Lowering LDL Cholesterol: Where Is the End of the Journey?

Lowering LDL cholesterol (LDL-C) with statins is a well-documented strategy to reduce the incidence rate of cardiovascular events and deaths. There has been consensus so far that LDL-C should at least be lowered to 100 mg/dl in individuals suffering from established atherosclerotic disease and/or diabetes mellitus. Results of recent intervention trials of highly effective statins have lead to suggest that the target for high-risk individuals be set at substantially lower concentrations. As demonstrated by the Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT) study this recommendation appears warranted particularly in patients with acute coronary syndromes. However, evidence is emerging that LDL-C levels well below 100 mg/dl would also produce significant additional clinical benefit in patients with stable coronary artery disease or type 2 diabetes.