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Episode Description
Should LDL be treated? In this episode of Metabolic Mind, Dr. Bret Scher explains why the better question is who may benefit from LDL lowering, how aggressively it should be treated, and what outcomes matter most to the individual patient.
Dr. Scher reviews two major trials that studied aggressive LDL lowering in very different populations. VESALIUS-CV looked at high-risk patients with serious vascular disease and found that adding a PCSK9 inhibitor reduced both cardiovascular events and all-cause mortality. STAREE studied older adults without known cardiovascular disease and found fewer cardiac events with statin therapy, while overall survival and hospitalizations did not change. Disability-free survival also showed no difference
He covers:
- Why LDL treatment depends on the person, not just the number
- What VESALIUS-CV found in high-risk patients with vascular disease
- Why STAREE tells a different story in older adults without known heart disease
- The difference between reducing cardiac events and extending life
- Why vascular disease should shape how aggressively LDL is treated
- How age, frailty, cognition, cancer risk, and independence affect the risk-benefit conversation
- Why LDL may need a different discussion for someone using ketogenic therapy
- How metabolic health, insulin resistance, and direct evidence of vascular disease fit into the decision
These trials illustrate why LDL treatment should be individualized with a healthcare provider. For some patients, aggressive lowering may save lives. For others, the benefits may be smaller or less connected to the outcomes they care about most.
🔎 Have questions about how to apply metabolic therapies effectively? Submit them at metabolicmind.org/questions to be featured in a future Metabolic Mailbag episode.
#LDL #CardiovascularHealth #MetabolicMind #MetabolicHealth
Expert Featured:
Bret Scher, MD - Baszucki Group Medical Director & Host of the Metabolic Mind Podcast
- https://www.linkedin.com/in/bret-scher-08baaa102/
- https://www.instagram.com/drscher858/?hl=en
- https://x.com/bschermd
Resources Mentioned:
Effects of Evolocumab on Mortality Outcomes in Patients Without Previous Myocardial Infarction or Stroke: A Prespecified Analysis of the VESALIUS-CV Randomized Clinical Trial
Atorvastatin, Cardiovascular Events, and Disability-free Survival in Older Adults
https://youtube.com/playlist?list=PLzWI83-NWCL5V7N6MjywX5QbkVn9Svi3q&si=oKVT518X1u0rUcMk
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Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them.
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