Statins have been used clinically for more than 20 years and many clinical trials on statins have shown that statins are effective in reducing mortality and significantly reducing the incidence of obstructive vascular events in patients with risk factors for cardiovascular disease. However, it is questionable whether high-dose statin therapy with potent LDL-lowering regimens is more effective than low-dose regimens in reducing vascular event rates and mortality. The newly published SEARCH study answers this question. In this randomized, double-blind trial with a mean observation period of 6.7 years and an enrollment of more than 10,000 patients, it was found that the 80 mg daily simvastatin group reduced LDL cholesterol by a further 0.35 mmol/L and reduced the incidence of major vascular events (coronary death, myocardial infarction, stroke, revascularization) by 6% compared to the 20 mg daily group. About 0.9% of patients developed myopathy, compared to only 0.03% in the 20 mg group. A meta-analysis over the same period showed that the potent lipid-lowering regimen reduced the incidence of major vascular events by 15% compared with the standard lipid-lowering regimen, including a 13% reduction in coronary mortality and nonfatal myocardial infarction events, a 19% reduction in coronary revascularization, and a 16% reduction in ischemic stroke. Each 1 mmol/L reduction in LDL reduced the incidence of vascular events similarly to the statin versus placebo trial, that is, each 1 mmol/L reduction in LDL reduced mortality by 10%, primarily from coronary and other cardiac disease, with no significant effect on stroke-related and other vascular disease-related deaths. Each 1 mmol/L reduction in LDL reduces the annual incidence of major vascular events by about 1/5, and a 2-3 mmol/L reduction in LDL reduces major vascular events by about 40-50%. Intense lipid-lowering regimens did not increase tumor incidence, tumor-related mortality, or other non-vascular disease-related mortality. The study concluded that the potent lipid-lowering regimen was safe and effective. Each 1 mmol/L reduction in LDL reduced the risk of major vascular events, regardless of the patient’s baseline LDL level, even if the baseline LDL level was less than 2 mmol/L. However, only a small number of patients on a potent lipoprotein-lowering regimen can reduce LDL to less than 2 mmol/L. The current study concluded that patients at high risk for cardiovascular disease would benefit from receiving a potent statin regimen, even if the baseline LDL level in this group of patients was already less than 2 mmol/L. The potent lipid-lowering regimen is effective primarily because of the reduction in coronary events, so it does not benefit those patients with chronic heart failure and chronic renal failure. It is not clear whether people of different ethnicities, such as Chinese and Japanese, benefit from intensive lipid-lowering regimens because stroke is a more common cause of death than coronary artery disease in these populations. Although the risk of hemorrhagic stroke is slightly increased with aggressive lipid-lowering regimens, the value is much less than the reduction in the risk of ischemic stroke. Whether these findings apply to populations at high risk for hemorrhagic stroke, such as the Chinese and Japanese stroke populations, where the incidence of hemorrhagic stroke is three times higher than in the US population, requires further study. A 10-year observational study from Japan showed that LDL less than 2 mmol/L was an independent risk factor for hemorrhagic stroke. In conclusion, a vigorous lipid-lowering regimen is safe and effective. Patients with multiple cardiovascular risk factors are recommended to receive potent lipid-lowering therapy, and low levels of LDL are not a reason to refuse lipid-lowering therapy if the patient has clear risk factors for cardiovascular events.