VentralinkKey Takeaways
- •Dyslipidemia—an imbalance in blood fats—is one of the strongest predictors of heart attacks and strokes
- •Cholesterol travels through your blood in particles; too many of certain particles leads to plaque buildup in arteries
- •Statins were discovered in the 1970s by a Japanese scientist searching through 6,000 fungal compounds
- •Today, statins are the most prescribed medications in the world because decades of research proved they save lives
The Epidemic Nobody Understood
In April 1945, President Franklin D. Roosevelt died suddenly from a massive stroke, complicated by years of heart disease. He was 63. At the time, his doctors had watched his blood pressure climb dangerously high for years, but they had little understanding of what was causing it—and almost nothing they could do about it.
Roosevelt wasn't alone. By the 1940s, cardiovascular disease had become an American epidemic. Heart attacks and strokes were the leading cause of death, claiming more lives every year, and doctors didn't know why.
What Doctors Believed in the 1940s
Clogged arteries were considered a normal part of aging—something that happened to everyone eventually. High blood pressure and elevated cholesterol were seen as inevitable consequences of getting older. There was no concept of prevention, because no one understood what was causing the problem in the first place.
Three years after Roosevelt's death, prompted by the growing epidemic, President Harry Truman signed the National Heart Act. It established the National Heart Institute and funded an ambitious research project: a long-term study of an entire community to figure out what was causing so many Americans to die of heart disease.
The town chosen was Framingham, Massachusetts. The study that began there in 1948 would change medicine forever.
The Framingham Discovery
The Framingham Heart Study recruited over 5,000 residents and began tracking everything about their health—what they ate, whether they smoked, their weight, their blood pressure, and their blood cholesterol levels. Then researchers waited and watched to see who developed heart disease.
By the early 1960s, patterns began to emerge. The study identified what they called "risk factors"—characteristics that predicted who would have a heart attack. This was a revolutionary concept. For the first time, doctors could see heart disease coming before it happened.
1960
Smoking linked to heart disease
Framingham provided clear evidence that cigarette smoking dramatically increased heart attack risk.
1961
Cholesterol and blood pressure identified as major risk factors
The study showed that high cholesterol and high blood pressure predicted heart attacks years in advance.
1967
First risk prediction model created
Researchers combined multiple risk factors to predict an individual's chance of having a heart attack—people in the highest risk group had a 30-fold greater risk than those in the lowest.
1977
"Good" vs. "bad" cholesterol distinguished
Framingham showed that HDL cholesterol was protective, while LDL cholesterol was harmful—the higher your LDL, the greater your risk.
The message was becoming clear: cholesterol levels in your blood were strongly connected to whether you would have a heart attack or stroke. But what exactly was cholesterol, and why did it matter?
Understanding Cholesterol and Dyslipidemia
Cholesterol itself isn't a villain. Your body needs it to build cell membranes, make hormones, and produce vitamin D. The problem isn't cholesterol existing in your body—it's how cholesterol travels through your bloodstream.
Because cholesterol is a fat, it can't dissolve in blood (just like oil doesn't mix with water). So your body packages cholesterol inside protein-covered particles called lipoproteins that can travel through your bloodstream. Think of these particles as delivery trucks carrying cholesterol to where it's needed.
This imbalance—too much LDL, too little HDL, or elevated triglycerides—is called dyslipidemia. It's not simply "high cholesterol." It's a pattern of blood fats that puts your arteries at risk.
Why "Normal" Cholesterol Can Be Misleading
You might eat well and exercise, yet still have dyslipidemia. That's because your liver produces most of your cholesterol—about 80%—regardless of what you eat. Genetics play a huge role in determining your cholesterol levels. This is why some people with excellent diets still need medication, while others seem to eat anything without consequence.
A Note on Newer Testing: ApoB
While LDL cholesterol has been the standard measure for decades, research now shows that a test called apoB (apolipoprotein B) may be an even better predictor of heart disease risk. ApoB counts the actual number of harmful particles in your blood, not just the cholesterol inside them.
About 10-20% of people have "normal" LDL cholesterol but elevated apoB—meaning their standard cholesterol test may underestimate their true risk. If you have metabolic conditions like diabetes, obesity, or high triglycerides, ask your doctor whether apoB testing might be helpful for you.
The Search for a Solution
By the 1970s, doctors knew that high cholesterol caused heart disease. But what could they do about it? Diet changes helped a little. Exercise helped a little. But for many patients, these lifestyle changes weren't enough—their cholesterol stayed stubbornly high because their bodies just produced too much of it.
Enter Dr. Akira Endo, a Japanese biochemist working at Sankyo pharmaceutical company. Endo believed there might be natural compounds that could block cholesterol production. His reasoning: if fungi and bacteria compete for survival in nature, some might have evolved ways to interfere with their competitors' ability to make cholesterol.
The Discovery of Statins
Dr. Endo and his team began testing thousands of mold and fungus samples. For two years, they found nothing. Then, in 1973, after testing more than 6,000 compounds, they found what they were looking for in a mold growing on rice at a grain shop in Kyoto. The compound they isolated—which they called compactin—was the first statin.
The discovery was revolutionary. This natural compound could dramatically reduce cholesterol by blocking an enzyme in the liver called HMG-CoA reductase—the same enzyme your body uses to manufacture cholesterol. By slowing down cholesterol production, the liver responded by pulling more LDL cholesterol out of the bloodstream to meet its needs.
Within a decade, pharmaceutical companies had developed more powerful versions. In 1987, the FDA approved lovastatin (Mevacor)—the first statin available in the United States. Simvastatin, pravastatin, and atorvastatin soon followed. Doctors finally had powerful tools to lower cholesterol.
But a crucial question remained: would lowering cholesterol actually save lives?
The Trials That Proved It
The medical community was skeptical. Cholesterol might be associated with heart disease, but that didn't prove that lowering it would help. What if cholesterol was just a marker, not a cause? What if lowering it did more harm than good?
To answer these questions, researchers launched some of the largest and most rigorous clinical trials in medical history. The results would transform cardiovascular medicine.
Scandinavian Simvastatin Survival Study
4,444 patients with heart disease were given either simvastatin or placebo and followed for over 5 years.
Key finding: This was the first trial to prove that lowering cholesterol with a statin actually saved lives. It ended the debate.
The 4S trial was followed by dozens more studies, all confirming the same thing: statins didn't just lower cholesterol numbers—they prevented heart attacks, strokes, and deaths. The evidence became overwhelming.
Statins Today
Today, statins are the most prescribed class of medications in the world. More than 200 million people worldwide take them. They've been credited with preventing millions of heart attacks and strokes.
High-Intensity Statins
- atorvastatin (Lipitor) 40-80mg
- rosuvastatin (Crestor) 20-40mg
Moderate-Intensity Statins
- atorvastatin (Lipitor) 10-20mg
- rosuvastatin (Crestor) 5-10mg
- simvastatin (Zocor) 20-40mg
- pravastatin (Pravachol) 40-80mg
- lovastatin (Mevacor) 40-80mg
- fluvastatin (Lescol) 80mg
- pitavastatin (Livalo) 1-4mg
Your doctor chooses the intensity based on your cardiovascular risk and treatment goals. High-intensity statins lower LDL by 50% or more; moderate-intensity statins lower it by 30-50%.
The Bottom Line
From a mysterious compound found in rice mold to the world's most prescribed heart medication, statins represent one of medicine's greatest success stories. They work by blocking cholesterol production in your liver, which forces your body to pull dangerous LDL particles out of your bloodstream. The result: cleaner arteries and dramatically fewer heart attacks and strokes.