The Case for Treating Cholesterol Before Plaque Appears | Dr Thomas Dayspring and Dr Dan Soffer

Atherosclerosis is a ubiquitous condition driven by the accumulation of ApoB-containing lipoproteins in the arterial wall, necessitating early and aggressive risk management. While genetics and lifestyle factors like smoking, blood pressure, and insulin sensitivity influence individual susceptibility, the primary prevention of major adverse cardiovascular events hinges on identifying and lowering these atherogenic particles. Clinical strategies have evolved from reactive treatment to proactive, primordial prevention, utilizing tools like the Prevent ASCVD Risk Calculator and coronary CT angiography to assess subclinical plaque burden. Experts emphasize that lower LDL-C and ApoB levels, ideally achieved through a combination of lifestyle modifications and pharmacological interventions like statins or PCSK9 inhibitors, significantly reduce long-term mortality. This approach shifts the focus from merely treating acute events to stabilizing or reversing the underlying disease process before clinical symptoms emerge.