Targeting LDL Cholesterol: Beyond Absolute Goals Toward Personalized Risk

Abstract

Purpose of Review The aim of this study was to review and assess the evidence for low-density lipoprotein cholesterol (LDL-C) treatment goals as presented in current guidelines for primary and secondary prevention of cardiovascular disease. Recent Findings Different sets of guidelines and clinical studies for secondary prevention have centered on lower absolute LDL-C targets [<70 mg/dL (<1.8 mmol/L)], greater percent reductions of LDL-C (≥50%), or more intense treatment to achieve greater reductions in cardiovascular risk. Population-based risk models serve as the basis for statin initiation in primary prevention. Reviews of current population risk models for primary prevention show moderate ability to discriminate [with c-statistics ranging from 0.67 to 0.77 (95% CIs from 0.62 to 0.83) for men and women] with poor calibration and overestimation of risk. Summary Individual clinical trial data are not compelling to support specific LDL-C targets and percent reductions in secondary prevention. Increasing utilization of electronic health records and data analytics will enable the development of individualized treatment goals in both primary and secondary prevention.

High Hydrostatic Pressure Induces a Lipid Phase Transition and Molecular Rearrangements in Low‐Density Lipoprotein Nanoparticles

“…More precisely, we investigated LDL samples isolated from normolipidemic donors; tested the influence of the core lipid composition using an LDL sample with a TG‐rich lipid core, which is typically found in blood samples of hypertriglyceridemic patients; and finally addressed the behavior of oxidatively stressed LDL . The latter two populations are suggested to have a major impact on the development of cardiovascular diseases and are therefore of great pathophysiological interest in particular for the development of new therapies . As such, it would be highly interesting to see whether structural and morphological features are distinctly different in modified LDL as response to external pressure‐induced stress.…”

Evolving worldwide approaches to lipid management and implications for Australian general practice

“…This is aligned with average fall in large trials. 40 The NICE guidelines, 31 which formerly recommended 'fire and forget', now emphasise more precise clinical practice.…”

“…41 More recently, there has been discussion of individualising treatment on the basis of the person's risk status. 40 While many countries, including Australia, previously favoured a percentage reduction approach, there has been a debate about what cholesterol target should be achieved with lipid lowering treatment. The targets were originally based on LDL-C (<2.6 mmol/L and <1.8 mmol/L for primary and secondary prevention, respectively), but increasingly non-HDL has gained favour.…”

Clinical Significance of Electronegative Low-Density Lipoprotein Cholesterol in Atherothrombosis

“…“No treatment goal”, “the lower the LDL-C, the better”, and “beyond absolute goals toward personalized risk” are the current strategies of primary and secondary prevention of CVDs [ 96 , 97 ]. The incidence of subclinical atherosclerosis remains as high as 64% in the LDL-C range of 150~160 mg/dL and 11% in the range of 60~70 mg/dL [ 4 , 98 ].…”