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Hit or miss: the new cholesterol targets
Robert DuBroff1, Aseem Malhotra2, Michel de Lorgeril3
1Internal Medicine/Cardiology, University of New Mexico, Albuquerque, New Mexico, USA rjdabq@gmail.com.
BMJ Evidence-Based Medicine
|August 5, 2020
Summary
New cholesterol guidelines recommend drug treatment for four high-risk groups. However, a review found no additional benefit, questioning the use of low-density lipoprotein cholesterol targets for cardiovascular disease prevention.
Area of Science:
- Cardiology
- Pharmacology
- Preventive Medicine
Background:
- Current guidelines recommend cholesterol-lowering drug treatment for four moderate- to high-risk patient populations.
- These populations include those with a history of cardiovascular events, adult diabetics, individuals with low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL, and those with a 10-year cardiovascular risk ≥7.5%.
Purpose of the Study:
- To evaluate the efficacy of achieving new cholesterol target levels in reducing cardiovascular events.
- To assess the validity of using LDL-C as a surrogate target for cardiovascular disease (CVD) prevention.
Main Methods:
- Systematic review of 35 randomized controlled trials (RCTs) investigating cholesterol-lowering treatments.
- Analysis focused on the benefits of achieving specific LDL-C target levels in the identified patient populations.
Main Results:
- Achieving the recommended cholesterol target levels did not confer any additional cardiovascular benefit across the studied trials.
- Current risk-based recommendations may lead to undertreatment of some high-risk individuals and overtreatment of low-risk individuals.
Conclusions:
- The effectiveness of current cholesterol-lowering treatment strategies based on achieving specific LDL-C targets is questionable.
- Rethinking the use of LDL-C as a sole surrogate marker for CVD prevention is warranted, given the negative results of numerous RCTs.
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