Editor’s Note: LDL: What’s the New Number?

Many patients are asking about the latest guidelines on reducing cardiovascular risks issued by the American College of Cardiology. These guidelines, which were published several months ago, suggests that patients without other cardiovascular risk factors can have LDL cholesterol levels up to 190 before they get treated. Prior to the release of the guidelines, our threshold for treatment was between 100 and 125. In general, for patients who’ve had cardiac events, angina, heart attack or stroke, the LDL target was 70 for treatment and prevention. For the average patient without a cardiac history, we advised trying to keep the LDL level below about 120.

What’s different now? The latest guidelines advise using a metric that calculate one’s risk of a cardiovascular event, such as a stroke or heart attack, in the following five to 10 years, based on risk factors in-cluding age, gender, race, total and HDL cholesterol (but not LDL), blood pressure, diabetes, and smoking status. If the risk is over 7.5 percent, the recommendations favor using lipid-lowering therapy in the form of statin drugs, such as Lipitor, Zocor, and Crestor. But if the risk going forward is less than 7.5 percent, no therapy is advised, unless the patient’s LDL is over 190.

So, what if you’re taking a statin, for a starting LDL of 150—should you discontinue it?

Not so fast, for several reasons. First, this study used a historical comparison of cardiac risk; that is, what the risk of heart attack would have been 15 years ago. That may not be applicable to current practice, because our ability to intervene and treat heart attack is so much better than it was in the past. Also, the statins clearly have other effects besides lowering cholesterol—they are anti-inflammatory and may have other beneficial effects, too. So exactly how they work to lower cardiovascular risks is unclear.

Bottom line: If you have questions about whether you should or should not be taking a statin, talk with your doctor—that’s the person who knows your history and risks the best, and can advise you based on your individual health profile.

—Editor-in-Chief Orli R. Etigin

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