[From guidelines: cardiovascular risk stratification and therapeutic targets]

The linear relationship between LDL cholesterol (LDL-C) concentrations and cardiovascular risk, together with evidence of clinical benefit associated with intensive and sustained LDL-C reduction, underlies the "the lower, the better" paradigm. Cardiovascular risk stratification is the prerequisite for defining treatment intensity. In the context of primary prevention, international guidelines recommend the use of validated scores for an objective definition of individual risk. This evaluation must be integrated by considering risk-amplifying factors not included in the algorithms, such as a family history of premature events, elevated lipoprotein(a) and triglyceride levels, and the presence of coronary artery calcium. Statin/ezetimibe combination therapy acts through complementary mechanisms, reducing hepatic synthesis and intestinal absorption of cholesterol, respectively. Evidence indicates greater efficacy in achieving LDL-C targets compared with statin intensification alone, along with favorable treatment adherence. Despite clear recommendations regarding target LDL-C levels, real-world data highlight persistent undertreatment and a low percentage of patients with LDL-C levels consistent with guideline recommendations. In both primary and secondary prevention, the statin/ezetimibe combination represents an effective and safe strategy to achieve recommended therapeutic goals and its early implementation contributes to reducing therapeutic inertia.