A new study has revealed that nearly 100,000 non-fatal heart attacks and tens of thousands of strokes could be prevented every year in the United States if more eligible patients took statins and other cholesterol-lowering medications as recommended. The research, conducted by a team at Johns Hopkins University and published in the Journal of General Internal Medicine, highlights persistent gaps in adherence to clinical guidelines despite decades of evidence underscoring statins’ life-saving potential. As cardiovascular disease remains a leading cause of death globally—including in Thailand—the findings resonate far beyond the U.S., carrying crucial implications for Thai patients, healthcare providers, and public health authorities.
The backdrop to this research is a global epidemic of heart disease. While some high-income countries have witnessed falling death rates from acute heart attacks thanks to medical advances, the prevalence of risk factors such as high cholesterol, hypertension, and obesity remains troublingly high. In Thailand, non-communicable diseases (NCDs)—with heart disease and stroke at the forefront—account for over 75% of total deaths, according to Thailand’s Ministry of Public Health and the World Health Organization (WHO Thailand). As the country’s population ages and lifestyles become more sedentary, accessible prevention methods are even more vital.
Statins work by lowering levels of LDL “bad” cholesterol in the bloodstream, thereby preventing the buildup of plaque in arteries—a leading cause of heart attacks and strokes. Despite decades of safe and widespread use, significant numbers of high-risk individuals globally are still not prescribed or are not taking statins. According to the new research, roughly 47 million Americans take statins daily, yet nearly all adults with high cholesterol or previous cardiac events could benefit from these medications (Best Life; U.S. News & World Report).
The Johns Hopkins analysis evaluated data from the 2013-2020 U.S. National Health and Nutrition Examination Surveys (NHANES), looking at the cardiovascular risk and cholesterol profiles of 4,980 adults aged 40 to 75. Among individuals who had never experienced a major cardiac event—those eligible for primary prevention—47% were theoretically eligible for statin therapy under official guidelines but only 23% were receiving treatment. For those who had already suffered a heart attack or stroke, 100% met eligibility criteria for secondary prevention, but only 68% used cholesterol-lowering medications.
The consequences of this treatment gap are substantial. Researchers estimate that, every year in the U.S. alone, closing the gap could prevent:
- Nearly 100,000 non-fatal heart attacks
- Up to 65,000 strokes
- Over 10,000 expensive heart surgeries and stent-placement procedures Moreover, improved prevention could reduce healthcare costs by as much as $30.6 billion per year.
The study’s lead author, a cardiology professor at Johns Hopkins University School of Medicine, emphasized the urgency of targeted interventions. “High cholesterol is an important chronic health condition that silently claims far too many lives—there are millions of people walking around with this condition that don’t even know they have it, and then when it is recognized, it too often goes undertreated. Evidence-based action is critical to close the gap and prevent devastating cardiovascular events,” the researcher stated (Best Life).
A co-author echoed this concern, noting, “These results add to a growing body of evidence that there are important shortcomings in the quality of care for common and costly chronic diseases such as high cholesterol, and that addressing those shortcomings would yield major public health benefits.”
Scientific consensus on statins’ effectiveness for lowering heart attack and stroke risk is robust. According to a recent review in the British Medical Journal (BMJ Group), widely prescribed statins (such as atorvastatin and rosuvastatin) are equally effective in both primary and secondary prevention of cardiovascular events. Furthermore, a major meta-analysis by the Cholesterol Treatment Trialists’ (CTT) Collaboration found that each 1 mmol/L reduction in LDL cholesterol translates to a 20% lowered risk of major vascular events (Lancet study). Statins remain central to global clinical guidelines, including those from the American College of Cardiology (ACC), American Heart Association (AHA), and the European Society of Cardiology (ESC).
However, statin therapy is not without controversy. Some critics argue that side effects—such as muscle pain, liver enzyme changes, or, rarely, increased diabetes risk—have contributed to hesitancy among patients and physicians alike (Mayo Clinic). Still, large-scale trials consistently show that the benefits for high-risk groups outweigh the risks, especially when statins are selected and dosed appropriately. Expert panels emphasize the importance of shared decision-making, patient education, and active monitoring for side effects, rather than abandoning statin therapy altogether.
The Thai context offers both challenges and opportunities. National health statistics show that more than 3 in 10 Thai adults have elevated cholesterol, yet population-wide screening and adherence to treatment lag behind countries with established primary care networks. The Universal Coverage Scheme has improved access to statins, yet recent research from Thai academic institutions highlights disparities: statin prescription rates are often lower in rural areas and among low-income, uninsured, or elderly populations (Thai Journal of Pharmaceutical Sciences). Additional barriers include insufficient health literacy about cardiovascular risk and inconsistent follow-up after initial diagnosis.
Cardiologists at leading Thai hospitals interviewed for this report note a similar pattern to the U.S.: Many patients present to clinics only after a major cardiac event. A senior researcher at Siriraj Hospital observed, “Too often we see [Thai] patients with hypertension and diabetes who never knew their cholesterol was high—or understood what that could mean. Preventing the first heart attack, rather than treating the consequences, must be a greater priority.” A clinician from Ramathibodi Hospital added, “We must do better at identifying those eligible for statins and ensuring long-term adherence. Patients need both clear explanations in plain Thai language and encouragement to come back for regular checkups.”
Relevant historical and cultural context further shapes Thailand’s response to heart disease prevention. Thai eating habits, which have shifted toward more processed and high-saturated fat foods, contribute to rising cholesterol levels. Yet local dietary customs, such as favoring vegetables, fish, and rice, could be re-emphasized within health promotion campaigns. Buddhism’s focus on moderation, or “the middle way,” also dovetails with preventive health approaches, as noted by a nurse educator at Mahidol University: “Promoting balance—both in diet and lifestyle—aligns with Thai values and can help patients accept medications like statins if needed.”
Looking forward, multiple trends could shape Thailand’s cardiovascular future. Advances in combination therapies (such as adding ezetimibe to statin regimens) show promise for individuals with especially stubborn cholesterol profiles (DDW Online). Newer, high-potency statins and innovative digital tools for patient education can also guide more Thais to long-term prevention. Additionally, population-wide screening programs and the use of coronary calcium scoring—already piloted in some Bangkok hospitals—could help target treatment to those most likely to benefit (FOX 13 Utah).
For Thai readers, the message is clear and urgent: Heart disease, stroke, and other cholesterol-related problems remain a silent but deadly threat. If you have risk factors like hypertension, diabetes, obesity, a family history of heart disease, or are over the age of 40, regular cholesterol screening is essential. Eligible patients should engage in open dialogue with their healthcare provider about whether statin therapy is right for them, balancing the proven benefits and possible side effects. Return for follow-up visits, take medications as directed, and ask about lifestyle changes—such as dietary improvements and increased physical activity—that amplify statins’ protective effects. Community-based public health campaigns, improved access to screening, and culturally mindful education materials are all critical for closing the treatment gap across Thailand.
For policy makers and healthcare professionals, prioritizing population cholesterol screening, promoting the latest clinical guidelines, and supporting patient adherence must be persistent goals. Together, these steps can help prevent thousands of premature heart attacks and strokes each year, saving lives and reducing the burden of chronic disease nationwide.
For more information on heart disease prevention and statin use in Thailand, visit resources from the Ministry of Public Health, consult the latest recommendations from the Royal College of Physicians of Thailand, or contact major public hospitals for screening programs and counseling.
Sources: Best Life, U.S. News & World Report, Mayo Clinic, BMJ Group, DDW Online, Thai Journal of Pharmaceutical Sciences, FOX 13 Utah