r/PeterAttia icon Go to PeterAttia r/PeterAttia • 14 hr. ago NewSteward 39M Elevated LPa - My Journey and Next Steps I'm a 39 year-old male. For the last 6 years, I've consistently done 5hrs of zone 2 training per week. My lipid and metabolic panels have been in what I would call the "generally acceptable" zone of most primary care providers. In April of 2025, my PCP suggested we do LPa and ApoB to better understand my risk (my LDL had previously fluctuated between 95-105). Embarrassing/comically/idiotically I've known about these tests for over 5 years through being a prudent listener of The Drive. I have mild health anxiety and was likely subconsciously avoiding pursuing testing outside the normal lipid panel. Lipid metrics are in mg/dL except for LPa, which is nmoL. April 2025 Baseline -Total Chol 185 -LDL 122 -Trigs 62 -ApoB 98 -LPa 159 -HDL 48 -A1c 5.2 -Glucose 98 When she called me with these results she suggested I do a calcium scan. I asked her if that was only to convince me to start a statin as I would not be resistant to taking a medication. She said yes, because most patients need the motivation to start a daily pill. I asked her if she was comfortable waiting 3 months to see how low I could get my numbers leveraging the advice I've seen in this forum around control of saturated fat. I am a data person and wanted to understand the impact of each lever I would be pulling in a controlled way. She agreed to give me 3 months. June 2025 (Self-test through Marek) I wanted to do my own in between test to capture reduction of saturated fat. I basically cut out eggs, cheese, butter, red meat, and any processed foods with more than half a gram of saturated fat per serving. My daily saturated fat intake was usually just at or below 10g. -Total Chol 129 -LDL 72 -Trigs 59 -ApoB 72 -HDL 44 August 2025 Final decision test. While I was slightly more relaxed with my diet (maybe closer to 12g sat fat) I did also introduce two servings of psyllium husk fiber daily. My Hope was that I would get my ApoB into the 60s. This did not happen. I was a little surprised to see this metric stay flat, although I had covid or some kind of bug that kept me off the treadmill for 4 weeks. I also started a higher stress position. I'm not sure if these impacted my numbers at all. -Total Chol 144 -LDL 86 -Trigs 63 -ApoB 76 -HDL 43 -LPa 173 While it was not particularly exciting to see my LPa score increase, I understand this is realistically within the margin of error with the assay. I do suspect I had some reduced LDL clearing based on a complete stop of zone 2 training. Thanks to Gruss and all the other posters of this sub. I've read anything that has been posted around lipids over the last year. I feel in control of the situation. I already had a plan in place with my doctor. I wanted my LDL and ApoB under 60, and if I wasn't able to achieve that, I would begin taking 5 mg daily of rosuvastatin. So that is my planned next step. I would welcome any feedback but would be surprised if I heard anything different. I'm optimistic that dosage will get me to a level both Peter and Dr. Dayspring would be comfortable with. Other relevant information. I have a large and well-tracked family on both my maternal and paternal side. We have a lot of longevity on my paternal side (many family members in their late '90s). While my maternal side is not quite as impressive, most family members live well into their '80s. We do not see any any examples of heart disease on either side of my family. There are several exceptions. One is a maternal grandfather who died of a heart attack at an early age but was a horrendous alcoholic and in poor health all around. The other exception is my father, who suffered a horrible stroke in his mid-40s. This is the one that has often terrified me. However, every professional I've spoken to has stated his stroke being caused by a double dissected carotid artery was a structural issue and not atherosclerosis. He has ironically had an angiogram that found zero plaque. It is a little unnerving to not understand the cause of his stroke, but he was a borderline alcoholic with uncontrolled hypertension and under the stress of a failing business. He also was in a severe car crash earlier in life. While I tend to have elevated in office blood pressure readings, my doctor views this as anxiety related. I take my blood pressure daily and at home readings taken the correct way as Peter describes generally land me in the 100/60-125/75 range. We are comfortable with my at-home readings as I bring my machine in annually to confirm it matches her in office readings. I see a lot of posts here about folks reacting in panic to an elevated LPa score. I had a similar reaction when I first saw my number. I've gotten very used to my diet at this point and don't really feel any difficulty in maintaining it in perpetuity. Just wanted to share a story of someone going through the process in case helpful to other posters. I will post my updated panel following the rosuvastatin impact once I have that. Thanks again to the wealth of information on this sub.