“One has to know what they are doing to actually reduce risk. Early studies were, I believe confounded by folks who should not have been treated.”
Well, I’m not sure that it is possible to ever completely know how statins work to reduce CV risk. In addition to LDL reductions, they do also appear to reduce inflammatory factors such as hs c-rp. Some believe the atherosclerosis is as much a function of inflammatory factors as high lipids. Early studies included both primary prevention and secondary prevention trials. Even the early studies with pravastatin demonstrated ~30% relative risk reductions, and that was with moderate LDL reductions.
After being a statistician in testing for the last job of my career, I now look at studies in a whole different way. I now wonder about blood type chemistry as related to side effects regarding statins. Some people I’ve personally known take enormous doses of statins with no problems or side effects and others like myself have problems with a very small dosage. Clearly there is a problem for many of us, a blanket statement that anyone over 40 should be on statins certainly isn’t science.
But we clearly over treated many folks back when we were treating total cholesterol. I spent years taking folks off statins. We are probably doing it again now we know LDL isn’t actually the risk factor but particles are.