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No Clear Evidence for Ultra-Low Cholesterol Targets?

an LDL level of 200 mg/dL if the two have the same overall heart attack risk. High-risk individuals are defined by NCEP as those who have survived a heart attack or who have clogged arteries or diabetes or multiple heart disease risk factors such as high blood pressure, smoking and a strong family history of heart disease.

The distinction between concentrating on LDL versus concentrating on statins is not a minor issue, the authors suggest. The paper notes that compared to simply treating all high CV-risk patients with statins, titrating cholesterol therapy to recommended LDL goals entails considerably greater complexity, frequent use of multi-drug therapy and greater societal and patient out-of-pocket costs, which can result in increased patient burden and lower adherence to all treatments.

“Pharmaceutical companies, which pay for most drug studies, have a natural and understandable interest in wanting to sell their medications to as many people as possible, but the scientific community has a public and moral responsibility of guarding the scientific integrity of the evidence,” Dr. Hayward notes. “In this instance, our analyses suggest that we should have done a better job.”

Until more evidence is available, the authors emphasize the importance of getting more people to modify their diet, exercise more, understand their overall risk of heart disease, and take a statin if their risk is high. “Statins are lifesaving medicines when used in high-risk patients. They can reduce the risk of heart attacks and strokes by 30 percent to 35 percent and the risk of dying by 20 percent to 25 percent, and we need to work harder to help people at risk take them and afford them,” says Hayward. “We do not have many instances where medicines can save lives and money, but this may be one of those instances.?

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