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Despite good evidence for reduced mortality on statins and decades of promotion, population uptake globally is less than 3%, and only around 10% even in the United Kingdom and the United States. Statins remain the only cholesterol\u2010lowering drug class shown to improve survival, albeit only in symptomatic coronary patients and on mid\u2010range doses. Population studies have consistently shown that coronary events and mortality are lower the lower the serum total cholesterol concentration. However, below 5\u2009mmol\/L (low\u2010density lipoprotein, LDL, cholesterol around 3.5\u2009mmol\/L), the population studies show that total mortality begins to rise. Statin research and competitive marketing have advanced to where a wide range of dosages has been approved in many countries. No specific target cholesterol concentration that maximizes survival has been demonstrated in appropriately designed randomized controlled trials (RCTs). As with any enzyme inhibitor, the efficacy of statins plateaus above mid\u2010range doses, but toxicities continue to increase manyfold. In the six largest RCTs that compared high versus mid\u2010range statin doses in coronary patients, a higher statin dose achieved marginally greater reductions in coronary events, in some studies, but without appreciable reduction in mortality. Newer drugs, which reduce PCSK9, and ezetimibe, have similarly not been shown to lower mortality. It is widely acknowledged that a sufficient statin dose is important in the management of symptomatic coronary disease, along with weight reduction and appropriate antithrombotic, blood pressure, and diabetes pharmacotherapy. Mid\u2010range statin doses have been shown to achieve the maximum improvements in total mortality and have the advantage of greater tolerability because of fewer adverse events and interactions.<\/jats:p>","DOI":"10.1002\/prp2.70187","type":"journal-article","created":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T05:15:08Z","timestamp":1765862108000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rethinking Statin Dosage in Coronary Disease"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0093-4949","authenticated-orcid":false,"given":"Simon B.","family":"Dimmitt","sequence":"first","affiliation":[{"name":"Division of Internal Medicine, Medical School University of Western Australia  Crawley Australia"},{"name":"School of Medicine and Public Health University of Newcastle  Newcastle 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