Evolution of More Aggressive LDL-Cholesterol Targets and Therapies for Cardiovascular Disease Prevention

• Published in: Journal of clinical medicine Vol. 12; no. 23; p. 7432
• Main Authors: Jones, Jeffrey E, Tang, Kevin S, Barseghian, Ailin, Wong, Nathan D
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 30-11-2023
• Subjects: Anticholesteremic agents; Apolipoproteins; Atherosclerosis; Cardiovascular disease; Cardiovascular diseases; Cholesterol; Cholesterol, LDL; Clinical medicine; Diabetes; Diet; Disease prevention; Dosage and administration; Drug therapy; Dyslipidemias; Health aspects; Heart; High density lipoprotein; Lipids; Liver; Low density lipoprotein; Metabolic disorders; Mortality; Mutation; Prevention; Statins; Triglycerides; Netherlands; United States > US; cardiovascular disease; guidelines; dyslipidemia; low density lipoprotein cholesterol
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm12237432

Over the last half-century, discussions on the exact targets for low-density lipoprotein cholesterol (LDL-C) reduction have evolved towards a more aggressive approach with lower LDL-C targets, particularly for high-risk patients with pre-existing atherosclerotic cardiovascular disease (ASCVD). A wealth of cardiovascular outcome trials have shown the efficacy of statin therapy in general, as well as the incremental impact of high-intensity statin therapy in particular. More recent trials have further demonstrated the impact of non-statin therapies, including ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, and, most recently, bempedoic acid, on reducing ASCVD outcomes. The availability of these and other newer therapies has prompted clinicians to strive for lower LDL-C targets to address residual ASCVD risk after statin therapy. This paper will provide an overview of the historical trends in lipid management and therapeutics and review the current state of evidence for lower LDL-C targets in clinical guidelines and recommendations.