- “Go as low as you can go” when it comes to low-density lipoprotein cholesterol (LDL-C) measures, per the latest European Society of Cardiology (ESC) dyslipidemia guidelines.
- That mantra applies especially in patients with high or very high cardiovascular disease (CVD) risk, say guidelines authors, with a recommended target
- Full guidelines are available here; clinicians can get a pocket version here or via the ESC mobile pocket guidelines app .
Why this matters
- The evidence is now “overwhelming” that high LDL-C “is a potent cause of heart attack and stroke,” said Colin Baigent, guidelines task force chair, in a statement.
- Risk for CVD falls regardless of starting LDL-C concentrations, he said, so that people with high or very high CVD risk can benefit from LDL-C reductions, even with below-average baseline levels.
- “There is no lower limit of LDL cholesterol that is known to be unsafe,” the guidelines state.
- New additions to the guidelines are listed here.
- New LDL-C target
- Statins are recommended (class I) for primary prevention according to risk level in people age 75 years or less.
- Changes from 2016 guidelines are listed here.
- A treatment algorithm is provided for pharmacological reduction of LDL-C.
- The guidelines include a list of what to do and what not to do.
- Among them: because of a lack of formal safety studies, statins are not recommended for women who might become pregnant.
- Fish oil supplements make the “do” list if added to a statin for hypertriglyceridemia that persists under statin therapy.
- This article provides only highlights; clinicians should consult the complete guidelines for details.