Why This Test Matters More Than Cholesterol

"Statins only help one in 10,000 people, so I'm not taking them." That's what a patient told me this week — right after I showed him a significant plaque sitting in his carotid artery on CIMT. He's had high cholesterol since his 20s, stopped his meds years ago, and had written off the whole class of drugs based on a number that isn't real. So let's fact-check it. The number needed to treat (NNT) for statins in the lowest-risk primary prevention group is around 400 — not 10,000, not 100,000. And the moment you find plaque on imaging, that patient is no longer low-risk primary prevention. He's high-risk primary prevention, or what I'd call secondary prevention light. The NNT drops into the 60s, 70s, maybe 100, depending on his LDL-C, apoB, Lp(a), and hs-CRP. Here's the difference imaging makes: labs tell you the probability of disease. Imaging tells you whether you actually have it. And if you have it, the risk-benefit math on every intervention — not just lipid-lowering therapy — changes. Cholesterol isn't the most important risk factor for atherosclerotic cardiovascular disease. But it's one of the most easily modifiable, and when you've had elevated levels since your 20s, you're dealing with a cumulative exposure problem that deserves a real conversation — not a shrug. Drop your questions in the comments. I read them. — What we cover: Why "1 in 10,000" is wrong about statins Numbers needed to treat (NNT) for primary vs. secondary prevention What CIMT and CT angiogram findings actually change Familial hypercholesterolemia, Lp(a), apoB, hs-CRP — why they matter The difference between having risk factors and having disease Subscribe for more straight talk on vascular health, prevention, and the things your doctor doesn't have time to explain. High Quality 3rd-party tested supplements at Fullscript (10% discount): https://us.fullscript.com/welcome/ljo... Other tools for optimal health (note these are affiliate links): Home BP Cuff: https://amzn.to/49Cq7rh Sonicare Toothbrush: https://amzn.to/3KllfMS WaterPik: https://amzn.to/4894Xi8 Apple Watch with sleep & HR monitoring: https://amzn.to/3XaUn5d Oura Ring with sleep, cycle, and recovery monitoring: https://amzn.to/4riyhLS Intake Breathing Nasal Support: https://amzn.to/48dfQQ1 Personal Blender: https://amzn.to/4pyNGGl True Nutrition Protein: https://oken.do/q2xzqeqw Glass Meal Prep Containers: https://amzn.to/4ocEPJ2 Sleep Mask: https://amzn.to/48fSJV5 Air Purifier: https://amzn.to/4puzTQZ ___________________________ 🧬 About Dr. Lily Johnston Dr. Johnston is a double board-certified vascular and general surgeon in San Diego, specializing in metabolic and cardiovascular prevention. She’s the founder of CorSight Health and a passionate advocate for reimagining how medicine approaches chronic disease. #MetabolicHealth #CardiovascularPrevention #HeartHealth #Longevity #InsulinResistance #DrLilyJohnston #DrLily #WomenInMedicine #Surgeon #VascularSurgeon #PreventiveMedicine #PADPrevention #HeartAttackRisks #HealthPortfolio #California #SanDiego #Arizona #Virginia #Minnesota