September 26, 2023

Preventing Chronic Disease

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

A review of the evidence for statins in combating heart disease

Peter Attia

Read Time 14 minutes

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.

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  1. What do you think about the study linking statin with mitochondrial dysfunction ? Could it impairs muscle adaption to endurance training – like VO2 max ? Do you prefers using some more ”hepato-selective” statin (if you believe the pharmaco-kinetic is convincing..) like pravastatin for this population ?

  2. I am most concerned about the reported increased risk of peripheral neuropathy caused by statins, especially given the potential impact on balance and physical function. I have seen some suggestions that taking CoQ10 or niacin might decrease the risk. If this is a valid concern, are some statins better than others to reduce this risk?

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