LDL-C: lower is better for longer-even at low risk

Peter E Penson, Matteo Pirro, Maciej Banach, Peter E Penson, Matteo Pirro, Maciej Banach

Abstract

Background: Low-density lipoprotein cholesterol (LDL-C) causes atherosclerotic disease, as demonstrated in experimental and epidemiological cohorts, randomised controlled trials, and Mendelian randomisation studies.

Main text: There is considerable inconsistency between existing guidelines as to how to effectively manage patients at low overall risk of cardiovascular disease (CVD) who have persistently elevated levels of LDL-C. We propose a step-by-step practical approach for the management of cardiovascular risks in individuals with low (< 1%) 10-year risk of CVD, and elevated (> 140 mg/dL, 3.6 mmol/L) LDL-C. The strategy proposed is based on the level of adherence to lifestyle interventions (LSI), and in case of non-adherence, stepwise practical management, including lipid-lowering therapy, is recommended to achieve a target LDL-C levels (< 115 mg/dL, 3.0 mmol/L).

Conclusions: Further studies are necessary to answer the questions on the long-term efficacy, safety, and cost-effectiveness of the suggested approach. This is critical, considering the ever-increasing numbers of such low-risk patients seen in clinical practice.

Keywords: Cardiovascular disease; Ezetimibe; Low risk; Risk stratification; Statins.

Conflict of interest statement

PEP owns four shares in AstraZeneca PLC and has received honoraria and/or travel reimbursement for events sponsored by AKCEA, Amgen, AMRYT, Link Medical, Napp, Sanofi; MP has received honoraria and/or travel reimbursement for events sponsored by Amgen, Alfasigma, Mylan, Neopharmed Gentili, Sanofi; MB - speakers bureau: Abbott/Mylan, Akcea, Amgen, Daichii Sankyo, KRKA, MSD, Novartis, Novo-Nordisk, Polpharma, Sanofi, Servier; consultant to Akcea, Amgen, Daichii Sankyo, Esperion, Freia Pharmaceuticals, MSD, Polfarmex, Resverlogix, Sanofi/Regeneron; Grants from Amgen, Mylan, Sanofi, and Valeant.

Figures

Fig. 1
Fig. 1
Proposed approach to the management of cardiovascular risks in individuals with low ( 140 mg/dL, 3.6 mmol/L) LDL-C

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