Lipid-lowering drugs for primary prevention are associated with a significant survival benefit, but their use has decreased over time, according to a study published in Circulation. Jeremy Miles, MD, and colleagues evaluated the predictors of long-term mortality in a large racially and ethnically diverse US patient cohort with LDL cholesterol 190 mg/dL or greater. The analysis included 18,740 patients (2010-2020). The study team discovered HDL cholesterol and BMI extremes were associated with higher mortality. HDL cholesterol and triglyceride levels were associated with an increased 9-year mortality risk in adjusted models. Higher mortality was associated with clinical factors such as male sex, older age, hypertension, chronic kidney disease, diabetes, heart failure, myocardial infarction, and BMI greater than 20 kg/m². Dr. Miles and colleagues also discovered a significant survival benefit with lipid-lowering therapy. HDL cholesterol less than 40 mg/dL was independently associated with higher mortality. Over time, there was a significant reduction noted in statin use: 56% of patients on primary prevention and 85% of those on secondary prevention were on statin therapy from 2019 to 2020.