From the Guidelines
The target LDL cholesterol level should be less than 1.8 mmol/L (70 mg/dL) for patients at very high CV 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.
Key Considerations
- For patients at high CV risk, an LDL-C goal of < 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) is recommended 1.
- A statin is the usual first line treatment to reach the LDL-C goal and should be used up to the highest recommended dose or highest tolerable dose to reach the goal 1.
- The evidence that reducing plasma LDL cholesterol reduces CVD risk is unequivocal, with every 1.0 mmol/L reduction in LDL cholesterol associated with a corresponding 20–25% reduction in CVD mortality and non-fatal myocardial infarction 1.
Treatment Approach
- Treatment typically begins with lifestyle modifications including a heart-healthy diet low in saturated fats, regular exercise, weight management, and smoking cessation.
- If these measures are insufficient, statin medications like atorvastatin (10-80 mg daily) or rosuvastatin (5-40 mg daily) are first-line pharmacological therapy.
- For patients who cannot reach targets with statins alone, additional medications such as ezetimibe (10 mg daily) or PCSK9 inhibitors (evolocumab or alirocumab) may be added.
Importance of LDL Targets
- LDL cholesterol directly contributes to atherosclerotic plaque formation in arteries, and reducing LDL levels has been consistently shown to decrease cardiovascular events including heart attacks and strokes.
- The 2016 ESC/EAS guidelines for the management of dyslipidaemias recommend using LDL-Cholesterol (LDL-C) as the primary lipid analysis for screening, risk estimation, diagnosis and management 1.
From the Research
LDL Target
- The recommended target for low-density lipoprotein cholesterol (LDL-C) is less than 70 mg/dL or at least 50% reduction of LDL-C in patients with very high cardiovascular risk 2.
- Achieving an LDL-C target of <70 mg/dL or ≥50% reduction is associated with a reduced risk of cardiovascular events 2, 3.
- Studies have shown that high-dose statin therapy, such as atorvastatin, can reduce the risk of cardiovascular events in patients with acute coronary syndrome 2.
- The addition of ezetimibe to statin therapy has been shown to further reduce LDL-C levels and decrease the risk of cardiovascular events 4, 5.
- The optimal target LDL-C level for statin treatment is still a topic of debate, with some studies suggesting a "threshold" value below which the incidence of cardiovascular events is no longer reduced 6.
- A threshold LDL-C value of 70 mg/dL has been suggested as the optimal target for secondary prevention of cardiovascular events in patients with coronary artery disease 6.