Uploaded September 2026 | Updated September 2026, 2 hours ago
Should LDL be treated? In this episode of Metabolic Mind, Dr. Bret Scher explains why the better question is who may benefit from LDL lowering, how aggressively it should be treated, and what outcomes matter most to the individual patient.
Dr. Scher reviews two major trials that studied aggressive LDL lowering in very different populations. VESALIUS-CV looked at high-risk patients with serious vascular disease and found that adding a PCSK9 inhibitor reduced both cardiovascular events and all-cause mortality. STAREE studied older adults without known cardiovascular disease and found fewer cardiac events with statin therapy, while overall survival and hospitalizations did not change. Disability-free survival also showed no difference
He covers:
- Why LDL treatment depends on the person, not just the number
- What VESALIUS-CV found in high-risk patients with vascular disease
- Why STAREE tells a different story in older adults without known heart disease
- The difference between reducing cardiac events and extending life
- Why vascular disease should shape how aggressively LDL is treated
- How age, frailty, cognition, cancer risk, and independence affect the risk-benefit conversation
- Why LDL may need a different discussion for someone using ketogenic therapy
- How metabolic health, insulin resistance, and direct evidence of vascular disease fit into the decision
These trials illustrate why LDL treatment should be individualized with a healthcare provider. For some patients, aggressive lowering may save lives. For others, the benefits may be smaller or less connected to the outcomes they care about most.
🔎 Have questions about how to apply metabolic therapies effectively? Submit them at metabolicmind.org/questions to be featured in a future Metabolic Mailbag episode.
#LDL #CardiovascularHealth #MetabolicMind #MetabolicHealth
*Expert Featured:*
Bret Scher, MD - Baszucki Group Medical Director & Host of the Metabolic Mind Podcast
- linkedin.com/in/bret-scher-08baaa102
- instagram.com/drscher858/?hl=en
- https://x.com/bschermd
*Resources Mentioned*
- *Effects of Evolocumab on Mortality Outcomes in Patients Without Previous Myocardial Infarction or Stroke: A Prespecified Analysis of the VESALIUS-CV Randomized Clinical Trial*
ahajournals.org/doi/10.1161/CIRCULATIONAHA.126.082436
- *Atorvastatin, Cardiovascular Events, and Disability-free Survival in Older Adults*
nejm.org/doi/10.1056/NEJMoa2607314
- youtube.com/playlist?list=PLzWI83-NWCL5V7N6MjywX5QbkVn9Svi3q&si=oKVT518X1u0rUcMk
*Free CME Clinician Trainings:*
Are you a clinician who would like to learn more about the science behind these therapies and how to implement them in practice? Earn CME with our growing library of courses from some of the top experts in the field including Dr. Chris Palmer, Dr. Georgia Ede, Dr. Matthew Bernstein, Dr. Mariela Glandt, Dr. Deanna Kelly, Dr. Julie Milder, Dr. Zoltan Sarnyai, and Dr. Bret Scher with more coming soon.
Our courses have been made *FREE* by grants from Baszucki Group, so we can spread these powerful therapies as widely as possible. Earn CME/CNE credits:
metabolicmind.org/for-clinicians/trainings-courses/?utm_medium=organic-social&utm_source=youtube&utm_campaign=cme-yt
Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry.
Learn more about metabolic psychiatry and find helpful resources at metabolicmind.org
*About us:*
Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them.
Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice nor establishing a provider-patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications.
*Timestamps:*
0:00 - Should We Be Treating LDL Cholesterol?
0:55 - VESALIUS-CV: Aggressive LDL Lowering in High-Risk Patients
2:29 - STAREE: Statins in Older Adults Without Cardiovascular Disease
5:01 - Who Benefits Most From Aggressive LDL Lowering?
6:12 - Why Cardiovascular Risk Should Guide LDL Treatment Decisions
6:53 - Ketogenic Therapy, Rising LDL & Putting the Risk in Perspective
Should LDL be treated? In this episode of Metabolic Mind, Dr. Bret Scher explains why the better question is who may benefit from LDL lowering, how aggressively it should be treated, and what outcomes matter most to the individual patient.
Dr. Scher reviews two major trials that studied aggressive LDL lowering in very different populations. VESALIUS-CV looked at high-risk patients with serious vascular disease and found that adding a PCSK9 inhibitor reduced both cardiovascular events and all-cause mortality. STAREE studied older adults without known cardiovascular disease and found fewer cardiac events with statin therapy, while overall survival and hospitalizations did not change. Disability-free survival also showed no difference
He covers:
- Why LDL treatment depends on the person, not just the number
- What VESALIUS-CV found in high-risk patients with vascular disease
- Why STAREE tells a different story in older adults without known heart disease
- The difference between reducing cardiac events and extending life
- Why vascular disease should shape how aggressively LDL is treated
- How age, frailty, cognition, cancer risk, and independence affect the risk-benefit conversation
- Why LDL may need a different discussion for someone using ketogenic therapy
- How metabolic health, insulin resistance, and direct evidence of vascular disease fit into the decision
These trials illustrate why LDL treatment should be individualized with a healthcare provider. For some patients, aggressive lowering may save lives. For others, the benefits may be smaller or less connected to the outcomes they care about most.
🔎 Have questions about how to apply metabolic therapies effectively? Submit them at metabolicmind.org/questions to be featured in a future Metabolic Mailbag episode.
#LDL #CardiovascularHealth #MetabolicMind #MetabolicHealth
*Expert Featured:*
Bret Scher, MD - Baszucki Group Medical Director & Host of the Metabolic Mind Podcast
- linkedin.com/in/bret-scher-08baaa102
- instagram.com/drscher858/?hl=en
- https://x.com/bschermd
*Resources Mentioned*
- *Effects of Evolocumab on Mortality Outcomes in Patients Without Previous Myocardial Infarction or Stroke: A Prespecified Analysis of the VESALIUS-CV Randomized Clinical Trial*
ahajournals.org/doi/10.1161/CIRCULATIONAHA.126.082436
- *Atorvastatin, Cardiovascular Events, and Disability-free Survival in Older Adults*
nejm.org/doi/10.1056/NEJMoa2607314
- youtube.com/playlist?list=PLzWI83-NWCL5V7N6MjywX5QbkVn9Svi3q&si=oKVT518X1u0rUcMk
*Free CME Clinician Trainings:*
Are you a clinician who would like to learn more about the science behind these therapies and how to implement them in practice? Earn CME with our growing library of courses from some of the top experts in the field including Dr. Chris Palmer, Dr. Georgia Ede, Dr. Matthew Bernstein, Dr. Mariela Glandt, Dr. Deanna Kelly, Dr. Julie Milder, Dr. Zoltan Sarnyai, and Dr. Bret Scher with more coming soon.
Our courses have been made *FREE* by grants from Baszucki Group, so we can spread these powerful therapies as widely as possible. Earn CME/CNE credits:
metabolicmind.org/for-clinicians/trainings-courses/?utm_medium=organic-social&utm_source=youtube&utm_campaign=cme-yt
Follow our channel for more information and education from Bret Scher, MD, FACC, including interviews with leading experts in Metabolic Psychiatry.
Learn more about metabolic psychiatry and find helpful resources at metabolicmind.org
*About us:*
Metabolic Mind is a non-profit initiative of Baszucki Group working to transform the study and treatment of mental disorders by exploring the connection between metabolism and brain health. We leverage the science of metabolic psychiatry and personal stories to offer education, community, and hope to people struggling with mental health challenges and those who care for them.
Our channel is for informational purposes only. We are not providing individual or group medical or healthcare advice nor establishing a provider-patient relationship. Many of the interventions we discuss can have dramatic or potentially dangerous effects if done without proper supervision. Consult your healthcare provider before changing your lifestyle or medications.
*Timestamps:*
0:00 - Should We Be Treating LDL Cholesterol?
0:55 - VESALIUS-CV: Aggressive LDL Lowering in High-Risk Patients
2:29 - STAREE: Statins in Older Adults Without Cardiovascular Disease
5:01 - Who Benefits Most From Aggressive LDL Lowering?
6:12 - Why Cardiovascular Risk Should Guide LDL Treatment Decisions
6:53 - Ketogenic Therapy, Rising LDL & Putting the Risk in Perspective
