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10.1007_s12170-019-0619-8.pdf (285.71 kB)

LDL-C Targets in Secondary Prevention: How Low Should We Go?

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journal contribution
posted on 2022-11-22, 21:15 authored by Karim Bayoumy, Mohammed Gaber, Preethi Mani, Rishi Puri, Eoin Donnellan, Leslie Cho, Donald Clark, Seth S. Martin, Mohamed B. Elshazly

The benefits of lowering low-density lipoprotein cholesterol (LDL-C), mainly using high-intensity statin therapy, and its impact on decreasing the recurrence of atherosclerotic cardiovascular disease (ASCVD) in secondary prevention has been well established. With the advent of non-statin medications, particularly PCSK-9 inhibitors, which can lower LDL-C to very low levels not seen before, it is important to answer some important questions regarding LDL-C lowering and the uses of these medications in clinical practice: how low should we go with LDL-C reduction? Is there a threshold beyond which lower LDL-C is not associated with any benefit and possibly harm? Does the benefit derived from more aggressive LDL-C lowering justify the cost of additional therapies? Our review has found overwhelming evidence to support the conclusion that lower achieved LDL-C levels correlate with a decreased burden of atherosclerosis and better clinical outcomes in secondary prevention. The concern for adverse effects with very low LDL-C levels is not backed by the literature, and side effects appear to be medication-specific. There still remains a question of the cost-effectiveness of some non-statin therapies particularly PCSK9 inhibitors, in spite of recent price decreases, and whether the benefit is worth the cost. It is prudent to always pursue an individualized patient-level approach to LDL-C lowering that considers the patient’s global cardiovascular risk, their side effect profile, and the cost-effectiveness of therapies in order to derive maximal benefit from aggressive lipid lowering.

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Published in: Current Cardiovascular Risk Reports
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  • English


Springer Science and Business Media LLC

Publication Year

  • 2019

Institution affiliated with

  • Weill Cornell Medical College in Qatar

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