Starting Strong: Why Doctors Should Begin with High-Dose Statins to Save Lives

There is broad consensus among medical professionals that lowering LDL (low-density lipoprotein) cholesterol levels provides significant benefits in treating and preventing cardiovascular disease. Often referred to as “bad” cholesterol, elevated levels of LDL can clog arteries and increase the risk of heart attacks and strokes.

Researchers from Florida Atlantic University’s Schmidt College of Medicine have published an invited editorial in Trends in Cardiovascular Medicine, urging cardiologists to achieve lower LDL cholesterol levels beginning with the highest doses of potent statins, such as rosuvastatin and atorvastatin. The authors emphasize that high-potency statins should be the primary pharmacologic treatment for cardiovascular disease, alongside therapeutic lifestyle changes.

Therapeutic lifestyle changes, including avoidance or cessation of smoking, healthy body weight and blood pressure, regular physical activity, and restricted alcohol consumption, are proven to be effective in treating and preventing cardiovascular diseases. However, despite these benefits, approximately 40% of adults in the United States have metabolic syndrome, a constellation of risk factors that significantly increases their cardiovascular risk.

The authors also highlight the importance of physical activity, noting that only about 21% of Americans meet the minimum daily requirement. They emphasize that meaningful increases in physical activity are possible at any age, including among older adults.

Based on the robust totality of randomized trial data and meta-analyses, the authors conclude that statins, particularly rosuvastatin and atorvastatin, have the strongest and most consistent body of evidence supporting their prescription in treatment and prevention for both men and women, including older adults.

The authors recommend starting therapy with the highest dose of these agents and titrating down if necessary. They also highlight the benefits of statins and aspirin being additive or potentially synergistic. Most secondary prevention patients should be prescribed aspirin; however, individual clinical judgments are necessary in primary prevention, and aspirin should be considered after statins.

“Practicing cardiologists may wish to consider that all adjunctive drug therapies to therapeutic lifestyle changes should be added only after achieving maximal doses of statins,” said Charles H. Hennekens, M.D., FACC, senior and corresponding author. “Further, statins have the largest and most persuasive body of evidence of any pharmacological adjunctive therapy in treatment and prevention of cardiovascular disease.”

The researchers offer cautious views on adjunctive therapies such as ezetimibe and evolocumab, which tend to be used more widely than optimal. They suggest that these therapies may be more appropriately reserved for select high-risk patients who have not achieved LDL goals with statins alone.

The authors also discuss the role of omega-3 fatty acids, noting that earlier trials were positive but later tended to show no net benefit. They opine that this may have been due to widespread statin use and suggest that icosapent ethyl was the only omega-3 fatty acid to demonstrate significant added benefits when added to evidence-based doses of high potency statins.

Hennekens reflected on the enduring relevance of Benjamin Franklin’s 1736 observation, “An ounce of prevention is worth a pound of cure.” The authors conclude that starting with high-dose statins can save lives and emphasize the importance of prevention in cardiovascular disease management.

The study published in the journal Gut has shed light on the potential link between high levels of the gut hormone INSL5 and up to 40% of cases of irritable bowel syndrome with diarrhea (IBS-D). Researchers at the University of Cambridge have been exploring whether this hormone plays a role in chronic diarrhea, which can be triggered by bile acid malabsorption. This is a significant breakthrough, as it may lead to the development of a blood test for diagnosing IBS-D and provide new insights into potential treatments.

Bile acid diarrhea (also known as bile acid malabsorption) affects around one person in every 100, causing urgent and watery diarrhea. The condition can be difficult to diagnose, with many individuals receiving a diagnosis of irritable bowel syndrome (IBS), an umbrella term for various conditions. Studies have suggested that INSL5 may play a role in chronic diarrhea, particularly in cases triggered by bile acid malabsorption.

Researchers at the University of Cambridge collaborated with pharmaceutical company Eli Lilly to develop a new antibody test that allows them to measure tiny amounts of INSL5. They analyzed samples from patients with IBS-D and found that levels of INSL5 were significantly higher in those with bile acid diarrhea, compared to healthy volunteers.

The study’s findings also provide potential targets for treatment. Dr. Chris Bannon, the first author of the study, notes that understanding the role of gut hormones like INSL5 is essential for developing effective treatments for IBS-D and other gastrointestinal disorders.

The research was supported by the Medical Research Council and Wellcome, with additional support from the National Institute for Health and Care Research Cambridge Biomedical Research Centre. The study’s findings have significant implications for the diagnosis and treatment of IBS-D, a condition that affects millions worldwide.

The World Health Organization predicts that over half of the global population will develop overweight or obesity by 2035. Despite treatment strategies like lifestyle changes, surgery, and medications, these methods are not universally available or effective. An international team of researchers has made a groundbreaking discovery – a genetic test that can predict adulthood obesity in early childhood.

By leveraging genetic data from over five million people, the researchers created a polygenic risk score (PGS) that identifies children at higher genetic risk of developing obesity. This finding could lead to targeted preventative strategies, such as lifestyle interventions, at a younger age.

“What makes this score so powerful is its ability to predict, before the age of five, whether a child is likely to develop obesity in adulthood,” says Assistant Professor Roelof Smit from the NNF Center for Basic Metabolic Research (CBMR) at the University of Copenhagen and lead author of the research published in Nature Medicine.

The study draws on data from the Genetic Investigation of Anthropometric Traits (GIANT) Consortium, an international collaboration of human genetics researchers. The research involved a partnership with 23andMe, inc., and contributions from over 600 scientists from 500 institutions globally.

Twice as effective at predicting obesity as the next best test, the new PGS combines the effects of thousands of genetic variants that increase our risk of obesity. These variants act in the brain and influence our appetite, making them a crucial factor in the development of adulthood obesity.

“This new polygenic score is a dramatic improvement in predictive power and a leap forward in the genetic prediction of obesity risk,” says Professor Ruth Loos from CBMR at the University of Copenhagen.

While genetics is not destiny, the researchers also investigated the relationship between a person’s genetic risk of obesity and the impact of lifestyle weight loss interventions. They found that people with a higher genetic risk of obesity were more responsive to interventions but also regained weight more quickly when the interventions ended.

However, the new PGS has its limitations – it was far better at predicting obesity in people with European-like ancestry than in people with African ancestry. Further research is needed to address these disparities and make this groundbreaking test universally useful.