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Comment by someguydave | Hacker News Reader

If moving “high risk” patients to lower cholesterol levels does not decrease mortality, why bother with statins?

It could be that it reduces mortality, but it's still above average.

I agree with this conclusion.

Not all mortality risk operates through cholesterol-dependent mechanisms. And even for those that do, decades of exposure to high cholesterol can’t be totally reversed by medications.

That’s reasonable. Does that mean that another endpoint aside from cholesterol should be the target of control?

Ultimately you want a readout of CAD risk, and we know that only a portion of CAD risk is attributable to LDL. We're always on the lookout for better biomarkers, but right now there isn't a comprehensive CAD biomarker (aside, perhaps, from coronary calcium - but we can't go around exposing everyone to radiation every year just to observe disease progression).

Last time I’d read into it, statins didn’t move mortality numbers for most members of the population.

Edit: they do decrease your risk of a heart attack a bit, but the increased incidence of cancer and diabetes actually eliminates the benefit for most users. The only people who showed any measurable reduction in mortality were non-elderly patients with a history of cardiovascular disease.

https://www.marksdailyapple.com/the-evidence-continues-to-mo...

This is a mix of outdated and simply wrong information.

I’m unconvinced by your unsupported assertion.

because they had high cholesterol for decades and the damage is already done. Decreasing cholesterol helps them, but they are not as healthy as someone with naturally such low cholesterol.

But naturally low cholesterol was not associated with decreased mortality in Koreans?

This study doesn't tell us if these participants had naturally low cholesterol or artificially low cholesterol (i.e., from medications). So no such conclusion can be determined.

Agreed, yet that conclusion (that low cholesterol is somehow harmful) cannot be excluded either. I agree that it would be interesting to see how the results of the Korean study would change if statin-takers were excluded.

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