by Dr.Harald Wiesendanger– Klartext
What the mainstream media is hiding
A radically revised cholesterol guideline promises better protection against heart attacks and strokes. One thing it certainly protects against is the business of lipid-lowering drugs. Its formula is as old as it is transparent: lower thresholds, more customers.
Let’s call him Jonas. He’s 32 years old, a nonsmoker, of normal weight, with a blood pressure of 122 over 78. He bikes to work every day, jogs three times a week, eats a fairly healthy diet, drinks alcohol only on rare occasions, and has neither diabetes nor heart problems. No one in his family has died prematurely from a heart attack. Jonas feels perfectly healthy—and as far as anyone can tell, he is.
Only his LDL cholesterol is 165 milligrams per deciliter of blood plasma.
By current standards, his risk of suffering a heart attack or stroke within the next ten years would be negligible.
Shouldn’t Jonas, just to be on the safe side, start worrying anyway?
People should spend as little of their lives as possible with elevated cholesterol: To this end, two influential U.S. professional organizations for cardiovascular medicine, the American College of Cardiology (ACC) and the American Heart Association (AHA), have adopted a radically revised guideline. It addresses dyslipidemia, a disorder of lipid metabolism: “Start early, get lower, treat longer” is their guiding principle: start earlier, lower levels more, and treat for longer.
Excellent, says the chairman of the German Society for Lipidology (DGFL), Prof. Dr. Oliver Weingärtner. He is urging its swift implementation across Europe. “The risk of atherosclerotic cardiovascular disease accumulates with the number of ‘cholesterol-years’—much like the ‘pack-years’ in smoking,” he explains. “If we treated patients early enough, 90% of these diseases could be prevented.”
Ninety percent. A figure that sounds like a promise from a sales brochure. “Lower, Earlier, Longer”: This snappy trio sounds more like the advertising slogan of a fast-food chain or a crude rule of thumb for better sex than a serious medical recommendation. So, what’s it really all about?
Pill-Poppers Starting at 30: The Impact of a Single Stroke of the Pen
The new guideline recommends considering cholesterol-lowering drugs as early as age 30—in the future, not just based on the risk of heart attack and stroke over the next ten years, but using a 30-year prognosis. Even those currently considered “low risk”—with a risk of less than three percent over the next ten years—can now become candidates for lifelong statin use as soon as the calculation tool projects a risk of at least ten percent over three decades or their LDL level falls between 160 and 189 mg/dl.
What are the implications of this policy change? According to a recent analysis in the journal JAMA, 87.5 million Americans between the ages of 30 and 79 now qualify for statins: 56.6% of this age group. This includes 21.5 million new patients, predominantly people with low short-term risk. Among those aged 70 to 79, more than 93% would be eligible for treatment. A single document thus transforms more than half of an entire age group into potential drug customers—by definition.
Certainly: In cases of existing cardiovascular disease and high risk, statins can help prevent heart attacks and strokes. That is precisely why this new expansion of the threshold is so insidious: Proven benefits in high-risk patients serve as a springboard to extend the same therapy ever further into healthy population groups, where the absolute benefit inevitably diminishes.
The guideline itself acknowledges that, with a 10-year risk of 3 percent, the number of people who need to be treated to prevent one cardiovascular event is roughly the same as the number in whom an additional case of diabetes will develop. One prevented event here, one new case of diabetes there. The guideline admits that the closer one gets to the threshold, the more “marginal” the benefit becomes. And the conclusion? Not “stay away,” but rather that prescribing the treatment could be “reasonable.”
Even more revealing is the fine print. There are no randomized long-term studies in people with a ten-year risk of less than three percent that prove that taking medication for decades does more good than harm. The authors explain that such studies are “impractical” due to the long follow-up period required. Nevertheless, they recommend statins—based on modeled 30-year risks and the simple assumption that keeping lifelong LDL “exposure” as low as possible must surely be beneficial. The lack of evidence does not translate into a reason for caution. Rather, it becomes a license to extrapolate.
The Therapeutic Escalator
At the same time, rigid target levels are making a comeback: below 100 mg/dL for borderline and moderate risk, below 70 for high risk, and below 55 for very high risk. Anyone who fails to reach the target through lifestyle changes and statins moves up the therapeutic escalator: ezetimibe, bempedoic acid, PCSK9 inhibitors. (1) The lower the target, the more often the inexpensive standard therapy is deemed “inadequate”—and the larger the market becomes for patent-protected add-on therapies. Are these newer drugs even worth their price? The guideline prudently omits this question. Prices and market conditions are said to be too volatile. How convenient.
As if on cue, Merck received U.S. approval in July 2026 for Lipfendra, the first PCSK9 inhibitor in tablet form. Whether the impressive reduction in LDL actually prevents heart attacks and deaths is still being examined in so-called outcome studies.
Nevertheless, analysts already foresee peak sales potential of up to five billion dollars. Approve the drug first, then figure out later whether patients live longer with it. This, too, is what medical progress can look like.
Certainly, these guidelines—which the ACC and AHA have been jointly developing since 1980—do not have the force of law. Yet the professional authority of both organizations acts like a law of the second order: It determines what doctors consider the medical standard, which lab value indicates a need for action, and which pill ultimately ends up on the prescription.
“Lifetime Exposure”: A New Risk Concept
The guideline introduces a new concept: It is not the current cholesterol level that is decisive, but rather the cumulative lifetime exposure to “atherogenic lipoproteins.” At first glance, this sounds plausible—after all, damage accumulates over decades. But a closer look reveals a cunning marketing ploy:
– Everyone becomes a high-risk patient. If it’s not the current value that counts, but rather total exposure from birth, then literally every person, from the very first day of life, is a potential candidate for lipid-lowering therapy. The question is no longer whether they need the pill, but simply when.
– Medication for minors. The guideline recommends “lifestyle counseling starting in adolescence” and—believe it or not—early pharmacotherapy for individuals with LDL ≥160 mg/dL or familial hypercholesterolemia. Early pharmacotherapy. In adolescents. With drugs whose long-term effects over 50 or 60 years simply no one knows.
That’s enough to bring a tear to the eyes of statin manufacturers. A market that previously began well past the age of fifty is now opening up earlier—all the way back to puberty. Customer loyalty for life, packaged as preventive care. They’re recruiting customers before they even have their first driver’s license. A market that begins almost at birth and ends only at the grave—in business administration, this is called a business model with excellent customer loyalty.
The new thresholds: The lower, the more profitable
The guideline drives treatment thresholds way down. Starting at a 10-year risk of 3%, lipid-lowering therapy should already be “considered.” Three percent. A medically justified threshold? Definitely a market expansion. At 5 to 10%, the therapy should already be “strongly recommended.”
This turns health into the preliminary stage of a problem that hasn’t yet been diagnosed. And prevention here means: starting as early as possible to declare healthy people sick.
By way of comparison: In the 1970s, a total cholesterol level of 300 mg/dL was considered acceptable. Today, the panic sets in at 200. (For more details, see the KLARTEXT article “The Great Cholesterol Lie.” ) With every reduction in this threshold, the global statin market grows by tens of billions. In 2025, it stood at 17 billion U.S. dollars. By 2032, it is projected to grow to over 24 billion, according to conservative estimates. The new guideline is likely to ensure that this forecast will soon have to be revised upward.
The PREVENT Equation: Arbitrary Risk Calculation
The old risk model is being replaced by so-called PREVENT™ equations: mathematical formulas that derive future cardiovascular risk from data such as age, blood pressure, cholesterol, smoking, diabetes, body weight, and kidney function.
The “™” trademark already gives it away: Someone didn’t just do some calculations—they developed a product. PREVENT™ is supposed to deliver “more accurate, more inclusive, and, on average, lower risk estimates.”
Lower risk estimates? Wait a minute.
If the tool spits out lower risk values, then fewer people would need treatment, right? Wrong. Because at the same time, the treatment thresholds are lowered so much that even these lower estimates are still sufficient to trigger a treatment recommendation. A double standard:
1. A new formula lowers the risk values. This reassures patients. (“You only have a 6% risk!”)
2. New thresholds make up for that. So treatment is provided anyway. (“But starting at 5%, we strongly recommend…”)
The result: more people on therapy, with a reduced sense of threat. It lowers both anxiety and the level of caution at the same time. Insidious.
New biomarkers, new markets
The guideline stipulates:
– Lipoprotein(a), an LDL-like fat-protein particle in the blood, should now be measured in every adult at least once. This is because a significantly elevated level can promote plaque buildup and blood clots. It is not automatically measured during routine cholesterol testing. While there is not yet an approved drug that specifically targets it, But Novartis, Amgen, Lilly, and others have been working on this for quite some time. This is how they’re creating a diagnosable customer base for tomorrow’s expensive Lp(a) injections. First the screening, then the fear, then the long-term therapy: a sales funnel that no marketing director could have devised more skillfully.
– Apolipoprotein B (ApoB for short) isaprotein found on nearly all fat particles that damage blood vessels. Because each of these particles typically carries one ApoB molecule, the ApoB level roughly indicates how many potentially harmful particles are circulating in the blood. To put it figuratively: LDL cholesterol measures the amount of cargo, while ApoB counts the trucks transporting it. This measurement is also set to become standard practice in the future: yet another additional test, again with the therapeutic imperative: lower, lower, lower.
– Coronary calcium score (CAC) is a value determined by a specialized CT scan of the heart. It indicates how much calcified plaque is visible in the coronary arteries. (Zeromeans no detectable calcification; the higher the value, the greater the burden of calcified plaque, generally speaking.) In cases of uncertainty, this procedure is supposed to tip the scales—in favor of treatment, of course.
Each of these tests leads to the same course of action: Intensify lipid-lowering medication! Not a single new biomarker leads to the recommendation: Wait and see, change your lifestyle, treat naturally. The variety of diagnostic tools serves a single purpose—to provide new reasons to prescribe more pills.
Shifting Responsibility, Excluding Liability
A key point of the new guideline is the mandatory “clinician-patient discussion” before treatment begins. This sounds like a decision-making process geared toward shared decision-making. In reality, it’s about legal protection:
· The doctor provides information (according to the guideline, of course)
· The patient “decides” (supposedly freely)
· If harm occurs—muscle pain, diabetes, cognitive decline, hemorrhagic strokes—it was all due to the patient’s informed consent.
You scratch my back, I’ll scratch yours…
The script for this kind of “explanation” comes from committees whose members—as is customary with such documents (2)—are deeply entangled financially with the pharmaceutical industry. In the guideline itself? Not a word about it. According to an analysis by Leitlinienwatch—a portal that evaluates medical guidelines with regard to their independence from the pharmaceutical industry—28 out of 33 authors (85%) had documented conflicts of interest or “Relationships with Industry and Other Entities.” 17 out of 33 authors served as consultants for drug manufacturers.
And the organizations behind them? The AHA reports approximately $70 million in grants from pharmaceutical, biotech, and medical technology companies for the 2024/2025 fiscal year. The list of supporters includes, among others, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Regeneron, Sanofi, as well as the U.S. pharmaceutical trade association PhRMA. A who’s who of the cholesterol economy.
The ACC also confirms regular financial inflows from pharmaceutical and medical technology companies, for example for continuing education, advertising, exhibition space at conferences, donations, sponsorship, and “promotional grants.”
In short: Both publishers maintain established financial ties to the very industry that thrives on earlier treatment initiation, lower LDL targets, additional tests, and decades of combination therapies. It’s like letting the fox write the rules for the henhouse.
And what about the aforementioned Professor Weingärtner, the eager advocate for the immediate adoption of foreign guidelines? His DGFL lists the following as sponsors for 2025, among others: Amgen, Apontis, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Daiichi Sankyo, GlaxoSmithKline, Hexal, Lilly, Medice, MSD, Novartis, Novo Nordisk, and Sanofi. Four of these support the DGFL as “associate members” in carrying out our statutory tasks. Six sponsor the DGFL’s continuing education program for “lipidologists.” And the DGFL chair himself? In early 2026, he admitted to having received speaking and consulting fees from Amgen, Sanofi, Novartis, Daiichi Sankyo, and Sobi. (3)
None of this proves a paid recommendation. But it raises suspicion of significant conflicts of interest—especially when these same actors are advocating for stricter targets, earlier diagnoses, and more intensive medication.
Of course, the guideline also recommends exercise, not smoking, adequate sleep, and a sensible diet.
These cost nothing, cannot be patented, and consequently become nothing more than inconsequential, pleasant background noise. The binding, measurable, and controllable core remains the lab value—complete with pills, follow-up tests, and therapeutic escalation. Addressing root causes such as lack of exercise, highly processed foods, chronic stress, social hardship, and an unhealthy environment is simply difficult to bill for.
It cannot be proven that the AHA/ACC guideline was intentionally written for pharmaceutical companies. That it serves their interests almost perfectly, however, can be proven: It lowers treatment thresholds, extends medication durations to decades, and defines additional risk markers. In the U.S. alone, this creates 21.5 million new patients—and opens the door to ever more combination drugs.
What the Guideline Omits
The new guideline doesn’t say a word about this:
· U-shaped mortality curve: Dozens of studies—from NHANES to Korean cohorts to Danish long-term studies—demonstrate that extremely low cholesterol levels increase mortality. The lowest overall mortality is observed at cholesterol levels between 210 and 249 mg/dL—precisely the range where the new guidelines have long been wielding the pharmaceutical hammer.
· Hemorrhagic strokes: Women with LDL below 70 mg/dL face more than twice the risk of cerebral hemorrhage. It is precisely this range that the new guidelines set as the target for high-risk patients.
· Cognitive impairment: The brain contains a quarter of the body’s total cholesterol. Statins inhibit cholesterol synthesis in glial cells. The consequences: amnesia, confusion, a shrunken hippocampus, and impaired semantic fluency. Pfizer knew about this even before Lipitor was launched—and kept quiet.
· Increased cancer risk: For every 10 mg/dL drop in LDL levels while taking statins, there are 2.2 additional cancer cases per 1,000 people.
· Diabetes: Statins significantly increase the risk of type 2 diabetes, particularly in women.
· 47% discontinuation rate within one year: Nearly half of all patients stop taking the medication due to side effects. Among seniors, the rate is 44.7%—even though doctors exert massive pressure to keep taking the medication.
Earlier, lower, longer: The three pillars of the billion-dollar business
The new guideline is not a scientific document. It is a business plan.
– Earlier (adolescents, young adults): Decades of additional treatment time.
– Lower (LDL targets of 55, 70 mg/dL): higher dosages, combination therapies with PCSK9 inhibitors, bempedoic acid, inclisiran—all of which are patent-protected, high-priced medications.
– Longer (“lifetime exposure” as a concept): lifelong medication as the medical standard
The five lipid-lowering drugs newly approved by the U.S. Food and Drug Administration (FDA), which are explicitly mentioned in the accompanying materials for the guideline—bempedoic acid (brand name Nexletol), inclisiran (Leqvio),
evinacumab (Evkeeza), olezarsen (Tryngolza), and plozasiran (Redemplo)—are not generic drugs costing 5 cents per tablet. The approximate drug costs per patient per year range from $5,200 (bempedoic acid) and $7,175 (inclisiran) to $40,000 (olezarsen) and $45,000 (plozasiran), up to approximately $600,000 (evinacumab). (4) These are, therefore, enormously expensive drugs, protected by patents, promoted by paid key opinion leaders—more details here », here », and here »—and prescribed according to guidelines whose authors deal with their conflicts of interest with astonishing nonchalance. What they have achieved is the first treatment recommendation in the history of medicine that could just as easily be read as a stock prospectus without changing a single word.
Follow the Money – A Guideline as a Surrender
What appeared on March 13, 2026, in the medical journal Circulation is less a breakthrough in prevention than the final surrender of cardiology to Big Pharma. The logic is as simple as it is deadly:
1. Lower the thresholds for what is considered pathological.
2. Invent a risk concept that turns everyone into a patient.
3. Set treatment goals that can only be achieved with medication.
4. Withhold data that refutes your model.
5. Let the industry fund the studies, sponsor the guideline authors, and pay for continuing education.
At the end of this equation lie the dead. From infections in weakened immune systems. From cerebral hemorrhages in fragile blood vessels. From cancer when the body’s tumor defense mechanisms are crippled. From suicides when serotonin pathways dependent on cholesterol collapse. This is called collateral damage. But it’s not the medical-industrial complex that pays the price. It’s us. With our lives.
And Jonas? The 32-year-old from the beginning, in perfect health, jogging three times a week? Under the new system, he’s no longer considered healthy. He’s a patient who just doesn’t know his diagnosis yet. One cholesterol-laden year of life after another ticks away against him.
Follow the Science? For all those who concocted this guideline and will implement it in the future at the expense of patients, the principle that applies is more likely: Follow the Money.
Notes
(1) PCSK9 inhibitors are medications that very significantly lower LDL cholesterol levels in the blood. How? The liver has small “tentacles” on its surface, known as LDL receptors. These receptors capture LDL cholesterol from the blood and break it down. However, the protein PCSK9 causes some of these receptors to be destroyed. PCSK9 inhibitors block this process. The result: More LDL receptors remain intact; the liver removes more LDL from the blood; the LDL level drops. Such medications can often lower the LDL level by an additional 50 to 60 percent. They are primarily used when statins are insufficient, are not tolerated, or when there is a hereditary condition causing very high cholesterol levels.
(2) For more details, see Harald Wiesendanger: The Healthcare System—How to Understand, Survive, and Transform It (2019, in German).
(3) https://www.sciencemediacenter.de/angebote/meta-analyse-angaben-von-moeglichen-nebenwirkungen-bei-statinen-meist-ohne-evidenz-26026; see also information at https://pubmed.ncbi.nlm.nih.gov/40864246/ and https://link.springer.com/article/10.1007/s00392-025-02751-z
(4) Bempedoic acid and inclisiran are of particular interest for the widespread expansion of LDL therapy. The remaining three drugs have so far been targeted primarily at rare, severe lipid metabolism disorders.
Illustrations: DALL-E.