Transforming the Paradigm for Lipid Lowering
Decades of research have demonstrated that low-density lipoprotein cholesterol (LDL-C) is a causative factor in the development of atherosclerotic cardiovascular disease, and lipid-lowering therapy can dramatically reduce this risk. Yet exactly when to begin lipid-lowering therapy has not been well demarcated. Atherosclerotic lesions develop slowly over many years, if not decades. However, guidelines for lipid management have largely recommended statins on the basis of a 10-year risk of cardiovascular events rather than the risk of developing atherosclerosis over a lifespan. As a result, young adults (aged <40 years) are eligible for statins only if they have familial hyperlipidemia, severely elevated LDL-C level (>190 mg/dL; to convert to millimoles per liter, multiply by 0.0259) or LDL-C of 160 mg/dL or higher, and a family history of premature atherosclerotic cardiovascular disease.1
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