Lowering LDL cholesterol, often referred to as the “bad” cholesterol, offers both statistically and clinically significant benefits for treating and preventing cardiovascular disease.
Elevated LDL levels can clog arteries and significantly raise the risk of heart attacks and strokes.
In an editorial published in Trends in Cardiovascular Medicine, researchers from Florida Atlantic University’s Schmidt College of Medicine urge cardiologists to begin LDL-lowering treatment with high doses of potent statins—specifically rosuvastatin and atorvastatin—alongside therapeutic lifestyle changes.
These lifestyle changes, which include quitting smoking, maintaining a healthy weight and blood pressure, engaging in regular physical activity, and limiting alcohol consumption, remain crucial in preventing and managing cardiovascular disease.
However, despite the known benefits of lifestyle changes, about 40% of U.S. adults have metabolic syndrome—obesity, hypertension, dyslipidemia, and insulin resistance—placing them at high cardiovascular risk. Many of these individuals remain undiagnosed and undertreated.
The authors note that only 21% of Americans meet the minimum daily physical activity requirement, but increases in physical activity are possible at any age.
They advocate for initiating statin therapy at the highest doses, as most patients tend to remain on their initial dose long term. Rosuvastatin and atorvastatin have the strongest and most consistent data supporting their use in both men and women, including older adults.
The editorial also highlights the benefits of combining statins with aspirin in secondary prevention, with potential additive or synergistic effects. For primary prevention, aspirin should be prescribed after statins and only if the residual cardiovascular risk exceeds the risk of major bleeding.
The researchers offer cautious perspectives on adjunctive therapies such as ezetimibe and evolocumab. For instance, ezetimibe added to simvastatin showed only minor benefits in the IMPROVE-IT trial, and evolocumab showed benefits in secondary prevention for familial hypercholesterolemia patients already on maximal statins in the FOURIER trial.
The ongoing ILLUMINATE trial may provide more evidence for high-risk primary prevention cases.
Regarding omega-3 fatty acids, while earlier studies were positive, more recent ones showed less benefit—possibly due to the widespread use of statins. Notably, the REDUCE-IT trial demonstrated that icosapent ethyl, a purified form of eicosapentanoic acid, reduced major cardiovascular events by 25% when added to high-dose statins.
Senior author Dr. Charles H. Hennekens emphasized that statins have the most persuasive evidence among all pharmacological adjunctive therapies for cardiovascular disease. He echoed Benjamin Franklin’s timeless advice: “An ounce of prevention is worth a pound of cure.”
If you care about heart health, please read studies about how eating eggs can help reduce heart disease risk, and herbal supplements could harm your heart rhythm.
For more health information, please see recent studies about how drinking milk affects risks of heart disease and cancer, and results showing strawberries could help prevent Alzheimer’s disease.
First author of the editorial is John Dunn, a third-year medical student at the Schmidt College of Medicine.
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