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t is consensus that Caucasian patients with coronary artery disease (CAD) should be preferentially treated with a potent statin to lower their low-density lipoprotein cholesterol (LDL-C) level to less than 70 mg/dl based on solid evidence from many randomized clinical trials (RCTs).1 However, for Asian patients, including Japanese, there is still a lack of concrete evidence for the type of statin and level of LDL-C that should comprise the treatment goals for CAD patients. In fact, although the Japan Atherosclerosis Society launched a new guideline for the diagnosis and prevention of atherosclerotic cardiovascular disease (CVD) in Japanese in April 2012, the recommended LDL-C level for secondary prevention in CAD patients was set lower than 100 mg/dl. One of the main reasons for this decision is that there are not yet results of RCTs for secondary prevention in Japanese CAD patients. In this editorial, the current status of evidence for secondary prevention in Japanese patients, inherent problems and future perspective are noted.

circulation journal

What Type of Statin and What Level of Low-Density Lipoprotein Cholesterol Should Be Appropriate for Secondary Prevention for Japanese Patients With Coronary Artery Disease?