LDL Cholesterol Goals in High-Risk Patients: How Low Do We Go and How Do We Get There?
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It is widely recognised that low-density lipoprotein cholesterol (LDL-C) is one of the most important and modifiable risk factors for cardiovascular disease (CVD). Statins (HMG-CoA reductase inhibitors) have consistently been shown to decrease both LDL-C and CVD risk in almost all patient categories, with the exception of heart and kidney failure as well as advanced aortic stenosis. As a consequence, statins have become the cornerstone in current prevention guidelines. In patients who do not reach the LDL-C target, combination therapy with additional LDL-C lowering drugs (e.g. ezetimibe, bile acid sequestrants or fibrates) should be considered. Guidelines provide different LDL-C levels to strive for, depending on the CVD risk. In this review, we describe the rationale for these LDL-C targets and how these goals might be reached by current and future therapies.
KeywordsEzetimibe Framingham Risk Score Familial Hypercholesterolaemia Bile Acid Sequestrant Mipomersen
Conflicts of Interest
The authors declare the following conflicts of interest that are potentially related to this review. JJPK is holder of a Dutch Heart Association award. He consults with and speaks for biotechnical as well as pharmaceutical companies that develop drugs that influence lipoprotein metabolism and/or inflammation in order to prevent cardiovascular disease, including AstraZeneca, Aegerion, Genzyme, JSiS, Boehringer Ingelheim, Roche, Pfizer, Eli Lilly, Sanofi, MSD, Cerenis, Regeneron and Novartis. GKH is a recipient of a ZonMW VENI grant. He has presented at satellite symposia sponsored by Genzyme and Pfizer. JVC holds an AMC Scholarship.
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