Lowering LDL cholesterol—the so-called “bad” cholesterol—is one of the most effective ways to prevent heart disease and strokes.
High LDL levels can clog arteries, leading to dangerous blockages that may trigger heart attacks or strokes. Medical experts agree that reducing LDL brings both clear and meaningful health benefits.
In a new editorial published in Trends in Cardiovascular Medicine, researchers from Florida Atlantic University’s Schmidt College of Medicine are encouraging cardiologists to aim for lower LDL levels by starting patients on the highest doses of the strongest statins available—rosuvastatin and atorvastatin.
They say these medications should be the main drug treatment for cardiovascular disease, used alongside healthy lifestyle changes.
Lifestyle changes remain critical for preventing and treating heart disease, whether or not patients are taking medication. Proven steps include quitting smoking, keeping a healthy weight, maintaining normal blood pressure, exercising regularly, and limiting alcohol.
However, many people struggle to meet these goals. In the United States, about 40% of adults have metabolic syndrome—a group of conditions such as obesity, high blood pressure, abnormal cholesterol levels, and insulin resistance—that raises …
Despite the known benefits of exercise, only about one in five Americans gets the recommended daily amount of physical activity. The good news is that improvements in activity levels can help at any age.
According to the authors, decades of research and large-scale clinical trials show that statins—especially rosuvastatin and atorvastatin—are the most reliable and effective drugs for both preventing and treating heart disease in men and women, including older adults.
Because patients often remain on their starting dose, they recommend beginning treatment with the highest safe dose, lowering it later if needed. They also note that statins and aspirin can work together for added protection.
Most patients who already have heart disease (secondary prevention) should take aspirin, but for those without heart disease (primary prevention), doctors must weigh the benefits against the risks, such as internal bleeding.
The authors advise that other cholesterol-lowering drugs like ezetimibe and evolocumab should be reserved for patients at very high risk who do not reach their LDL targets with statins alone.
For example, the IMPROVE-IT trial found only small benefits when ezetimibe was added to simvastatin. Evolocumab has shown benefits for people with inherited high cholesterol who are already on strong statins, but its wider use may not be necessary.
Omega-3 fatty acids were once thought to lower heart risk, but more recent studies have been less convincing—possibly because so many people now take statins.
One exception is the REDUCE-IT trial, which showed that icosapent ethyl, a purified form of omega-3, cut major heart events by 25% when added to high-dose statins. In that study, only 21 patients needed to be treated to prevent one serious cardiovascular event.
Senior author Dr. Charles H. Hennekens summed up the approach simply: start with the most proven therapy—high-dose statins—before adding other drugs. His advice echoes Benjamin Franklin’s old saying from 1736: “An ounce of prevention is worth a pound of cure.”
If you care about heart health, please read studies about This vaccine could reduce risks of heart disease, stroke in older people and How napping influences your heart health.
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The study is published in Trends in Cardiovascular Medicine.
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