From the Guidelines
According to the ESC 2024 guidelines, LDL-cholesterol targets vary based on cardiovascular risk categories, with very high-risk patients aiming for <40 mg/dL (<1 mmol/L) as stated in the 2024 recommendations on the optimal use of lipid-lowering therapy 1. For HbA1c targets in diabetic patients, the general recommendation is between 7% and 8% for most patients to reduce microvascular complications, as suggested by the American College of Physicians guidance statement update from 2018 1. However, this target should be individualized based on age, comorbidities, and hypoglycemia risk. Some key points to consider include:
- Very high-risk patients should aim for an LDL-cholesterol level of <40 mg/dL (<1 mmol/L) 1.
- High-risk patients should aim for an LDL-cholesterol level of <55 mg/dL (<1.4 mmol/L) or at least a 50% reduction from baseline 1.
- For diabetic patients, an HbA1c target between 7% and 8% is recommended for most patients, with individualization based on factors such as age, comorbidities, and hypoglycemia risk 1.
- For younger patients with shorter diabetes duration and without significant cardiovascular disease, a stricter target of ≤6.5% (48 mmol/mol) may be appropriate, while for elderly patients or those with comorbidities, a less stringent target of 7.5-8.0% (58-64 mmol/mol) is reasonable 1. These targets are important because lower LDL levels reduce atherosclerotic plaque formation, while optimal glycemic control helps prevent both micro and macrovascular complications in diabetic patients.
From the Research
Target LDL Levels
- The target LDL levels vary based on cardiovascular risk, with higher risk patients requiring lower LDL levels 2, 3.
- For patients at extreme cardiovascular risk, an LDL level <55 mg/dL is advised 2.
- The European Society of Cardiology (ESC) guidelines recommend an LDL target of <55 mg/dL and LDL reduction ≥50% for very high-risk patients 3.
- However, achieving these targets can be challenging, with only 3.2% of very high-risk patients reaching an LDL level <55 mg/dL 3.
Target HbA1c Levels
- There is no direct information available on target HbA1c levels based on cardiovascular risk according to ESC 2024 guidelines in the provided studies.
- The studies primarily focus on LDL cholesterol goals and lipid-lowering therapies, with no mention of HbA1c targets.
Cardiovascular Risk and LDL Targets
- Patients with established atherosclerotic cardiovascular disease (ASCVD) are considered very high-risk and require more aggressive lipid-lowering therapy 3, 4.
- The use of high-intensity statins, ezetimibe, and PCSK9 inhibitors can help achieve LDL targets in high-risk patients 2, 3, 4.
- However, treatment gaps in lipid management persist, and greater efforts are needed to improve LDL goal attainment rates in high-risk cardiovascular patients 5.