re: Statins for cholesterol? Yes or No

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Cholesterol is not nearly as big of an issue as we've been told. Just saying...

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"Cholesterol" is not a big deal at all. The lipoprotein, which carries the cholesterol, is the 800 lb gorilla. Atherosclerosis is a lipoprotein mediated disease, not a cholesterol mediated disease.

You get heart attacks by having too many lipoprotein particles, not by having too much cholesterol in those lipoprotein particles. Which is why simply getting an LDL-C lab, which most primary providers will get, is analogous to weighing the cars on the road instead of counting them to find out how close you are to a traffic jam (heart attack).

If your provider is not getting an LDL-P, you should ask for one or find a different provider. And that is the number that needs to be brought down, either by lifestyle or medications such as statins or PCSK9 inhibitors.

Every year in lipidology research, they're finding that the lower the LDL, the lower the risk of heart attacks. Previous guidelines had the cut off at 140, then moved to 100, now move to 70 for only high risk patients and 55 in super high risk patients. Eventually they're going to recommend LDL levels below 50 for every person, including healthy people, because it is only at those levels that atherosclerotic heart disease does not develop, and the level at which current atherosclerotic heart disease begins to recede in the other direction. That's why the number needed to treat with current statin therapy is so terrible, because the guidelines only recommend going below 100 or below 70, which is not enough. That's why 30 to 40% of people on statins still have heart attacks, because their levels were not reduced sufficiently.