I think you're over-simplifying the Alzheimer's treatment. The medicine was shown to be effective in reducing plaques, and has been approved for any medical use where reducing plaques is the goal. However, reducing plaques does not seem to actually help patients with Alzheimer's. So the medicine "works" in the sense that it does what it's supposed to (reduce plaques) but does not help Alzheimer's patient outcomes and should not be used for that purpose. The FDA made the bone-headed decision to let the medicine get its seal of approval anyway, knowing full well that every doctor in the USA would prescribe it anyway.
I like Gary, but on the issue of cholesterol is more complex than he portrays.
It is absolutely the case that LDL-C is correlated with heart disease at the population level. It is absolutely the case that LDL-P is correlated with heart disease at the individual level. Beyond the correlation, there is considerable mechanism of action evidence that small particle lipoproteins are the driver of atherosclerosis.
The primary issue with statins / LDL is that they are prescribed based on LDL-C, which is not appropriate at the individual level and are thus considerably over proscribed. LDL-C only matters at the population level, not individual. When lowering LDL-C for the population, you will only see small benefits since most people get little to no benefit from the drug.
However, people with high LDL-P will absolutely see a benefit from statins. You need only look at the FH groups to see this.
