Evolocumab, a prescription injectable medication administered every two or four weeks, helps the liver clear the cholesterol-carrying particles that build plaque in arteries. In large trials, its strong, lasting cholesterol lowering translated into fewer heart attacks, strokes and artery procedures, in people with established artery disease and in higher-risk people before a first event. Side effects are mild. Longer survival is not confirmed; for low-risk individuals, benefit remains untested. (Full Review)
| Marker | Target | Why |
|---|---|---|
| LDL cholesterol | Below 55 mg/dL; many longevity practitioners aim for 30–40 mg/dL | Primary treatment target |
| apoB | Below 60 mg/dL | Counts all artery-clogging particles |
| Lp(a) | Below 75 nmol/L (about 30 mg/dL) | Inherited risk; expected about 25% fall |
| Non-HDL cholesterol | Below 85 mg/dL | Captures all cholesterol in harmful particles |
| Triglycerides | Below 100 mg/dL | Residual risk not addressed by evolocumab |
| HbA1c | Below 5.4% | Screens for new-onset diabetes |
| Fasting glucose | 75–90 mg/dL | Complements HbA1c |
| hsCRP | Below 1.0 mg/L | Residual inflammatory risk |
| Coronary calcium score | 0, or no progression from own baseline | Documents plaque burden |
| Blood pressure | Below 130/80 mmHg | Main modifiable driver of brain bleeding |
Cadence: Baseline before starting (lipid panel with apoB, one-time Lp(a), HbA1c, fasting glucose, blood pressure, and a coronary calcium scan where plaque status is unknown); lipids and apoB 4–12 weeks after starting or changing dose, then every 6–12 months once at target; HbA1c every 12 months (every 6 months with prediabetes); blood pressure at each visit; calcium scan repeated no sooner than 3–5 years. With monthly dosing, blood is drawn just before the next injection.