Doctors agree that lowering LDL (low-density lipoprotein) cholesterol is key to preventing heart disease and stroke.
LDL is often called the “bad” cholesterol because high levels can clog arteries and increase the risk of serious heart problems.
In a new editorial in Trends in Cardiovascular Medicine, experts from Florida Atlantic University’s Schmidt College of Medicine say cardiologists should begin treatment with high doses of powerful statins—especially rosuvastatin and atorvastatin.
These medications should be used alongside healthy lifestyle changes.
The authors emphasize that lifestyle changes, such as quitting smoking, maintaining a healthy weight and blood pressure, exercising regularly, and limiting alcohol, are always important.
However, lifestyle changes alone may not be enough—especially since about 40% of U.S. adults have metabolic syndrome, which raises their heart disease risk to the level of those who’ve already had a heart attack or stroke.
Unfortunately, only about 1 in 5 Americans meet the minimum recommended daily physical activity. But it’s never too late to start. Even older adults can benefit from moving more.
Statins, especially rosuvastatin and atorvastatin, are supported by the strongest evidence from clinical trials.
Because patients usually stay on the first dose they’re prescribed, the authors suggest starting at the highest dose and reducing later if needed.
Statins and aspirin can also work well together—especially for people who have already had heart problems. For others, doctors should consider the risks and benefits before adding aspirin to statin therapy.
Other cholesterol-lowering treatments like ezetimibe and evolocumab may help certain high-risk patients who don’t meet LDL goals with statins alone. But the benefits are often smaller.
For example, the IMPROVE-IT trial showed only a small improvement with ezetimibe, and the FOURIER trial showed that evolocumab was most helpful in patients with familial hypercholesterolemia already on statins.
As for omega-3 supplements, the results are mixed. Most did not show added benefits when people were already taking statins. However, one form—icosapent ethyl—did reduce major heart events by 25% in the REDUCE-IT trial, especially when added to high-potency statins.
Dr. Charles Hennekens, senior author of the editorial, reminds us of a wise quote from Benjamin Franklin: “An ounce of prevention is worth a pound of cure.”
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