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