Cholesterol dropped 80 points and my doc is shook

Starting a dedicated lipid panel thread because the cholesterol improvements on GLP-1 therapy are seriously underappreciated. Everyone focuses on A1c and weight — but the cardiovascular risk reduction from lipid changes might be even more impactful long-term. Here's mine. 38M, semaglutide 2.4mg, 11 months: | Marker | Baseline | 6 Months | 11 Months | Optimal Target | |--------|----------|----------|-----------|---------------| | Total Cholesterol | 268 mg/dL | 212 mg/dL | 188 mg/dL | <200 | | LDL-C | 168 mg/dL | 128 mg/dL | 108 mg/dL | <100 (or <70 high risk) | | HDL-C | 34 mg/dL | 42 mg/dL | 48 mg/dL | >40 M / >50 F | | Triglycerides | 328 mg/dL | 164 mg/dL | 118 mg/dL | <150 | | ApoB | 158 mg/dL | 112 mg/dL | 92 mg/dL | <90 | | Non-HDL-C | 234 mg/dL | 170 mg/dL | 140 mg/dL | <130 | | Lp(a) | 42 nmol/L | 40 nmol/L | 41 nmol/L | <75 | Key observations: 1. Triglycerides dropped 64% — this is the most dramatic GLP-1 effect on lipids 2. HDL increased 41% — likely from trig reduction + exercise + weight loss 3. LDL dropped 36% — NOT on a statin. This is diet + GLP-1 alone 4. ApoB almost at target — may add low-dose statin to get below 90 5. Lp(a) unchanged — as expected, it's genetically determined. Nothing moves it except PCSK9i or the new antisense drugs. Who else has lipid data to share?

Love this. Here's mine — and the reason I was able to STOP my statin: Tirzepatide 12.5 mg, 8 months. Previously on atorvastatin 20mg. | Marker | On Statin Pre-Tirz | 4 Mo Tirz + Statin | 8 Mo Tirz, No Statin | Target | |--------|-------------------|-------------------|---------------------|--------| | LDL-C | 92 mg/dL | 78 mg/dL | 88 mg/dL | <100 | | HDL-C | 52 mg/dL | 58 mg/dL | 64 mg/dL | >50 | | Triglycerides | 198 mg/dL | 124 mg/dL | 96 mg/dL | <150 | | ApoB | 98 mg/dL | 82 mg/dL | 86 mg/dL | <90 | My cardiologist agreed to discontinue the statin at month 5 because my numbers were so good AND I was having muscle pain (statin myalgia). My LDL bumped slightly from 78 to 88 without it but is still under target. Triglycerides actually CONTINUED to drop after stopping the statin.

These are both excellent results. Let me add some clinical context: GLP-1 RA effects on lipids — mechanism: - Triglycerides: GLP-1 directly reduces hepatic VLDL production and increases lipoprotein lipase activity. This is the largest and most consistent effect — typically 15-40% reduction. - LDL-C: Modest reduction (5-15%) likely from decreased cholesterol absorption and enhanced LDL receptor expression - HDL-C: Modest increase (3-8%) partly from reduced CETP-mediated transfer due to lower triglycerides - ApoB: Reflects total atherogenic particle count. Reductions generally mirror LDL-C changes. Important note on calculated vs. measured LDL: When triglycerides are above 200 mg/dL, the standard Friedewald equation underestimates LDL-C. Alex, your baseline LDL of 168 with trigs at 328 was likely calculated and may have been inaccurate. The Martin-Hopkins equation or direct LDL measurement is more reliable in hypertriglyceridemia. > the reason I was able to STOP my statin Jen, I'm glad your cardiologist is monitoring this closely. I'd keep checking ApoB every 6 months to make sure it stays below 90 off the statin. Weight regain (even partial) can cause lipids to rebound.

My trigs were INSANE before semaglutide. Like, pancreatitis-risk levels: | Marker | Baseline | 4 Mo | 8 Mo | |--------|----------|------|------| | Triglycerides | 684 mg/dL | 312 mg/dL | 148 mg/dL | | Total Cholesterol | 342 mg/dL | 248 mg/dL | 196 mg/dL | | HDL-C | 26 mg/dL | 34 mg/dL | 44 mg/dL | | LDL-C | N/A (too high trigs to calculate) | 142 mg/dL | 106 mg/dL | I was on fenofibrate + fish oil + semaglutide. Just dropped the fenofibrate last month because trigs normalized. My PCP literally said "I've never seen triglycerides drop this fast without medication changes." I said... it IS a medication change, doc. 😂

Terry, 684 to 148!!! That's a 78% reduction. You literally went from acute pancreatitis risk territory to normal range. That's not just a lipid improvement, that's a life-saving change. > I said... it IS a medication change, doc LOL. Some docs still think of GLP-1s as "just weight loss drugs." The cardiovascular data from SELECT, SUSTAIN-6, and LEADER trials should have changed that perception but old habits die hard.