Author Affiliations: The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland.
Should a 55-year-old man who is otherwise well, with systolic blood pressure of 110 mm Hg, total cholesterol of 250 mg/dL, and no family history of premature CHD be treated with a statin?—Yes.
Atherosclerotic coronary heart disease (CHD) is the most common cause of morbidity and mortality in the world. The “lipid hypothesis” of CHD is clearly established: (1) circulating cholesterol plays a central role in atherogenesis and is an integral component of the requisite lesion, the coronary plaque; (2) cholesterol levels beginning in childhood predict lifetime risk of atherosclerotic CHD events in a dose-response relationship; and (3) statins lower cholesterol levels and reduce CHD and cerebrovascular events directly proportional to the degree of low-density lipoprotein cholesterol (LDL-C) lowering. As a result, guidelines from around the world support a combined lifestyle and pharmacologic approach to cholesterol lowering directed at patients with elevated CHD risk.
Blaha MJ, Nasir K, Blumenthal RS. Statin Therapy for Healthy Men Identified as “Increased Risk”. JAMA. 2012;307(14):1489–1490. doi:10.1001/jama.2012.425
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