Statins: effectiveness, safety, and common myths on their role in ASCVD prevention

Atherosclerotic cardiovascular disease (ASCVD) is one of the few chronic diseases for which we have a clear, causative factor that can be targeted therapeutically to reduce long-term risk. The strength of evidence from genetic, randomized, and observational data all points in the same direction: ASCVD is caused by circulating, cholesterol-carrying, apolipoprotein B (apoB)-containing lipoprotein particles, which above certain threshold concentrations have the ability to leave plasma, pass through the arterial endothelial lining and enter the underlying intima layer, where atherogenesis occurs. Reducing apoB particle numbers can thus drastically slow disease progression. Of the various pharmacological treatments now available for reducing circulating apoB particles, one of the earliest classes of drugs to be developed remains one of the most effective (and affordable) options – statins.