Identifying patients for aggressive cholesterol lowering: the risk curve concept

The National Cholesterol Education Program's 2004 report identified more aggressive optional low-density lipoprotein (LDL) cholesterol treatment goals of <70 mg/dl for secondary prevention patients and <100 mg/dl for moderately high risk, primary prevention patients. Although LDL cholesterol reduction is the first step in reducing cardiovascular risk, it may be difficult for clinicians to visualize the risk reduction benefit for patients from various risk interventions. The concept of a "risk curve," or the absolute risk of a patient for subsequent cardiovascular events over a range of LDL cholesterol values, is proposed. In conclusion, placing a patient on the appropriate risk curve may facilitate an individualized clinical management strategy that takes into account the patient's absolute benefit from further LDL cholesterol reduction as well as from shifting the risk curve downward through non-LDL cholesterol interventions.