Two years ago, I was prescribed a statin by my PCP to bring down my LDL.
The statin - a drug used by over 200 million worldwide to reduce the risk of heart attack and stroke by lowering LDL cholesterol - is an awesome case study both in how it came to be and then how it was “rolled out.”
In 1973, Japanese scientist Akira Endo discovered a fungal metabolite that could inhibit cholesterol production. But by 1980, the project stalled. Early animal trials suggested the molecule carried too much risk to scale, and development was shelved globally.
Dr. Roy Vagelos at Merck decided to restart the research by coordinating across the right stakeholders: he used NIH-funded research from UT Southwestern to explain the drug’s biological mechanism to the FDA. He then brokered a unique deal: the FDA would allow Merck to sell the drug based on a lab value (cholesterol levels) if Merck agreed to fund the massive, decade-long trials required to prove it actually saved lives.
The result was both a proven drug and the research to apply it as preventative medicine at scale.
The FDA approved Lovastatin, the first statin for the American market.
Twenty-five health innovations that changed the world.
The statin emphasizes a pivot in medicine towards prevention. Statins were a case where doctors could prescribe based on preventing a probability, versus fixing something that was already broken.
The statin was a major step in turning the heart attack from an inevitable crisis into a manageable lab value. It was a demonstration that by regulating our internal biology decades in advance, we could extend the human lifespan.
All of us should be getting regular lab work to check our risk of heart disease (LDL, HDL, Triglycerides, ApoB) as well as the test for LP(a), which can indicate a higher genetic risk. As we sit today, there are an increasing number of prevention and longevity-enabling medicines that can form what my Partner Alex Karnal calls the #Healthstack, one of the most exciting of which are PCSK9 inhibitors, which can reduce bad cholesterol and risk of heart disease beyond the progress we have made with Statins. Great topic to learn about and explore with medical professionals.