I am 50 years old and my LDL cholesterol is high, but my CT angiogram shows no plaque. Does this mean I don’t have to take statins?

Elevated cholesterol alone may not be enough to trigger a process of atherosclerosis in all patients (although for some patients, this is the only identifiable risk factor). Oftentimes, other factors which promote inflammation have to be present (such as diabetes or pre-diabetes, hypertension, stress, kidney disease), which, together with elevated LDL cholesterol, trigger the cascade of inflammation within arteries, which promotes atherosclerosis.

The decision of whether or not to take statins is ultimately yours, but it should be made with the specialist advice from a cardiologist, who will be able to explain the nuanced pros and cons. Some have a view that it’s not if, but when, patients will develop coronary artery disease, and as far as cardiovascular longevity is concerned, your extended risk (beyond the typical 10-year risk calculators such as Q-risk) of developing atherosclerosis over a lifetime should be considered.