Less is More: Benefit of Achieving Very Low Low-Density Lipoprotein-Cholesterol Levels on Cardiovascular Events

Abstract

Low-density lipoprotein-cholesterol (LDL-C) reduction with statin therapy is one of
the most pivotal interventions for atherosclerotic cardiovascular disease (ASCVD) prevention
and treatment. The risk of coronary artery disease (CAD) decreases with reduction in LDL-C
but there is no established level at which the risk becomes insignificant. The current practice
guidelines for the primary prevention of CAD recommends calculation of ASCVD risk instead
of targeting a particular cholesterol level for initiating statin therapy.1,2 It is recommended that
patients with known CAD or those presenting with acute coronary syndromes (ACS) receive
high intensity statin independent of baseline LDL-C levels. However, the target LDL-C goal
for secondary prevention of CAD remains unclear. Besides reducing LDL-C, statins also have
pleiotropic effects, such as lowering inflammation and stabilizing atherosclerotic plaques