Drug Preventative Cardiovascular Therapy – PCSK9 Inhibitors (i.e. Repatha) – Here’s the problem

High LDL levels and a history of heart disease in the family are not a reason to take a drug to modify your lipid profile. The sdLDL particle size in the presence of high triglycerides, high inflammation and a poor lifestyle is the real concern, and no drug will help this without a significant trade-off for increased risks for systemic disease vulnerability. Think twice and read on if you are taking or are planning to take a monoclonal antibody like Repatha.

Repatha (Evolocumab)

Repatha is a monoclonal antibody that inhibits PCSK9, a protein that degrades LDL receptors. By blocking PCSK9, Repatha increases LDL receptor availability in the liver, removing more LDL cholesterol from the blood. It’s prescribed for people with high LDL, particularly those at high cardiovascular risk or with genetic conditions like familial hypercholesterolemia.

Why This Can Be Problematic

Reducing LDL cholesterol excessively with PCSK9 inhibitors like Repatha can interfere with key functions of cholesterol in the body, including:

1. Stress Response Buffering: LDL carries cholesterol essential for producing cortisol, the stress hormone, needed for energy and resilience during stress.

2. Steroid Hormone Synthesis: Cholesterol is the precursor for hormones like testosterone, progesterone, and estrogen. Lower LDL will disrupt hormone production, leading to fatigue, hormonal imbalances, and reduced fertility.

3. Cell Membrane Integrity: Cholesterol is essential for maintaining the fluidity, integrity, and permeability of cell membranes, and insufficient LDL-derived cholesterol weakens membrane structure, impairing signal transmission (e.g., hormone or neurotransmitter receptor function) and the transport of essential molecules into and out of cells.

4. Vitamin D Synthesis: Cholesterol is necessary for producing vitamin D in the skin upon exposure to UV light. Lower levels of circulating LDL leads to Vitamin D deficiency, weakening immune function, bone health, and disrupting calcium regulation.

5. Bile Acid Production: Cholesterol is used to synthesize bile acids, essential for digesting and absorbing dietary fats. Lowering LDL in the blood disrupts lipid transport and reduces cholesterol availability for bile acid production, impairing fat digestion and beta-oxidation. This forces the body to rely more on glucose for energy, increasing insulin demand and potentially worsening metabolic inefficiency and insulin resistance.

6. Immune System Function: LDL binds to and neutralizes bacterial toxins, aiding in immune defense. Lowering circulating LDL weakens the innate and adaptive immune systems, reducing the body's ability to fight infections and manage inflammation.

7. Neuroprotection: Cholesterol is vital for myelin sheath formation around neurons in the brain and overall brain function. Lowering available LDL cholesterol will impair cognitive function and increase neural vulnerability to all toxins and stressors.

8. Energy Regulation: Cholesterol supports mitochondrial function and the production of coenzyme Q10, essential for energy metabolism. Lowering LDL cholesterol levels available to the mitochondria will result in a reduction in bioenergetics and energy availability for the entire body, slowing every biologic process from oxygen and nutrient delivery to waste removal.

Why High LDL May Not Be a Problem in the Right Context

• Circadian Signaling: When the body’s circadian rhythms are optimized (via proper light exposure, sleep, and activity patterns), LDL cholesterol is utilized effectively for all the above processes especially repair, protection and hormone production.

• Low Inflammation: LDL only becomes problematic when it’s oxidized due to chronic inflammation. If inflammation markers (e.g., CRP) are low, high LDL may not pose a risk.

• Low Triglycerides: When triglycerides are in the bottom quartile of the reference range, LDL particles are typically larger and less likely to be oxidized or contribute to plaque formation.

• Particle Size: Small, dense LDL (sdLDL) is atherogenic, while large, buoyant LDL is not. Measuring LDL particle size gives a clearer picture than total LDL levels. It makes absolutely no sense to take a monoclonal antibody to prevent LDL receptor reduction in the liver, lowering circulating LDL when you have not tested for sdLDL, triglycerides and inflammatory levels or looked at the person’s lifestyle (sleep, light exposure, meal timing, exercise habits, stress management, social connection and purpose). In all of those is where the problem lies, not in a broad lab value or fear around a history of heart disease in the family, those are meaningless by themselves.
  
  

The elevation of LDL in the blood is a symptom of an underlying problem and covering it up by increasing the LDL cholesterol uptake in the liver is not solving the root cause, it may lower the number but then leave the circulatory system still armed and ready to keep risks of heart disease elevated. The larger fluffy cholesterol m molecules such as VLDL is a stress protective substance and also is fuel for steroid hormones and many other essential bodily biomolecules for essential functions. As a blanket statement lowering LDL cholesterol in the blood is not going to lower your risk of cardiovascular disease, heart disease, atherosclerosis and heart attack. In the scientific literature there is evidence of cholesterol levels being linked to heart conditions for the same reason that fire trucks are found at the site of fires. They did not cause each other the inflammation or fire caused it; the cholesterol or firemen are merely there as an intelligent response.]

The Root Cause of High LDL

Elevated LDL often signals an underlying issue, such as:

• Poor Metabolic Health: Insulin resistance, high triglycerides, or low HDL.

• Inflammation: From insufficient full spectrum light exposure, poor meal timing or composition, excessive stress, or environmental toxins such as exposure to wireless radiofrequency radiation or dirty electricity (high frequency transients) in the bedroom or office.

• Liver Dysfunction: Impaired cholesterol recycling.

• Poor Circadian Health: Disrupted light exposure and sleep patterns.

By addressing these root causes, LDL levels and overall health improve naturally without the need to artificially suppress cholesterol with Repatha.

Why Repatha Can Be Harmful

1. Weakens the Stress Response: Lower cholesterol reduces cortisol production, impairing energy and resilience under stress.

2. Hormonal Deficiencies: Testosterone, progesterone, and vitamin D levels drop, affecting mood, energy, and overall health.

3. Fatigue: A weaker morning cortisol spike reduces energy levels.

4. Disrupted Natural Regulation: The liver’s cholesterol management system is highly adaptive. Overriding it with drugs ignores its intelligence.

5. Focuses on Symptoms, Not Causes: High LDL is often a marker, not the problem itself. Without addressing underlying inflammation or metabolic issues, the root cause persists.
   
   

In short, while Repatha may lower circulating LDL cholesterol, you can see that this fails to address the real problem and leaves the person with increased vulnerability to a myriad of other problems mentioned above. This uninformed approach ignores the vital roles cholesterol plays in the body and will absolutely harm overall health by disrupting the body’s natural balance.