The Management of Low-density Lipoprotein in Cardiovascular disease- the Lower the Better?

A robust evidence supports the association of the incidence of atherosclerotic disease and the level of low-density lipoprotein cholesterol (LDL-C). With the help of optimal outcome-proven lipid-lowering treatment, such as statins, ezetimibe or proprotein convertase subtilisin/kexin type 9 (PCSK 9) inhibitors, the goal attainment rate of LDL-C is improving in patients with cardiovascular (CV) disease. Lots of studies showed better cardiovascular outcomes while achieving lower LDL-C levels either in primary or secondary prevention. However, some adverse effects, including liver and muscular complications, new onset diabetes mellitus or neurocognition disorders, with potent statin treatment to achieve lower LDL-C levels should be kept in mind. Nevertheless, these side effects were not observed in other lipid-lowering treatment, such as ezetimibe or PCSK9 inhibitors, even when very low LDL-C levels were achieved. According to this evidence-based review, the ideal LDL-C level with optimal CV benefit, minimal adverse effect, and favorable cost-effectiveness could be around 30 to 55 mg/dL, especially in patients at high CV risk.