LDL cholesterol: how low to go?

Packard, C. J. (2018) LDL cholesterol: how low to go? Trends in Cardiovascular Medicine, 28(5), pp. 348-354. (doi: 10.1016/j.tcm.2017.12.011) (PMID:29336946)

Abstract

Epidemiology and the results of large-scale outcome trials indicate that the association of LDL with atherosclerotic cardiovascular disease is causal, and continuous not only across levels seen in the general population but also down to sub-physiological values. There is no scientific basis, therefore, to set a target or 'floor' for LDL cholesterol lowering, and this presents a clinical and conceptual dilemma for prescribers, patients, and payers. With the advent of powerful agents such as proprotein convertase/subtilisin kexin type 9 (PCSK9) inhibitors, LDL cholesterol can be lowered profoundly but health economic constraints mandate that this therapeutic approach needs to be selective. Based on the need to maximize the absolute risk reduction when prescribing combination lipid-lowering therapy, it is appropriate to prioritize patients with the highest risk (aggressive and established CVD) who will obtain the highest benefit, that is, those with elevated LDL cholesterol on optimized statin therapy.

• Item Type: Articles
• Keywords: PCSK9 inhibitor, cardiovascular disease, clinical trial, prevention, statin.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Packard, Professor Chris
• Authors: Packard, C. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Trends in Cardiovascular Medicine
• Publisher: Elsevier
• ISSN: 1050-1738
• ISSN (Online): 1873-2615
• Published Online: 28 December 2017
• Copyright Holders: Copyright © 2017 Elsevier Inc.
• First Published: First published in Trends in Cardiovascular Medicine 28(5): 348-354
• Publisher Policy: Reproduced in accordance with the publisher copyright policy