When is it Appropriate to Lower Low Density Lipoprotein-Cholesterol Levels to <30 mg/dL?

With emerging scientific evidence, there is a need for updated cholesterol management guidelines with newer low-density lipoprotein-cholesterol (LDL-C) goals. The new guidelines are mentioned in a research article titled “When is it Appropriate to Lower Low-Density Lipoprotein-Cholesterol Levels to <30 mg/dL?” published in The American Journal of Cardiology. The summary of this article is given below:

Objective:

To elaborate on recent guidelines for LDL-C goals to prevent ASCVD risk.

Method:

The guideline was developed from the currently available evidence and scientific and medical knowledge.

Finding:

Extreme risk group identified by the American Association of Clinical Endocrinologists
(AACE) is as follow:
(1)Progressive ASCVD with unstable angina in patients after reaching an LDL-C <70 mg/dL
(2) Established clinical cardiovascular disease in patients with chronic kidney disease (CKD) stages 3-4, diabetes mellitus (DM), or heterozygous familial hypercholesterolemia (HeFH)
(3) History of premature ASCVD in which an LDL-C treatment goal of <55 mg/dL was mentioned.

Extreme risk subcategory of ASCVD patients:

Category A

Those with Chronic Heart Disease with at least 1 of the following:

a)DM without target organ damage and ≤ 2 major ASCVD risk factors
b)Heterozygous familial hypercholesterolemia
c)≥ 3 major ASCVD risk factors
d)Chronic kidney disease stage 3B or 4
e)≥2 major ASCVD risk factors plus ≥1 moderate non-conventional risk factor
f)Lp(a) ≥50 mg/dL
g)Coronary calcium score of ≥300
h)A single extreme risk factor
i)Peripheral arterial disease
j)Non-stenotic carotid plaque
k)Transient ischemic attack
l)Stroke

Category B

Those with Chronic Heart Disease and at least 1 of the following:

a)Diabetes with ≥2 major ASCVD risk factors or target organ damage
b)Recurrent acute coronary syndrome (within 12 months) despite having LDL-C <50 mg/dL
c)Polyvascular disease or
d)Homozygous familial hypercholesterolemia.

While intensive research is required in the future, there still exists evidence that suggests that lowering LDL-C from 70 mg/dL to 30 mg/dL can help in reducing ASCVD risk further. Patients should be warranted for the same.

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