I'm 36. I'm a physician. I take a statin—and ezetimibe—every day. No symptoms. No cardiac history. Just an honest read of the evidence. Here's what I found—and why I stopped waiting for a reason to act.

If you're a regular drinker of coffee or tea, you might rely on that morning cup to think more clearly through the day. A new study suggests your daily habit might help your brain in the long term, too. #HarvardHealth buff.ly/E2N1PXd

The exercise prescription most of us learned was built around volume: 150 minutes a week, any movement counts, accumulate time and the benefits follow. For most chronic diseases, that serves well but for dementia and cardiovascular disease, data from nearly half a million people suggest that how hard you push matters more than how long you go. Let me explain. 🧵

Measuring cholesterol levels has long been the main way doctors assess the risk of heart disease. Increasingly, people are opting, too, for a simple, relatively affordable test: a coronary artery calcium scan, or CAC. on.wsj.com/4diRusm

New mega-analysis showing statin therapy is associated with reduced risk of AD and related out comes, pubmed.ncbi.nlm.nih.gov/4176… @nationallipid @society_eas @ASPCardio @escardio @atherosociety @FamilyHeartFdn @MenopauseOrg

☝️It’s time to stop overcomplicating this. 👉LDL-C < 55 mg/dL. For anyone with: ∙✅ Prior MACE (MI, stroke, revascularization) ∙✅ Type 2 diabetes ∙✅ High or very high cardiovascular risk — by any validated score ∙✅ Significant subclinical atherosclerosis on imaging 👉And < 40 mg/dL for: ∙✅ Polyvascular disease ∙✅ Recurrent events despite optimal therapy 📍We have the tools: 💊Statins. Ezetimibe. Bempedoic acid. 💉PCSK9 inhibitors. Inclisiran. 📍We have the evidence. 📍We have the targets. 👉Less than 25% of ASCVD patients reach LDL-C < 55 mg/dL in real life. 💊💉That’s not a pharmacology problem. That’s a mindset problem. 📍Simplify the decision. Intensify the therapy. Protect the patient. 📍One threshold. All high-risk patients. No excuses.

I'm tired of watching people die from preventable heart disease. The cholesterol wars are over. LDL causes atherosclerosis. That's not a pharmaceutical talking point—it's the convergent conclusion of genetics, Mendelian randomization, and 170,000 patients across 26 randomized trials. Next week, we put diet tribalism and LDL denialism aside and go straight to the science that saves lives. Sign up to receive my newsletter: substance-over-noise.beehiiv…

ACC 2026 | Two Trials, One Message: Lower LDL-C Targets Deliver Superior CV Outcomes 👉Two landmark trials presented today at #ACC26 in New Orleans converge on the same conclusion: being aggressive with LDL-C lowering saves lives and prevents events — whether in secondary or high-risk primary prevention. 📌 VESALIUS-CV Diabetes Subgroup (JAMA, March 28, 2026) 👉Evolocumab in high-risk primary prevention — no prior MI/stroke, no known significant atherosclerosis, diabetes ∙3,655 patients, median follow-up 4.8 years ∙LDL-C achieved: 52 mg/dL (evolocumab) vs. 111 mg/dL (placebo) at 48 weeks ∙3-P MACE: 5.0% vs. 7.1% — HR 0.69 (95% CI 0.52–0.91), p=0.009 ∙4-P MACE: 7.6% vs. 10.5% — HR 0.69, p=0.001 ∙All-cause mortality: HR 0.76 (95% CI 0.61–0.95) ∙Benefit emerged after year 1 — consistent with atherosclerosis prevention rather than plaque stabilization ∙Median achieved LDL-C at 96 weeks: 44 mg/dL — approaching the extreme-risk threshold 📌 Ez-PAVE (NEJM, March 28, 2026) 👉LDL-C target <55 vs. <70 mg/dL in established ASCVD — a head-to-head RCT ∙3,048 patients, 3-year follow-up, 17 Korean centers ∙Median LDL-C achieved: 56 vs. 66 mg/dL ∙Primary composite (CV death, MI, stroke, revascularization, UA hospitalization): 6.6% vs. 9.7% — HR 0.67 (95% CI 0.52–0.86), p=0.002 ∙Nonfatal MI: HR 0.46 | Any revascularization: HR 0.63 ∙No signal of harm: no excess diabetes, myopathy, or liver toxicity; creatinine elevation was actually lower in the intensive arm ∙Critical gap: only 60.8% reached <55 mg/dL at 3 years; PCSK9i used in only 2.3% — underscoring the implementation crisis in real-world practice 🔑 The Integrated Message ∙The “lower is better” paradigm now has direct RCT support across the CV risk continuum — from primary prevention with diabetes to established ASCVD ∙VESALIUS-CV challenges the binary secondary/primary prevention framework: a diabetic patient without clinical ASCVD already benefits from PCSK9i-level LDL-C reduction ∙Ez-PAVE validates ESC/EAS 2025 guideline targets with hard outcome data — no longer just extrapolated from drug trials ∙The real-world gap remains unacceptable: <25% of ASCVD patients reach <55 mg/dL; <10% receive ezetimibe; ~1% receive PCSK9i ∙Together, these data support a universal aggressive approach: early combination therapy, lower thresholds, and broader access to non-statin agents DOI: 10.1056/NEJMoa2600283 DOI:10.1001/jama.2026.3277 @society_eas @nationallipid @LipidJournal @ACCinTouch

Presented at #ACC26: Among patients with atherosclerotic cardiovascular disease, targeting an LDL cholesterol level below 55 mg per deciliter led to a lower 3-year risk of cardiovascular events than targeting a level below 70 mg per deciliter. Full Ez-PAVE trial results: nejm.org/doi/full/10.1056/NE… Editorial: Paving the Road toward Targeted Lipid Lowering nejm.org/doi/full/10.1056/NE… @ACCinTouch