Debate: "How low should LDL cholesterol be lowered?" Viewpoint: "It doesn't need to be very low"

Sergio Fazio, MacRae F. Linton

    Research output: Contribution to journalComment/debate

    6 Scopus citations

    Abstract

    The importance of low-density lipoprotein (LDL) control in the management of patients at high risk of cardiovascular events is unquestionable. The major statin trials have shown that the benefits of LDL lowering extend throughout the range of risk and the range of serum cholesterol, and have indicated that the protective effects of the intervention are mostly related to the baseline risk. Statin therapy is, for this reason, currently seen as an anti-atherogenic approach for the majority of high risk individuals and possibly all coronary heart disease patients. This debate is not about the value of statin therapy or the importance of LDL reduction, but about the goals to be set once we decide that LDL cholesterol must be reduced. With the National Cholesterol Education Program (NCEP) guidelines representing a solid middle ground, the two viewpoints in this debate try to argue, on one hand, that the LDL goals should be substantially lower than our current standards or, on the other, that a specific on-treatment LDL value may not be the most important goal to pursue. We defend the latter position by presenting the case that the most effective LDL intervention in high risk patients is to achieve a reduction of at least 30%. This strategy complies with the NCEP guidelines, as most of the high risk patients treated with an average dose of an average statin would experience a 30-40% LDL reduction that would put on-treatment LDL levels safely below goal. Our position differs from both the guidelines and the proponents of more aggressive LDL goals in the management of the two extremes of the cholesterol distribution, where our lack of interest in a predefined on-treatment LDL concentration would make us more aggressive than guidelines on low baseline LDL patients and less aggressive than guidelines on high baseline LDL patients.

    Original languageEnglish (US)
    Article number008
    Pages (from-to)8-11
    Number of pages4
    JournalCurrent Controlled Trials in Cardiovascular Medicine
    Volume2
    Issue number1
    DOIs
    StatePublished - Mar 28 2001

    Keywords

    • Atherosclerosis
    • Clinical trials
    • Coronary disease prevention
    • Coronary heart disease risk
    • Low-density lipoprotein cholesterol
    • Meta-analyses
    • Statins

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

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