[Abandon LDL cholesterol target levels]

Abstract

In guidelines for the management of stable cardiovascular disease, targets are specified for LDL cholesterol and blood pressure. However, observational studies reveal that in many patients such targets cannot be reached, in spite of intensive medication. In particular, LDL cholesterol levels of < 1.7 mmol/l (European guidelines) or < 2.5 mmol/l (Dutch guidelines) can often not be reached with statin therapy. Recent USA guidelines recommend statin therapy without specific targets for the LDL cholesterol level. Since no clinical efficacy has been demonstrated for other cholesterol-lowering drugs, in particular ezetimibe and fibrates, these are not recommended as preventive therapy. Physicians should prescribe statins at doses used in the relevant clinical trials, independent of the LDL cholesterol level achieved.