Optimal lipid targets for the new era of cardiovascular prevention

Optimal lipid targets (OLT) should be the goal for all individuals treated in the new era of cardiovascular (CV) disease prevention. Evidence supports that average LDL cholesterol (LDL-C) values in Westernized populations are not optimal. Lessons from nature and science support a physiologic LDL-C target of <70 mg/dL. Clinical trial evidence further supports optimal LDL-C targets, although several critical questions remain unanswered. Using a calculated LDL-C may have limitations in clinical practice. Non-HDL-C cholesterol may be a better predictor of outcomes, and should therefore be provided on all laboratory reports. Specific HDL cholesterol (HDL-C) targets are significantly more complicated. Although a low HDL-C predicts a less favorable outcome independent of LDL-C level, an HDL-C level > 50 mg/dL is associated with lower CV risk. Clinical trials on HDL-C have thus far been disappointing. OLT should be the goal for all individuals as an important part of addressing global CV risk.