LDL cholesterol: should guidelines include targets?

Abstract

Elevated low-density lipoprotein cholesterol (LDL-C) is associated with adverse cardiovascular outcomes. The strategy of target-based LDL-C lowering to reduce the risk of coronary heart disease and secondary event rates is now well established. However, the strategy for treating to a target LDL-C, and whether there is a lower threshold level for LDL-C continues to be debated. We present, and critically analyze the evidence for a target-based LDL-C lowering strategy, and the safety and efficacy of intensive plasma LDL-C-lowering with traditional, and novel LDL-lowering therapies below current guideline targets.

Keywords::

• LDL-C
• lipid lowering therapy
• treatment targets

Financial & competing interests disclosure

S Banerjee has received research grants from Boston Scientific; consultant/speaker honoraria from Medtronic, Covidien; ownership: Mdcare Global (spouse); intellectual property: HygeiaTel. ES Brilakis has received research grants and consulting fees/speaker honoraria from St Jude Medical, Boston Scientific, Asahi, Janssen, Sanofi, Abbott Vascular and Terumo; research support from Guerbet; spouse is an employee of Medtronic. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.