Statins and low-dose aspirin therapy

Statins lower LDL (the artery‑clogging cholesterol) by blocking the liver’s HMG‑CoA reductase enzyme, prompting the liver to remove more LDL from the blood. Over time this stabilizes plaque with a thicker cap and less inflammation, which reduces heart attacks, strokes, and the need for stents. The benefit grows as LDL/ApoB is lowered (e.g., targets <70 mg/dL for high‑risk patients, <55 mg/dL for established disease or high CAC). Common cautions include muscle aches, occasional liver‑enzyme elevations, and a small increase in diabetes risk; management may involve dose reduction, switching statins, or adding CoQ10 and vitamin D. Baby aspirin (75–100 mg daily) blocks platelet COX‑1, lowering thromboxane A2 production so platelets do not clump, thereby decreasing clot‑triggered heart attacks and some strokes. It is routinely used for secondary prevention after a heart attack, stent placement, stroke, or known ASCVD. For primary prevention it is generally avoided because bleeding (stomach or brain) can outweigh benefit, especially after age 60. Additional cautions include a history of ulcers or GI bleed, kidney disease, concurrent anticoagulant use, uncontrolled hypertension, or heavy alcohol consumption.