For a long time, the target for "bad" cholesterol (LDL) in established cardiovascular disease has been around 70 mg/dL (= 1.8 mmol/L). It has been something of a clinical standard. But new research now questions whether that is really enough.
A recently published study shows that patients who were treated more intensively, to a target of <55 mg/dL (1.4 mmol/L), had a 33% lower risk of major cardiac events compared with those treated to the traditional target. That is a substantial difference, especially considering that the difference in LDL levels between the groups was relatively small.
"Lower is better", but why?
LDL cholesterol is a central driver of atherosclerosis. The lower the level, the less plaque progression and the lower the risk of:
- heart attack
- stroke
- the need for new procedures
The study strengthens what has long been a hypothesis: there is no clear lower limit where the benefit tapers off, lower still appears to be better.
The most important thing to understand
This applies above all to people who already have established cardiovascular disease (ASCVD). But the insight is broader than that:
- Many patients do not even reach today's targets
- The risk of new events remains high despite treatment
- There is often room to optimise treatment further
This is a clear example of a larger trend in preventive medicine: we are moving from "good enough" to "optimal". Instead of simply staying below a threshold, it is about:
- identifying individual risk
- optimising levels more aggressively where warranted
- following the trajectory over time
This study indicates that LDL cholesterol is not just something you "pass the threshold" on: it is a continuous risk factor where lower levels can provide substantial additional protection. For the right patient, the difference can be decisive.
Source: https://lnkd.in/eFMCV6iG
