Adding ezetimibe for high Lp(a) and CAC
Dr. Joshi, firstly Thanks for your selfless service to our community I am currently taking 40 mg Atorvastatin and my LDL is 60, Apo B is 58 and Lp(a) is 106. I have a CAC of 296 as just determined with a CT test with dye. Would it be beneficial to add any other medicine like Ezetimibe? I am seeing an Indian cardiologist but want to get your expert opinion
Great Q Ravi! With Lp(a) 106 and CAC 296, the strategy we’ve been advocating is to drive atherogenic particles even lower. Your LDL 60 and ApoB 58 are good, but given high Lp(a) and plaque burden, many experts aim LDL/ApoB into the <55 range. Adding ezetimibe is a reasonable next step: it’s well‑tolerated, generic, and typically lowers LDL/ApoB another ~15–20%, helping you clear that <55 target (especially helpful when Lp[a] is high). If you don’t reach goal or have events/symptoms, a PCSK9 inhibitor is the next escalation.