[pdmtong]

Originally Posted by dziehr

Foremost, if you have had an MI, lowering your LDL with a statin has been shown repeatedly in large, blinded, randomized controlled trials to reduce both cardiovascular morbidity and overall mortality. In other words, for secondary prevention, there are exceedingly few cases when you should not be on a statin (or other lipid-lowering therapy). Period.

Most folks here are commenting on statins for primary prevention (ie prevention of the first MI for someone at risk of atherosclerotic coronary disease). There is unequivocal evidence from both prospective randomized trials as well as epidemiological studies with hundreds of thousands of patients that show that: 1. there is a dose response between LDL and incidence of heart disease and all-cause mortality and 2. when patients lower their LDL (with medication or lifestyle modification), this risk decreases.

It's also worth mentioning that many of the cardiologists and endocrinologists who study statins believe that their effects are pleiotropic; that is, they lower LDL but also have other antiinflammatory off-target effects that reduce atherosclerosis and stabilize coronary plaques. (And we know that inflammation is a prime driver of atherosclerosis.)

For those with elevated LDL, there are risk calculators that use strong epidemiological data to determine if you and your doctor should consider a statin. These calculators are helpful but not a panacea. Statin myopathy can be troublesome, and folks will sometimes need to try different meds (we handle different statins differently) or dosing strategies. The decision to start a medication should always be collaborative, but expert guidance with facts from innumerable studies should outweigh uniformed anecdote.

Finally, there's new evidence to suggest that it's not just the degree of elevation of LDL but also the duration of that elevation (tracking back decades, before other risk factors were introduced) that contributes to coronary artery disease. (Which is common sense I suppose.) There's a lot of hereditary hypercholesterolemia and we Western folk in the 21st century are exposed to an environment that is driving up our lipids for various other reasons. I know several folks (physicians) in my age cohort (30s) who know the data and take a statin.

Nota bene: I'm an MD.

I'll chime in too. THANK YOU!