Hard Drugs Should everyone be taking statins?
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Feb 27, 2026 A lively dive into the cholesterol revolution, from fungal statin discoveries to new LDL-busting drugs that last months. They trace how cholesterol travels, causes artery plaque, and why lowering it became medical consensus. The conversation highlights genetic breakthroughs, PCSK9 and RNA therapies, and the big unanswered questions about who should be treated.
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How Heart Disease Deaths Fell By Three Quarters
- Cardiovascular mortality has dropped ~75% in the U.S. since the 1950s due to combined public health, emergency care, surgery, and medicines.
- Saloni highlights smoking reduction, CPR, pacemakers, statins and blood-pressure drugs as stacked contributors to that fall.
Why LDL Causes Atherosclerotic Plaques
- Atherosclerosis is cholesterol-driven plaque buildup in artery walls that narrows flow and can rupture to cause heart attacks or strokes.
- Jacob explains plaques form when lipoprotein particles penetrate damaged endothelium and attract immune cells that become foamy and trapped.
The Quantitative LDL Risk Relation
- Each 40 mg/dL rise in LDL increases cardiovascular risk ≈20% on average, shown by randomized trials lowering LDL and observing event reductions.
- Jacob cites the Cholesterol Treatment Trialists meta-analyses linking LDL change magnitude to proportional risk drops.
