Is LDL-C Passed Its Prime?

Recently, my son, an internal medicine resident of a major academic medical center, called to ask my advice about a patient in the hospital. The case involved a 52-year-old female with type 2 diabetes mellitus, cigarette smoker with an LDL-C of 95 mg/dL, an HDL of 32 mg/dL, and triglycerides of 300 mg/dL. He wanted to initiate statin therapy, but both his senior residents and attending physician were adamant that pharmacological therapy was not indicated because her LDL-C was already below the 100 mg/dL goal according to the ATP III guidelines. This case, along with the tragic death of Tim Russert with an “optimal level” of LDL-C of 68 mg/dL (but a low HDL and elevated triglycerides), highlight the need for a different paradigm to better assess CHD risk and guide treatment.See accompanying article on page 1666 Targeting LDL-C as the primary goal of therapy was established by the NCEP ATP I guidelines and reinforced in ATP II and ATP III.1 ATP III added non–HDL-C as a secondary goal in patients at their LDL-C target with triglycerides ≥200 mg/dL, but according to surveys, non-HDL goal achievement has significantly lagged …