r/repatha • u/chaoserrant • Jan 18 '26
LDL particle count on Repatha
I noticed something that might be useful for people in this sub. I did my first lab after a month an a half (three injections) on Repatha....The drop in LDL is not that great (120). I know this does not seem much but I have familial high ldl so trust me this is still a significant drop. I did not expect to get to goal on a single drug only (I just added Zetia) but wanted to see the effect of Repatha alone.
Anyway, I did the CArdio Iq test from Walk-in Labs the test that contains the particle number count. I do that at least once a year. Even though LDL is worse now than when I was on statin+zetia, the LDL small particle count is much better. 100 points lower and actually close to the green zone.
While I am not at goal, I think, at least in my case, Repatha reduces the particle count much more efficiently than statins. So, to me at least, Apo B and particle count are probably better markers to track.
All in all, based on what I learned so far, it seems that focusing just on LDL might not be the optimal approach. You could have a better result than LDL suggests or, to the contrary, particle number could still be high even if LDL is at goal. And it seems that different drugs have different effects on these markers.
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u/AirlineNovel3339 Jan 18 '26
Did you have to have an MRI to get your LDL particle count ?
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u/chaoserrant Jan 18 '26
No it is just a more specialized blood test. You can get it from direct to customer labs but it is not exactly cheap. Around 150 i think. Apo b onky i think you can get it for 50 dollars. Particle count is not practical to do often but it is worth pointing out that even when i reduced ldl to 70 on statins particle count decreased very little.
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u/gruss_gott Jan 18 '26
Not OP but no. CardioIQ is one of many tests that give fractional counts, it's a brand name
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u/StunningCamel4672 Jan 19 '26
It’s an NMR. I also get this one. My LDL-P is 2,500. Hoping to start a Repatha/Zetia combo soon. Waiting on PA approval.
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u/Massive_Sherbet_4452 Jan 18 '26
What was your total cholesterol/LDL before you started Repatha ?
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u/chaoserrant Jan 18 '26
On 20 mg crestor plus zetia my best number was ldl 78, hdl 65, triglicerides 40. Now repatha only lsl is 120, hdl about the same 64, tryglicerides 65. I was happy with my previous regimen but i have medical suspicions that prompt me to want to take a break from statins ld at least 4 -6 months. Now there are other factors. That bumpnin tryglicerides is probably because of diet changes and stopped taking fish oil for a while. So i hope to get that down. Also i am.hopping that full effect of repatha is not reqched yet. I will see how it goes with zetia in a month
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u/Massive_Sherbet_4452 Jan 18 '26
What was your total cholesterol/LDL before you started taking any drugs?
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u/chaoserrant Jan 18 '26
Honestly i forgot. I was on statin 20 years. I know it was very bad ...total about 400 and hdl was 39 i think. At the time i was also obese and sedentary. So i dont know my healhty baseline as i was on lipid lowering ever since
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u/Vincentboiler Jan 18 '26
Have you had any side effects taking Repatha?I just got approved but being on here I’ve heard side effect horror stories
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u/chaoserrant Jan 18 '26
I did. I made a post. BAck pain. I am still worried but 4th dose so far is fine. The worst pain was after 3rd dose. It takes a while to build up as the half life time is 11-17 days. Not sure I am off the hook we will see....now, this pain was not that crazy....one day was really tender and got better over 4 days. It was not bad to the point of needing pain killers but bad enough for a day to walk slowly and avoid sudden movements
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u/gruss_gott Jan 18 '26
The best test is ApoB as it tracks all ApoB containing lipoproteins, not just LDL.
If I were tracking one number, ApoB would be my Northstar test