LDL Cholesterol

When high

Supplements:

• Citrus Bergamot -- 500mg 2x/day
• Red Yeast Rice -- as directed
• Plant Sterols -- as directed
• Omega-3 (EPA/DHA) -- 2-3g/day

Lifestyle:

• Increase dietary fibre (oats, psyllium husk, vegetables)
• Reduce processed foods and trans fats
• Regular cardio 3-5x/week
• If LDL >4.5 mmol/L on-cycle, consider shortening cycle or dropping oral AAS

Pharmacological options (first-line when LDL >3.5 mmol/L on cycle):

• Rosuvastatin -- 5-10mg/day; first-line; physician oversight; monitor CK (athletes already have elevated baseline) and ALT
• Ezetimibe -- 10mg/day; ~20% LDL drop; additive with statin; minimal side effects; useful as stand-alone for statin-intolerant athletes
• Bempedoic acid -- 180mg/day; statin alternative with no muscle uptake; ideal when statins cause CK elevation
• PCSK9 inhibitors (alirocumab 75mg, evolocumab 140mg subQ q2 weeks) -- ApoB-driven elevation when statin/ezetimibe insufficient; very effective (~60% LDL drop) but expensive; physician supervision required
• All require physician oversight; baseline liver/CK panel before starting

Compound rankings and an on-cycle management protocol for a worsening lipid panel: How to protect your cholesterol on steroids.

What a permanent PCSK9 knockout would and would not do to a lipid panel like yours: Does Verve 102 fix the cholesterol damage from steroids?.