Low-density lipoprotein cholesterol targets in 2003
University of Aarhus, Aarhus, Denmark
* Ole Faergeman, MD, DMSc, Professor of Preventive Cardiology, Department of Internal Medicine and Cardiology, Faculty of Health Sciences, Aarhus University Hospital, AAS, Tage Hansens Gade 2, Denmark-8000 Aarhus C.
Abstract
There is considerable evidence suggesting that the current low-density lipoprotein cholesterol (LDL-C) goals to prevent coronary heart disease could be lower. This evidence includes calculations of physiological LDL-cholesterol levels and data from observational and interventional epidemiologic studies, including the Heart Protection Study. However, Heart Protection Study data can also be taken to support a strategy based on percentage reductions in LDL-C rather than a strategy of attaining absolute values of LDL-C. More effective LDL-C lowering agents, as well as combination drug therapy, will reduce LDL-C more efficiently, but it remains to be documented that such therapy is accompanied by greater reduction in risk for coronary heart disease. Moreover, even very intensive therapy will not reduce LDL-C to physiological concentrations in many patients. These considerations justify increasing emphasis on reduction in overall, multifactorial risk in individual patients at the expense of a focus on individual risk factors.
Key Words: Coronary heart disease • lipid goals • low-density lipoprotein cholesterol
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