How Beneficial are Statins and PCSK9-Inhibitors?

Abstract

Cholesterol is a combination of cholesterol, protein and fat, assembled in different combinations, yielding various forms of cholesterol molecules. Routine evaluation of one’s risk for coronary artery disease has focused on measuring cholesterol levels in the blood. Assessment of the benefit of lowering LDL cholesterol has focused on the use of these blood tests, coronary arteriograms and Coronary Artery Calcium (CAC) scores. However, evidence demonstrates that changes in blood cholesterol and other inflammatory markers does not correlate with actual changes in physiologic CAD. The use of most cholesterol lowering medications is not associated with a reduction in body LDL cholesterol, but rather a shift of LDL from the blood into the cells of the body, where actual oxidative damage is associated with inflammatory problems. Absent the demonstration of improvement in physiologic CAD, coupled with increased questions about benefit to risk ratios, the true benefit of these drugs should be transparently reviewed along with a call for more investigation into the impact of the dietary issues related to CAD.