Why is the tradeoff of statins worth it when PCSK9i’s are available? Seems to me they Pareto dominate statins.
Statins have pleiotropic benefits, so it’s not all about lowering LDL/ApoB or CVD prevention/amelioration. PCSK9i of course have strong benefits, but the Venn circles of all benefits for these two drug classes do not overlap. Therefore from my perspective it makes sense to take statins even when PCSK9i are available. Of course, if someone is primarily or exclusively interested in CVD impact, PCSK9i might be a good/better choice. There’s also that small niggling concern with PCSK9i and Alzheimer’s based on one MR study, probably nothing (Chinese study), but for those who are especially and exaggeratedly paranoid about any even super tiny hint of dementia (me!) this might be motivation to hold off for a while until there’s more clarity in longitudinal studies of PCSK9i and dementia.
Rob Tuck: So so so well said. At 78, I exercise 5d/wk and walk 4mi/d on the weekends. I do not get that infamous endorphin high! I do not get ‘pleasure’ out of my exercise. I do it because I think/know it is good and I want to stay healthy and able as long as possible. Would I rather listen to Bach and read a book. Damn right. Would I rather listen to Keith Jarret and read a paper on molecular bioenergetics. Damn right.
Thanks for you post.