American College of Cardiology annual meeting: Music still playing for the LDL limbo

American College of Cardiology annual meeting,March 6–9, Orlando

Music still playing for the LDL limbo

Over the course of a decade or so, the first generation of statin studies identified who benefits from these cholesterol-lowering drugs. The second generation has a different emphasis: How far should LDL (bad) cholesterol be lowered?

Since 1993, national guidelines set out three main targets for LDL — under 160 mg/dL for people with no heart disease and low heart-attack risk, under 130 for people with no heart disease but at moderate heart-attack risk, and under 100 for those with heart disease or at high risk for it.

In 2004, a study called PROVE-IT yanked the rug from under the 100 target. PROVE-IT looked at people recovering from a heart attack or chest pain at rest. Those who got their LDL levels down to 95 did fine, but those who got their LDL levels under 70 did even better. The improvement wasn't huge — 77.6% in the super-low LDL group didn't die, have a heart attack or stroke, or need bypass surgery or angioplasty during the two-year trial, compared with 73.7% in the higher LDL group. But it would translate into thousands of lives saved a year.

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