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LDL Cholesterol Goals in High-Risk Patients: How Low Do We Go and How Do We Get There?

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Abstract

It is widely recognised that low-density lipoprotein cholesterol (LDL-C) is one of the most important and modifiable risk factors for cardiovascular disease (CVD). Statins (HMG-CoA reductase inhibitors) have consistently been shown to decrease both LDL-C and CVD risk in almost all patient categories, with the exception of heart and kidney failure as well as advanced aortic stenosis. As a consequence, statins have become the cornerstone in current prevention guidelines. In patients who do not reach the LDL-C target, combination therapy with additional LDL-C lowering drugs (e.g. ezetimibe, bile acid sequestrants or fibrates) should be considered. Guidelines provide different LDL-C levels to strive for, depending on the CVD risk. In this review, we describe the rationale for these LDL-C targets and how these goals might be reached by current and future therapies.

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Conflicts of Interest

The authors declare the following conflicts of interest that are potentially related to this review. JJPK is holder of a Dutch Heart Association award. He consults with and speaks for biotechnical as well as pharmaceutical companies that develop drugs that influence lipoprotein metabolism and/or inflammation in order to prevent cardiovascular disease, including AstraZeneca, Aegerion, Genzyme, JSiS, Boehringer Ingelheim, Roche, Pfizer, Eli Lilly, Sanofi, MSD, Cerenis, Regeneron and Novartis. GKH is a recipient of a ZonMW VENI grant. He has presented at satellite symposia sponsored by Genzyme and Pfizer. JVC holds an AMC Scholarship.

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Correspondence to G. Kees Hovingh.

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Besseling, J., van Capelleveen, J., Kastelein, J.J.P. et al. LDL Cholesterol Goals in High-Risk Patients: How Low Do We Go and How Do We Get There?. Drugs 73, 293–301 (2013). https://doi.org/10.1007/s40265-013-0028-0

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