Jeff Sternlicht: Lifetime Exposure to LDL and Cardiovascular Risk
Jeff Sternlicht, Emergency Physician and Medical Director at Vituity, shared a post on LinkedIn:
“We May Be Starting Statins Too Late
What if we are not under-treating cholesterol…
But simply treating it too late?
We wait for thresholds.
We wait for scores.
We wait for patients to ‘qualify.’
But biologically, that may already be late.
Atherosclerosis does not begin at age 55.
It begins decades earlier.
Fatty streaks form in the 20s and 30s.
Plaque builds slowly over time.
And the artery keeps a record of every year of exposure.
Recent AHA, ACC, and NLA guidance is moving in one direction:
- earlier LDL lowering, not later.
Because cardiovascular risk is not just about how high LDL is today.
It is about how long the arteries have been exposed to it.
By the time someone meets traditional treatment thresholds, they may already have decades of cumulative ApoB exposure.
At that point, we’re not preventing disease.
We’re managing the consequences of it.
Lowering LDL later stabilizes plaque.
Lowering it earlier prevents it.
Those are two very different strategies.
The shift is already happening:
- from reacting to risk – to reducing lifetime exposure.
This is where preventive cardiometabolic care is going.
And it’s where I spend most of my time now.
Disclaimer: Views are my own and not those of my employer or affiliates.
For educational purposes only and not medical advice.”
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