LDL-C Targets Called into Question

An analysis with critically reviewing the clinical outcomes of randomized controlled trials (RCTs) of cholesterol reduction challenges the current approach to cardiovascular disease (CVD) prevention through targeted reductions of low density lipoprotein cholesterol (LDL-C). Drug treatment to reduce LDL-C to target levels (30% and 50% or more reduction for individuals at moderate or high risk, respectively) is recommended in four patient populations: patients who have already sustained a CVD event, adult diabetic patients, individuals with LDL-C levels ≥190 mg/dL and individuals with an estimated 10-year cardiovascular risk ≥7.5%. Recommending cholesterol lowering treatment based on estimated CVD risk fails to identify many high-risk patients and may lead to unnecessary treatment of low-risk individuals. Some RCTs with very modest reductions of LDL-C (11%–15%) reported CVD benefits while others with much greater degrees of LDL-C reduction (50% or more) did not. This lack of exposure–response relationship suggests there is no correlation between the percent reduction in LDL-C and the absolute risk reduction in CVD events, and call into question the validity of using LDL-C as a surrogate target for the prevention of CVD. Thus, informed decision-making should be encouraged, including a discussion of absolute risk reduction and/or number needed to treat for an individual patient. Source: https://ebm.bmj.com/