Global cardiovascular risk: The benefits of a precocious, aggressive treatment strategy

Low-density lipoprotein cholesterol (LDL-C) plays a pivotal role in the pathogenesis of coronary heart disease (CHD). A considerable body of evidences supports the clinical benefit of lipid-lowering therapy in term of coronary events and cardiovascular death reduction. Based on these observations, current international guidelines indicate a LDL-C below 100–115 mg/dl as target in subjects with high cardiovascular risk. In the last years, however, new evidences have emerged, suggesting that levels of LDL-C around 50–70 mg/dl are physiologically normal and associated with a significantly lower development of atherosclerosis. For this reason, several large trials involving more than 25,000 patients with stable CHD or presenting an acute coronary syndrome have tested the hypothesis if an aggressive lipid-lowering strategy might result in better cardiovascular outcomes compared to the conventional therapy. Taken together, these studies demonstrated that, when lower levels of LDL-C is attained by high-dose lipid-lowering agents, a significant reduction of coronary events and death, and of any cardiovascular events with a favourable trend toward decreasing cardiovascular mortality can be obtained. Intensive lipid lowering strategy, therefore, provides a significant benefit over standard-dose therapy, supporting a broader use of high-dose lipid-lowering agents for patients with high global cardiovascular risk.