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Heart disease remains the biggest killer of U.S. men, women, and minorities, according to the Centers for Disease Control and Prevention: In the U.S., one person dies every 34 seconds from cardiovascular disease.
Statins, oral medications that lower the amount of cholesterol in the blood and prevent cardiovascular events, are the primary focus of the new Department of Veterans Affairs and the Department of Defense guideline Lipids Management for Cardiovascular Disease Risk Reduction, published in December 2025.
“Taking a statin reduces your risk of heart attack or stroke by about 25%,” explained Capt. Michael Arnold, a U.S. Navy family medicine physician and the officer in charge of the Naval Undersea Medical Institute, Groton, Connecticut. Statins remain the first-line treatment drug to prevent cardiac events.
Arnold served as a champion from the Military Health System on the working group for an updated clinical practice guideline. They suggested that primary care providers should prescribe their patients moderate-intensity, oral, once-daily statins as a core therapy for the primary prevention of heart disease and stroke.
Statins help stabilize and can reduce the buildup of plaques in your heart walls and the arteries leading to your brain. Plaque is a waxy, sticky substance made up of low-density lipoproteins (also called “bad” cholesterol, or LDL). It can harden your arteries and reduce blood’s ability to pass through the arteries, according to the National Heart, Lung and Blood Institute. Blood clots can stick to plaques, further narrowing arteries and increasing the risk of heart attack, stroke, or other cardiovascular events.
The VA and DOD last revised the lipids CPG in 2020. The working group began reviewing new data in October 2024 using published research from May 16, 2019, to Jan. 15, 2025. Clinical practice guidelines serve as evidence-based tools grounded in current science and aimed at primary care providers of service members, beneficiaries, and veterans and their families.
“The key point,” Arnold said, is “statins are still the medicine we should go to, especially in people who don't have a history of heart attack who aren't already at an enormous risk,” of a cardiac event.
Heart-threatening health conditions
Arnold emphasized this recommendation is “pretty big because there isn't much else we can do” that will provide a one-quarter risk reduction “off the top” of other complex diseases that affect your heart. According to the guideline, these diseases combine genetic, environmental, and lifestyle factors and include:
Lifestyle changes play an equally important role in reducing the risk of heart disease or stroke. High blood pressure, high cholesterol levels, and smoking are key risk factors. About half of the U.S. population has at least one of these three risk factors, CDC data show.
Cholesterol and heart disease
According to the guideline, cholesterol builds cells and produces hormones necessary for life. We store cholesterol in our liver until it is needed. High LDL cholesterol is often linked to diet, genetics, and lifestyle choices.
Providers used to prescribe statins only for those with high LDL levels, but today, they also prescribe statins for those determined to be at high risk of cardiovascular disease or events, even if their LDL levels are not high. Risk- measurement calculators determine this.
Key CPG topics and takeaways
The working group advised the use of the Predicting Risk of Cardiovascular Disease EVENT calculator, known as PREVENT, to estimate 10-year and 30-year risks for total cardiovascular disease; however, the 10-year is more realistic, Arnold said. PREVENT is the first tool to combine cardiovascular, kidney, and metabolic health measures to guide primary prevention-focused treatment.
Arnold said the calculator is “only important if you haven't had a heart attack or some kind of cardiovascular event,” including a stent placement to unblock arteries or heart surgery. After those events or procedures, “we know the risk is high enough thatother lipid-lowering medications and statin intensities may be effective.”
These alternatives include high-intensity statins alone or a moderate-intensity statin combined with an oral intestinal cholesterol absorption inhibitor, or an injectable inhibitor, which allows your liver to remove more LDL from your blood, he noted.
Arnold said primary care providers in the VA and DOD health care systems also should know about apolipoprotein, a protein particle much stickier than other types of LDL. Elevated apolipoprotein levels can be passed down in families and limit the improvement from lifestyle and dietary changes. The particle also supports blood clotting, which may make it worse than LDL in creating clogged arteries, according to data from the National Heart, Lung and Blood Institute.
In the military, Black service members or veterans who have a family history of premature heart disease are the highest-risk group, Arnold said.
He stated patients with coronary vascular disease who take the maximum amounts of statins and who have high levels of triglycerides should use the single molecule fish oil called icosapent ethyl and only as secondary prevention. He explained that regular fish oil dietary supplements don’t reduce cardiovascular events.
Healthy lifestyle for healthy heart
Arnold said lifestyle changes still represent the primary nondrug factor in lowering our risk of cardiovascular disease.
“Any increase in exercise, any shift toward the Mediterranean diet” — one that focuses on plant- and nonred meat-based foods — “and away from the standard American diet, [trying to] sleep seven to eight hours, enhance social connections, quit tobacco, minimize alcohol, manage stress, address overweight/obesity” — all those modifications can help lower your risk, said Arnold.
Increased lifespan globally “has been due to our improvements with cardiovascular disease in the past,” he emphasized. “What has us worried, I think is, with the obesity epidemic, we're starting to see [lifespan] go the other way,” back to shorter and sicker.
Resources
Clinical support tools for practitioners and patients include:
| Date Taken: | 03.02.2026 |
| Date Posted: | 03.02.2026 12:28 |
| Story ID: | 559192 |
| Location: | US |
| Web Views: | 27 |
| Downloads: | 0 |
This work, Clinical practice guideline emphasizes statins remain core therapy for lipid lowering, reducing cardiovascular risk, by Janet A. Aker, identified by DVIDS, must comply with the restrictions shown on https://www.dvidshub.net/about/copyright.
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