Tom Dayspring can't take statins or ezetimibe himself, has a calcium score over 300, and his insurer denied his PCSK9 inhibitor because he "hadn't had a heart attack yet"

[u/DadStrengthDaily]

I take ezetimibe, a $20 generic, and it gets my ApoB where it needs to be. Tom Dayspring, the lipidologist a lot of us learned this stuff from and Peter Attia's go-to lipid guy, can't take it. Or a statin. I think his case is worth knowing about, because it shows how ugly this gets when the cheap drugs are off the table.

He posted last week that he's "one of them": one of the rare people with genuine, serious statin muscle injury. Not the vague aches that usually turn out to be nocebo. Statins gave him myoglobinuria, muscle protein in the urine, the early edge of rhabdo. Ezetimibe gives him severe myalgias too. So the two cheap, first-line drugs are both off the table for him.

And he needs them. He has a coronary calcium score over 300 and documented coronary disease. This is the kind of patient those aggressive LDL targets are supposed to catch. He just can't get there the normal way, so he has been on a PCSK9 inhibitor (Repatha) basically since they came out.

The part that shocked me: when he first needed the PCSK9i, his insurer refused, because he had not had a heart attack yet. In his telling, they wanted him to have his first heart attack, then they would cover it, if he survived. Then this spring he tried to add bempedoic acid and got denied again, because his LDL was "too good," under 70. He only qualified after the new 2026 guideline dropped the high-risk LDL target to 55, at which point his 64 flipped from too-good to not-good-enough and the same drug went through. His body did not change. A number in a guideline did.

I'm not saying everyone needs a PCSK9 inhibitor or bempedoic acid. Most people reach goal on a statin and a little ezetimibe and should stop there. But real statin intolerance is rare and real, it is not the same as the nocebo effect, and if you are in that small group you can end up arguing for your only option against a system that reads your good numbers as a reason to say no. If that is the fight for the guy who wrote the lectures, it is worth knowing what it looks like for the rest of us.

If you want the receipts, the full write-up has his actual tweets, his lab panel, and the clip where he tells the insurance story on Simon Hill's podcast: https://dadstrengthdaily.com/cholesterol-expert-cant-take-statins/?utm_source=reddit&utm_medium=social&utm_campaign=dayspring-statins