What is the goal low-density lipoprotein (LDL) level for patients with hyperlipidemia?

From the Guidelines

The goal LDL level for patients with hyperlipidemia should be less than 1.8 mmol/L (70 mg/dL) for those at very high cardiovascular risk, or a reduction of at least 50% if the baseline LDL-C is between 1.8 and 3.5 mmol/L (70 and 135 mg/dL), as recommended by the 2016 ESC/EAS guidelines for the management of dyslipidaemias 1. For patients at high cardiovascular risk, the goal LDL level is less than 2.6 mmol/L (100 mg/dL), or a reduction of at least 50% if the baseline LDL-C is between 2.6 and 5.1 mmol/L (100 and 200 mg/dL) 1. Key considerations in determining the goal LDL level include:

• The patient's individual cardiovascular risk factors, such as established cardiovascular disease, diabetes, or familial hypercholesterolaemia
• The presence of other major risk factors, such as smoking or high blood pressure
• The patient's baseline LDL-C level and potential for reduction with treatment Treatment typically begins with lifestyle modifications, including a heart-healthy diet and regular exercise, and may include medication therapy with statins or other lipid-lowering agents 1. The intensity of statin therapy should match the patient's risk level, with high-intensity statins reserved for those at greatest risk 1. Additional medications, such as ezetimibe or PCSK9 inhibitors, may be added for patients who cannot reach their LDL goals with statins alone. These targets are important because LDL cholesterol contributes directly to atherosclerotic plaque formation in arteries, and lower LDL levels correlate with reduced risk of heart attacks, strokes, and other cardiovascular events 1.

From the Research

Goal LDL Level for Patients with Hyperlipidemia

The goal low-density lipoprotein (LDL) level for patients with hyperlipidemia is a topic of discussion among medical professionals.

• According to a study published in 2006 2, a low-density lipoprotein (LDL) cholesterol goal of less than 100 mg/dl is recommended for patients at moderate to high risk of cardiovascular disease, with an optional LDL goal of less than 70 mg/dl for patients at a very high risk of cardiovascular disease.
• Another study published in 2011 3 found that 79% of patients with coronary artery disease achieved an LDL cholesterol goal of <100 mg/dl, while only 35% achieved the more aggressive goal of <70 mg/dl.
• A study published in 2011 4 investigated the proportion of very high-risk patients with coronary heart disease who achieve the optional LDL-C target of <70 mg/dl and found that only 15.1% of them had LDL-C levels of <70 mg/dl.
• A more recent study published in 2022 5 suggests that the best overall therapeutic target is LDL-cholesterol 1.8 mmol/l (70 mg/dl) or less or decreased by at least 50% whichever is lower.
• However, a study published in 2006 6 found that there is a lack of evidence for recommended low-density lipoprotein treatment targets, suggesting that current clinical evidence does not demonstrate that titrating lipid therapy to achieve proposed low LDL cholesterol levels is beneficial or safe.

Factors Influencing LDL Goal Achievement

Several factors can influence the achievement of LDL goals, including:

• The use of intensive lipid-lowering medication, which was associated with a 12-fold higher possibility of achieving LDL-C levels of <70 mg/dl 4
• The initial LDL-C level, with percentage decreases in LDL-cholesterol or non-HDL-cholesterol concentration being better in people with initial concentrations of less than 3.6 mmol/l 5
• Patient characteristics, such as age and sex, with women and younger men being less likely to achieve their lipid goals 3