Cardiovascular disease is a solved problem

Summary

Executive summary Cardiovascular disease is the #1 cause of death in modern nations Lifetime exposure to circulating LDL is the root cause of cardiovascular disease Circulating LDL can be dramatically lowered with safe pharmacological treatments For young adults in good health, preventative usage of LDL-lowering therapies eliminates future risk of cardiovascular disease Abstract Cardiovascular disease (CVD) is the leading cause of death in the developed world. The progression of cardiovascular disease is fully dependent upon the retention of low-density lipoproteins (LDLs) into the arterial wall, triggering the growth of atherosclerotic plaques. Only certain LDLs, namely those attached to apolipoprotein B (apoB) and apolipoprotein(a) (Lp(a)), tend to become pathologically embedded in the arterial wall in the course of their circulation in the bloodstream. Circulating levels of lipoproteins are largely genetically determined, with minimal influence from lifestyle factors, and modern pharmaceuticals are capable of dramatically reducing LDL levels to those incapable of causing cardiovascular disease in the span of a human lifespan. These pharmacological treatments are safe and well-tolerated, and there is no lower limit at which LDL reduction stops being beneficial. For young adults in relatively good health, aggressive LDL reduction will permanently protect them from developing cardiovascular disease with nearly zero downside. Consequently, cardiovascular disease is effectively a fully solved problem. Introduction The claim that cardiovascular disease is solved is at first glance outlandish. In 2020, the CDC ranked heart disease as the most common cause of death in the United States, surpassing even the death toll from all cancers combined.1 How is it possible to claim that CVD is “solved?” In this article, I will advance the conclusion that cardiovascular disease is, indeed, solved. Half a century of scientific advances, beginning with the development of HMG-CoA redu...