High Lp(a), Strong Lifestyle Changes, LDL Controlled – Should I Add Repatha?

Hi everyone,
I’m a 28-year-old male. After my mom had a premature heart attack (NSTEMI with one stent placed in the LAD), I started taking my health much more seriously.
Over the last few years I:
Quit smoking
Lost 38 kg (84 lbs)
Started exercising regularly
Built muscle
Cycle to work instead of driving
Swim moderately
Follow a mostly Mediterranean diet
Reduced saturated fat and increased fiber intake
I’ve always had high LDL cholesterol since my teens (typically 150–167 mg/dL), but I largely ignored it when I was younger.
Family history is somewhat mixed:
Mom: NSTEMI in her early 50s, one LAD stent, heavy smoker, uncontrolled hypertension for many years
Maternal grandmother: died at 83 after multiple ischemic strokes (had 3 strokes total)
Paternal grandmother: died at 75 with kidney disease and a hemorrhagic stroke, had untreated high cholesterol
After my lifestyle changes, I was able to lower my LDL to around 109–120 mg/dL without medication.
I then checked additional markers:
ApoB: 120 mg/dL
Lp(a): 97 nmol/L
What surprised me was that my Lp(a) kept increasing on repeat testing despite no medications:
97 nmol/L
128 nmol/L
140 nmol/L
148 nmol/L
I saw a cardiologist and had:
ECG
Echocardiogram
Stress test
CIMT
Everything was normal.
My cardiologist then prescribed:
Rosuvastatin 5 mg
Ezetimibe 10 mg
After 6 weeks:
LDL: 64 mg/dL
ApoB: 61 mg/dL
Lp(a): 168 nmol/L
The dose was then increased to:
Rosuvastatin 10 mg
Ezetimibe 10 mg
I just repeated my labs:
LDL: 64 mg/dL
ApoB: 64 mg/dL
Lp(a): 183 nmol/L
HbA1c: 5.3% (previously 5.1%)
Fasting glucose: 83 mg/dL
Fasting insulin: 8
hs-CRP: normal
Kidney function: normal
Liver enzymes: normal
Platelets: normal
Vitamin D: normal
CK: 189 (upper limit 171)
I have essentially no significant side effects from rosuvastatin + ezetimibe. Occasionally I notice some mild muscle aches and maybe some mood swings, but nothing major.
My cardiologist has managed to get Repatha approved for me, and now I’m trying to decide whether it’s really necessary.
Questions:
Would you start Repatha in my situation?
Would you stay on rosuvastatin 10 mg + ezetimibe 10 mg and add Repatha?
Would you lower rosuvastatin back to 5 mg and add Repatha?
Would you stop rosuvastatin altogether and use Repatha instead?
One reason I’m hesitant is that I’ve read a lot of negative experiences online involving Repatha, including reports of increased blood pressure, elevated blood sugar, severe muscle pain, and other side effects.
For context, before my lifestyle changes:
BP was around 155/90
Resting heart rate was 95–110 bpm
Now:
BP is usually around 120/65
Resting heart rate is 65–70 bpm
Given my age, family history, current LDL/ApoB levels, and rising Lp(a), would you personally start Repatha if you were in my position?
I appreciate any insight or experiences. Thanks!