In this episode, I’m joined by Dr Tom Dayspring and Dr Dan Soffer for a comprehensive look at lipid-lowering therapy. We unpack the science behind statins, ezetimibe, PCSK9 inhibitors, fibrates, and newer agents like bempedoic acid, asking what really works, who should take them, and how early treatment might prevent disease.

From guideline thresholds to real-world decision making, historical trials to future therapies, this conversation offers clarity on one of the most important areas in cardiovascular prevention.

In this episode, we cover:

What lipid-lowering therapy actually is
Statins, ezetimibe, fibrates, and PCSK9 inhibitors
How these drugs work and who benefits most
Absolute vs relative risk reduction explained
Guidelines vs clinical practice
Lipoprotein(a) and new therapies on the horizon

A detailed yet practical discussion to help you cut through the noise and make sense of lipid-lowering therapies.

Intro: What Are Cholesterol-Lowering Drugs and How Do They Work? (00:00:00)
How Do Cholesterol-Lowering Medications Lower Heart Risk? (00:05:00)
Who Should Start Statins or Other Cholesterol Drugs? (00:09:29)
Landmark Cholesterol Trials That Changed Heart Disease Treatment (00:22:54)
Do Fibrates Still Matter for High Triglycerides? (00:36:27)
Ezetimibe & PCSK9 Inhibitors: Do They Add Benefits Beyond Statins? (00:42:30)
CLEAR Outcomes Trial: What It Means for Statin-Intolerant Patients (00:52:02)
Bempedoic Acid vs Statins: Effectiveness, Side Effects & Cost (00:53:45)
What Do Statin Trials Really Show? Heart Attacks, Death & Risk Reduction (01:00:35)
When to Use Low vs High-Intensity Statins (and Add Ezetimibe) (01:10:52)
Hydrophilic vs Lipophilic Statins: What’s the Difference? (01:14:17)
Do Statins Affect the Brain or Your Body’s Cholesterol? (01:19:03)
PCSK9 Therapies Explained: Antibodies, siRNA, Oral Drugs & Gene Editing (01:24:28)
What’s the Best Combination Therapy After Statins? (01:30:33)
LDL Guidelines Explained: Thresholds vs Goals (01:32:49)
The Most Up-to-Date Cholesterol Guidelines (2025) (01:40:25)

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Simon Hill, MSc, BSc (Hons)

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