and expects the LDL score to move up to the 35-40 range. It's impressive how precise they can be with those calculations.

In addition to Lipitor, I am also taking Repatha (a PCSK9 inhibitor) and Ezitimibe (Zetia) to help lower the LDL, cholesterol and triglycerides.

I did ask how I could increase my HDL (good cholesterol and should be higher than 40), and my doctor indicated that at this point, increased exercise was the only way as I had already made improvements to my diet and lifestyle changes (limited alcohol consumption/non-smoker, lost 20 pounds). In addition to my daily 4-mile run/walks, I will start incorporating some resistance training to see if I can increase that number between now and mid-July when I have another lipid panel and follow-up.

Between the beginning of January and this week, I am down about 19 lbs. I was at 246 and am now at 227. I'm targeting 220 and seeing where we can get to after that. I'm already noticing that I'm probably closer to a 36 than a 38 in my waist and have had a few people comment that I'm looking like I lost some weight, so that's a positive sign.
Wow that is super impressive amigo. Those are some low low #’s. Repatha really helps with LDL. I’m like you - finally got HDL in green with the last blood test. Always high 30’s and finally got low 40’s. Your LDL and triglycerides are super low. Well done. How much did you change your diet?
I haven't had any red meat, i.e., beef or pork, since the beginning of February. I am eating a vegetable-heavy diet with some chicken and fish thrown in. A lot of lentils. I have greatly reduced my consumption of anything with added sugar or processed food. I eat a good bit of fruit but no ice cream/candy/pastries/sweets, etc. I have tried a few of the Beyond Meat products and have been pleasantly surprised. A lot of whole grains like brown rice and quinoa. No or very low dairy. I use fat-free creamer or oat milk for my coffee and vegan cheese substitutes (still experimenting here to find one I like). Plenty of nuts like almonds, pistachios, pecans and walnuts, cashews, macadamias and hazelnuts. It's a little easier that my wife has fully bought into a similar diet, so she will find different recipes that fit with what we allow ourselves to eat.

Next month I'm on a two-week business trip to San Diego, Barcelona and Monte Carlo so it's going to be challenging but in this day and age, there are plenty of options for someone that is vegan so while I may not be able to be as strict, I think I can stick with my "approved" food pretty easily.
Barcelona will be easy. Some of the best tapas we had were completely vegan. The one thing I'll say about Beyond Meat is watch your blood pressure. They are sodium bombs.
 
It's been about two months since my STEMI (ST-elevation myocardial infarction) so I had my 2nd follow-up visit with the cardiologist to see how my recovery has been going. I had a lipid panel done last week to check on current numbers and I have to say, those statins really do the trick. Yes, my diet has had some impact but there is no way I would have seen this type of improvement from diet changes alone.

Lipid Panel Standard
Blood PanelsRange
4/10/2025​
% change​
2/2/2025​
% change​
10/4/2024
Cholesterol Totals<200 mg/dl
69​
-64%​
191​
-22%​
245
Triglycerides<150 mg/dl
45​
-78%​
202​
-33%​
301
HDL Cholesterol>= 40 mg/dl
39​
-15%​
46​
15%​
40
LDL Cholesterol<100
17​
-84%​
105​
-34%​
159
Non HDL Cholesterol<130
30​
-79%​
145​
-29%​
205
CHOL/HDLC Ratio<5.0
1.8​
-57%​
4.2​
-31%​
6.1​

As a point of reference, I started on a statin (Rosuvastatin) in October 2024 after a previous lipid panel and appointment with my previous cardiologist. I saw some mild improvement between October and February when I had my STEMI. Truthfully, this was a result of statins alone, as I justified taking a statin as a reason that I didn't necessarily have to change my diet. That's what the meds were for. Yes, stupid logic, but that's man-logic. LOL.

I had a lipid panel on 2/2/2025 during my hospital stay and then again last week. The difference is staggering. I am actually going to reduce my statin dosage slightly as my LDL is significantly lower than it has to be. The range listed above is standard (>100) for someone that doesn't necessarily have the genetic or medical history that I have. My cardiologist wants mine to be closer to 50 as anything lower has no material effect, so there is some room to work with. He is going to halve my current dosage of Atorvastatin (Lipitor) and expects the LDL score to move up to the 35-40 range. It's impressive how precise they can be with those calculations.

In addition to Lipitor, I am also taking Repatha (a PCSK9 inhibitor) and Ezitimibe (Zetia) to help lower the LDL, cholesterol and triglycerides.

I did ask how I could increase my HDL (good cholesterol and should be higher than 40), and my doctor indicated that at this point, increased exercise was the only way as I had already made improvements to my diet and lifestyle changes (limited alcohol consumption/non-smoker, lost 20 pounds). In addition to my daily 4-mile run/walks, I will start incorporating some resistance training to see if I can increase that number between now and mid-July when I have another lipid panel and follow-up.

Between the beginning of January and this week, I am down about 19 lbs. I was at 246 and am now at 227. I'm targeting 220 and seeing where we can get to after that. I'm already noticing that I'm probably closer to a 36 than a 38 in my waist and have had a few people comment that I'm looking like I lost some weight, so that's a positive sign.
Wow that is super impressive amigo. Those are some low low #’s. Repatha really helps with LDL. I’m like you - finally got HDL in green with the last blood test. Always high 30’s and finally got low 40’s. Your LDL and triglycerides are super low. Well done. How much did you change your diet?
I haven't had any red meat, i.e., beef or pork, since the beginning of February. I am eating a vegetable-heavy diet with some chicken and fish thrown in. A lot of lentils. I have greatly reduced my consumption of anything with added sugar or processed food. I eat a good bit of fruit but no ice cream/candy/pastries/sweets, etc. I have tried a few of the Beyond Meat products and have been pleasantly surprised. A lot of whole grains like brown rice and quinoa. No or very low dairy. I use fat-free creamer or oat milk for my coffee and vegan cheese substitutes (still experimenting here to find one I like). Plenty of nuts like almonds, pistachios, pecans and walnuts, cashews, macadamias and hazelnuts. It's a little easier that my wife has fully bought into a similar diet, so she will find different recipes that fit with what we allow ourselves to eat.

Next month I'm on a two-week business trip to San Diego, Barcelona and Monte Carlo so it's going to be challenging but in this day and age, there are plenty of options for someone that is vegan so while I may not be able to be as strict, I think I can stick with my "approved" food pretty easily.
Barcelona will be easy. Some of the best tapas we had were completely vegan. The one thing I'll say about Beyond Meat is watch your blood pressure. They are sodium bombs.
Good point. It's always something, isn't it? Sheesh.
 
as a typical guy, I was brushing it off somewhat

My dad did this with a liver infection that damn near killed him several years ago. And then ignored a cocktail of weird symptoms the winter before last that ended with him spending 3 weeks in the hospital last Spring, before coming home to hospice and dying.

In Feb, my FIL thought he'd pulled a muscle in his back and ignored the pain for more than a week, until it got so bad he was ambulanced to the ER where they discovered an aneurysm in his abdomen that would have killed him in minutes/hours/days (who knows). Doc told him going into surgery it was 50/50 whether he'd come out. He survived, but obviously it was a close thing.

I'm not sure what a good rule of thumb is as far as not overreacting to every little thing, but most men just don't seem to do that. All the errors are on the other side.

So, for me... if you're older and have a weird pain, especially one that's "deep", or doesn't seem to be caused by movement/position, or go away when you change position, just see a doctor. If you have weird symptoms, just see a doctor. (hopefully an actual doctor can correct that if it's not quite right, or elaborate on it if it is)
 

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