LDL-C: The Only Causal Risk Factor for ASCVD. Why Is It Still Overlooked and Underestimated?

Area of Science:

• Cardiology
• Lipidology
• Preventive Medicine

Background:

• Low-density lipoprotein cholesterol (LDL-C) is a primary causal risk factor for atherosclerotic cardiovascular disease (ASCVD).
• Numerous studies confirm the critical role of LDL-C in ASCVD development and progression.

Purpose of the Study:

• To review the reasons why LDL-C is often overlooked and underestimated in clinical practice.
• To discuss the gap between new dyslipidemia guidelines and real-world patient management.

Main Methods:

• Review of recently published EAS/ESC Guidelines for dyslipidemia and prevention.
• Analysis of real-life registry data on LDL-C treatment adherence.
• Identification of factors contributing to undertreatment.

Main Results:

• New guidelines establish lower LDL-C targets for ASCVD prevention.
• Real-world data indicate significant undertreatment, with patients exceeding target LDL-C levels.
• Poor patient/physician adherence, inadequate education, and healthcare system factors contribute to this gap.

Conclusions:

• Effective implementation of LDL-C guidelines requires addressing patient and physician education.
• Shared decision-making is crucial for improving adherence and achieving target LDL-C levels.
• Overcoming undertreatment is essential for reducing ASCVD event rates.