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.