Maybe LDL is the wrong target. Look at the curve from the FOURIER trial, we reduced LDL from 92 to 30. If LDL were the villain everyone thought then why are the results so….weak?
What FOURIER showed
11.3 percent had a heart attack, stroke, stent or cardiac death on placebo, 9.8 percent on the drug. Death from any cause 3.1 vs 3.2. Nobody lived longer.
SPARCL said the same thing
Similar results in the SPARCL trial with high dose atorvastatin. Strokes down 2 in 100 after 5 years. Actually an increase in hemorrhagic strokes which are usually much worse than the atherosclerotic strokes which it prevented. No change in mortality either.
Is LDL the wrong target?
Maybe we should target things that will help patients in all aspects of life. Promote a nutrient rich diet, HIIT, reduce glucose and insulin spikes, better sleep hygiene, spend more time outside in the sun, avoid chemicals mold and heavy metals. You aren’t living in your grandmother’s world, over 80,000 chemicals are registered for use in the US.
If your cardiologist quotes you 15 percent ask for the absolute number.
If you would like a second opinion on a lipid drug you have been prescribed, that is exactly what my telehealth second-opinion consults are for. More of my writing lives at andrewrudinmd.com.
Sources
- Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. New England Journal of Medicine. 2017;376(18):1713–1722.
- Amarenco P, Bogousslavsky J, Callahan A, et al. High-dose atorvastatin after stroke or transient ischemic attack. New England Journal of Medicine. 2006;355(6):549–559.