LDL-C Goals, Guidelines & Treatment

Treating LDL-C alone doesn’t close the case on risk^1,2

Atherosclerotic cardiovascular disease (ASCVD) risk reduction begins with lowering low-density lipoprotein cholesterol (LDL-C), yet residual cardiovascular risk can remain.^1-3

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Managing LDL-C LDL-C Goals Guidelines Nonstatin Therapy

Managing LDL-C

Lowering LDL-C sooner and longer improves outcomes^4,5

High levels of LDL-C are the root cause of atherosclerosis, the process that leads to ASCVD.⁴

Every 39 mg/dL reduction correlates to an ≈22% reduction in major adverse cardiovascular events (MACE).⁶

LDL-C Goals

Lower is good. 
Earlier is even better.

Lower LDL early and keep it low. Sustained LDL-C lowering may delay ASCVD events by decades.⁴

25% Lower Lifetime LDL-C*

97–104 mg/dL=

-year delay

>50% lower lifetime risk
of ASCVD events⁴

50% Lower Lifetime LDL-C*

60–70 mg/dL=

-year delay

Very low lifetime risk  
of ASCVD events⁴

*Individuals with average LDL-C levels

Even slight delays in managing LDL-C following an ASCVD event can lead to adverse outcomes^7,8

There is no level of LDL-C that is considered “too low.”⁹

ASCVD events could be significantly reduced if more patients achieved evidence-based LDL-C goals^10,11

Adding potent lipid-lowering therapy (LLT) to statins+ezetimibe in high-risk patients with elevated LDL-C could prevent¹⁰

≈8000

events annually

per 1 million treated patients

Nearly all these events would be nonfatal events, including MI, stroke, and coronary revascularization, each associated with increased risk of future events

If all secondary prevention patients could be maintained at an LDL-C <70 mg/dL, it could prevent¹¹

≈634,000

events over 10 years

550,000 CHD events
198,000 ischemic strokes
244,000 CV deaths

22.5% of all ASCVD events could be averted

Guidelines

American College of Cardiology (ACC) 2022 expert recommendations

Stringent LDL-C thresholds have been set for the management of ASCVD risk.

LDL-C thresholds^9,*

<100mg/dL

for primary prevention (FH, diabetes, or borderline/intermediate ASCVD risk)

<70mg/dL

for secondary prevention (not at very high risk)

<55mg/dL

for secondary prevention (very high risk)

*≥50% LDL-C reduction from baseline also considered a threshold for intensifying therapy.⁹

For your reference

See the latest 2022 ACC guidance on nonstatin LDL-C therapies

2022 ACC Expert Consensus Decision Pathway on the Role of Nonstatin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk

Nonstatin Therapy

Consider nonstatins when LDL-C remains elevated despite statin therapy⁹

*≥50% LDL-C reduction on maximally tolerated statin therapy.⁹

For more information, explore these websites from leading organizations:

See how lipid factors contribute to ASCVD risk: LDL-C and beyond

VIEW

References

References: 1. Matsuura Y, Kanter JE, Bornfeldt KE. Highlighting residual atherosclerotic cardiovascular disease risk. Arterioscler Thromb Vasc Biol. 2019;39(1):e1-e9. doi:10.1161/ATVBAHA.118.311999 2. Reijnders E, van der Laarse A, Jukema JW, Cobbaert CM. High residual cardiovascular risk after lipid-lowering: prime time for predictive, preventive, personalized, participatory, and psycho-cognitive medicine. Front Cardiovasc Med. 2023;10:1264319. doi:10.3389/fcvm.2023.1264319 3. Raja V, Aguiar C, Alsayed N, et al. Non-HDL-cholesterol in dyslipidemia: review of the state-of-the-art literature and outlook. Atherosclerosis. 2023;383:117312. doi:10.1016/j.atherosclerosis.2023.117312 4. Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459-2472. doi:10.1093/eurheartj/ehx144 5. Ray KK, Ference BA, Séverin T, et al. World Heart Federation Cholesterol Roadmap 2022. Glob Heart. 2022;17(1):75. doi:10.5334/gh.1154 6. Baigent C, Blackwell L, Emberson J, et al; Cholesterol Treatment Trialists’ (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010;376(9753):1670-1681. doi:10.1016/S0140-6736(10)61350-5 7. Kytö V, Saraste A, Tornio A. Early statin use and cardiovascular outcomes after myocardial infarction: a population-based case-control study. Atherosclerosis. 2022;354:8-14. doi:10.1016/j.atherosclerosis.2022.06.1019 8. Åivo J, Ruuskanen JO, Tornio A, Rautava P, Kytö V. Lack of statin therapy and outcomes after ischemic stroke: a population-based study. Stroke. 2023;54(3):781-790. doi:10.1161/STROKEAHA.122.040536 9. Lloyd-Jones DM, Morris PB, Ballantyne CM, et al. 2022 ACC expert consensus decision pathway on the role of nonstatin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: a report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2022;80(14):1366-1418. doi:10.1016/j.jacc.2022.07.006 10. Katzmann JL, Becker C, Bilitou A, Laufs U. Simulation study on LDL cholesterol target attainment, treatment costs, and ASCVD events with bempedoic acid in patients at high and very-high cardiovascular risk. PLoS One. 2022;17(10):e0276898. doi:10.1371/journal.pone.0276898 11. McKinley EC, Bittner VA, Brown TM, et al. The projected impact of population-wide achievement of LDL cholesterol <70 mg/dL on the number of recurrent events among US adults with ASCVD. Cardiovasc Drugs Ther. 2023;37(1):107-116. doi: 10.1007/s10557-021-07268-x

Treating LDL-C alone doesn’t close the case on risk1,2

Lowering LDL-C sooner and longer improves outcomes4,5

Lower is good. Earlier is even better.

Lower LDL early and keep it low. Sustained LDL-C lowering may delay ASCVD events by decades.4