Management of hyperlipidemia: new LDL-C targets for persons at high-risk for cardiovascular events

Coronary heart disease (CHD) remains the leading cause of mortality in the United States, and is associated with significant health care costs. Current evidence overwhelmingly confirms the role of low-density lipoprotein cholesterol (LDL-C) in the pathogenesis of atherosclerosis and the risk of CHD events. The approach to the management of hyperlipidemia has evolved dramatically over the past decade. Randomized clinical trails have provided strong evidence that lowering plasma cholesterol with statins reduces the risk of cardiovascular events, particularly in high-risk patients, irrespective of baseline cholesterol levels. The National Cholesterol Education Program (NCEP) report was released in July 2004. The report examined the results of recently concluded clinical trials and provided consensus recommendations on the management of hyperlipidemia. The report expands on the core content of the previously published guidelines. However, it is by far the most aggressive approach to date for reducing CHD risk. A focal element of the report is the modification of LDL-C goal in high-risk patients to <70 mg/dL. This goal is provided as a therapeutic option and is based on findings of recently concluded clinical trials. The more aggressive recommendations add challenges to the health care system, as the number of patients requiring drug therapy is likely to increase. In spite of the challenges, there are ample opportunities for improving the management of hyperlipidemia. Adherence to the recommendations will vastly reduce morbidity and mortality associated with CHD.