I wrote this post in reply to another thread, but I thought it may be useful for others to see.
Reduction of LDL at any point in time will reduce the cumulative risk of heart attack (myocardial infarction, MI)
Based on this paper, you have a total of ~5000 mg-years before cardiovascular risk starts to really increase. Add up all LDL averages for each year, and once it totals 5000, the vast majority of people will have detectable cardiovascular disease. So 50 years at an average of 100 LDL will be the point at which cardiovascular health begins to clinically deteriorate. Since most people have had LDL levels significantly above this, it makes sense to reduce LDL as much as possible as early as possible.
Source
The statin pitavastatin has recently gone generic and insurance should no longer require preauthorization to be prescribed it. Most doctors don't even know about it, probably because of the prohibitive cost before it became generic.
Pitavastatin not only lowers LDL but also helps arteries relax (via enhanced NO2 release, also helping erectile function), calms systemic inflammation (reduces CRP), stabilizes plaques, supports better glucose handling, reduces oxidative damage, improves HDL function, and lowers clot risk. The combination of 4mg of pitavastatin and 10mg of ezetimibe can reduce LDL up to 60% with practically no side effects.
Pravastatin is probably the next best choice if pitavastatin isn't available since it doesn't have the risk of causing insulin resistance. Shown below is the dose response curves for statins. Below is another chart which shows even more comparison of statins and their relative effectiveness. 4mg of pitavastatin is the first choice depending on how much LDL needs to come down. Second choice would be 40mg of pravastatin. Last choice would be 5mg of rosuvastatin. All of these can have 5-10mg of ezetimibe added with practically no additional side effects. If that still doesn't bring LDL down enough then add bempedoic acid, however that could potentially have a long term tendon risk.
The absolute best drugs for cholesterol are the PCSK9 inhibitors like repatha, but those are very expensive and hard to get.
Reduction of LDL at any point in time will reduce the cumulative risk of heart attack (myocardial infarction, MI)
Based on this paper, you have a total of ~5000 mg-years before cardiovascular risk starts to really increase. Add up all LDL averages for each year, and once it totals 5000, the vast majority of people will have detectable cardiovascular disease. So 50 years at an average of 100 LDL will be the point at which cardiovascular health begins to clinically deteriorate. Since most people have had LDL levels significantly above this, it makes sense to reduce LDL as much as possible as early as possible.
Source
The statin pitavastatin has recently gone generic and insurance should no longer require preauthorization to be prescribed it. Most doctors don't even know about it, probably because of the prohibitive cost before it became generic.
Pitavastatin not only lowers LDL but also helps arteries relax (via enhanced NO2 release, also helping erectile function), calms systemic inflammation (reduces CRP), stabilizes plaques, supports better glucose handling, reduces oxidative damage, improves HDL function, and lowers clot risk. The combination of 4mg of pitavastatin and 10mg of ezetimibe can reduce LDL up to 60% with practically no side effects.
Pravastatin is probably the next best choice if pitavastatin isn't available since it doesn't have the risk of causing insulin resistance. Shown below is the dose response curves for statins. Below is another chart which shows even more comparison of statins and their relative effectiveness. 4mg of pitavastatin is the first choice depending on how much LDL needs to come down. Second choice would be 40mg of pravastatin. Last choice would be 5mg of rosuvastatin. All of these can have 5-10mg of ezetimibe added with practically no additional side effects. If that still doesn't bring LDL down enough then add bempedoic acid, however that could potentially have a long term tendon risk.
The absolute best drugs for cholesterol are the PCSK9 inhibitors like repatha, but those are very expensive and hard to get.
