Opinion
Video
Target LDL-C Levels for Patients
Author(s):
Panelists discuss how cardiology practice has evolved toward more aggressive low-density lipoprotein cholesterol (LDL-C)–lowering strategies across specialties, with current guidelines generally recommending targets below 70 mg/dL for high-risk patients and even lower thresholds (below 55 mg/dL) for very high-risk individuals, though these targets require personalization based on age, comorbidities such as diabetes and hypertension, and other cardiovascular risk factors.
Video content above is prompted by the following:
Treatment Patterns in Intensive LDL-C–Lowering Therapies: A Summary for Physicians
Current LDL-C Target Levels Based on Guidelines
Current guidelines recommend the following LDL-C target levels:
- Very high-risk patients (e.g., with established atherosclerotic cardiovascular disease [ASCVD], multiple major risk factors, or history of cardiovascular events): less than 55 mg/dL (less than 1.4 mmol/L)
- High-risk patients (e.g., with familial hypercholesterolemia or diabetes with target organ damage): less than 70 mg/dL (less than 1.8 mmol/L)
- Moderate-risk patients: less than 100 mg/dL (less than 2.6 mmol/L)
- Low-risk patients: less than 116 mg/dL (less than 3.0 mmol/L)
Target Variation Based on Patient Characteristics
Age
- Younger patients (younger than 75 years): More intensive LDL-C target levels are generally recommended.
- Elderly patients (older than 75 years): Less stringent targets may be appropriate, with treatment decisions based on comprehensive risk assessment, comorbidities, and life expectancy.
Diabetes
- With target organ damage/multiple risk factors: Treated as very high risk (less than 55 mg/dL)
- Without complications: Treated as high risk (less than 70 mg/dL)
- Long-standing diabetes (more than 10 years): Generally, warrants more aggressive targets
Hypertension
- Considered an additional risk factor that may lower the threshold for more intensive therapy
- When combined with other risk factors, often indicates the need for more aggressive LDL-C target levels
Other Risk Modifiers
- Chronic kidney disease (CKD): Associated with higher cardiovascular risk; more intensive target levels (less than 70 mg/dL for moderate CKD and less than 55 mg/dL for severe CKD)
- Inflammatory conditions (e.g., rheumatoid arthritis and psoriasis): May warrant more aggressive treatment
- Family history of premature ASCVD: Lowers threshold for intensive therapy
Recent Shifts in Treatment Patterns
- Increasing adoption of PCSK9 inhibitors and ezetimibe as add-on therapies to statins
- Greater specialty variation: Cardiologists tend to pursue more aggressive LDL-C target levels compared with primary care physicians
- Growing emphasis on early and intensive therapy for very high-risk patients
- Trend toward treating lower-risk patients more aggressively when multiple risk enhancers are present
- Increased use of risk calculators and clinical decision support tools to guide therapy selection.
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