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[Management of hypercholesterolemia: what target for LDL cholesterol?]

Bertrand Cariou1, Michel Krempf

  • 1Clinique d'endocrinologie, hôpital Guillaume-et-René-Laennec, CHU de Nantes, 44093 Saint-Herblain Cedex 1. bertrand.cariou@univ-nantes.fr

La Revue Du Praticien
|December 6, 2011
PubMed

Insights

Lowering low-density lipoprotein cholesterol (LDL-c) is crucial for preventing atherosclerosis. Optimal LDL-c targets, informed by physiological ranges and clinical trials, guide cardiovascular risk management.

Area of Science:

  • Cardiovascular Medicine
  • Lipid Metabolism
  • Atherosclerosis Research

Context:

  • Low-density lipoprotein cholesterol (LDL-c) is a key independent risk factor for cardiovascular disease, driving atherosclerosis development and progression.
  • Randomized clinical trials with statins indicate an optimal LDL-c target below 70 mg/dL for cardiovascular risk reduction.
  • The physiological LDL-c range in atherosclerosis-resistant populations (hunter-gatherers, wild mammals) is 0.5 to 0.7 g/L.

Purpose:

  • To evaluate the optimal therapeutic targets for LDL-c in cardiovascular disease prevention.
  • To assess the safety and efficacy of achieving low LDL-c levels.
  • To inform clinical guidelines on personalized LDL-c targets based on overall cardiovascular risk.

Summary:

  • Achieving LDL-c levels below 70 mg/dL is recommended for cardiovascular risk reduction, supported by statin trial data.
  • Genetically determined low LDL-c levels in humans show no major safety concerns.
  • While statin therapy can moderately increase risks of hemorrhagic stroke and diabetes, guidelines advocate tailoring LDL-c targets to individual cardiovascular risk profiles.

Impact:

  • Provides evidence-based recommendations for managing LDL-c to mitigate cardiovascular events.
  • Highlights the importance of considering physiological LDL-c levels in therapeutic goal setting.
  • Supports personalized medicine approaches in cardiovascular risk management by adjusting LDL-c targets based on total risk assessment.

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