In this episode, I talk about why I believe everyone should take lipid lowering medications. Cardiovascular disease is the number one cause of death in the United States. In one paper published in JAMA in 2012, men at age 45 who had risk factors that were all optimal still had a risk of having a cardiovascular event of 15% by age 80. Men with just one risk factor had a risk of 35% by age 85 (PMID 23117780). Subclinical atherosclerosis, which affects quality of life, sexual, and physical functioning, is even more prevalent than these figures indicate.
We know that statins reduce cardiovascular risk regardless of whether or not lipids are elevated (PMID 28444290). Furthermore, impact of LDL cholesterol on cardiovascular disease risk is cumulative, similar to pack-years in tobacco smoking; therefore benefits of lipid-lowering are also cumulative. And as one article points out: “LDL-C exposure in early adulthood may pose greater risk than the same level of exposure later in life” (PMID 34763773).
The side effects of statins are overstated in the popular media. As one meta-analysis showed, “only a small minority of symptoms reported on statins are genuinely due to statins” (PMID 24623264). A paper published this month showed that intensive lipid lowering of LDL cholesterol levels below 40 mg/dL due to statins produced minimal additional risks; it is safe. The risks are even smaller in those treated with the newer classes of lipid-lowering agents such as ezetimibe and the PCSK9 inhibitors (https://doi.org/10.1093/ehjopen/oeac038).
I take 2.5 mg of rosuvastatin and 5 mg of ezetimibe. I experience no side effects, despite a highly active lifestyle as a combat sports athlete. For people who experience a similarly non-existent side effect profile of lipid lowering, I think the decision to use these drugs to minimize long-term cardiovascular disease risk is cut-and-dry.
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