Low‐density lipoprotein‐cholesterol lowering in individuals at intermediate cardiovascular risk: Percent reduction or target level?

Background Recommendations for blood cholesterol management differ across different guidelines. Hypothesis Lipid‐lowering strategies based on low‐density lipoprotein‐cholesterol (LDL‐c) percent reduction or target concentration may have different effects on the expected cardiovascular benefit in intermediate‐risk individuals. Methods We selected individuals between 40 and 75 years of age with 10‐year risk for atherosclerotic cardiovascular disease (ASCVD) between 5.0% and <7.5% who underwent a routine health screening. For every subject, we simulated a strategy based on a 40% LDL‐c reduction (S 40% ) and another strategy based on achieving LDL‐c target ≤100 mg/dL (S target‐100 ). The cardiovascular benefit was estimated assuming a 22% relative risk reduction in major cardiovascular events for each 39 mg/dL of LDL‐c lowered. Results The study comprised 1756 individuals (94% men, 52 ± 5 years old). LDL‐c and predicted 10‐year ASCVD risk would be slightly lower in S 40% compared to S target‐100 . The number needed to treat to prevent 1 major cardiovascular event in 10 years (NNT 10 ) would be 56 with S 40% and 66 with S target‐100 . S 40% would prevent more events in individuals with lower baseline LDL‐c, whereas S target‐100 would be more protective in those with higher LDL‐c. A dual‐target strategy (40% minimum LDL‐c reduction and achievement of LDL‐c ≤100 mg/dL) would be associated with outcomes similar to those expected with the S 40% (NNT 10 = 55). Conclusions In an intermediate‐risk population, cardiovascular benefit from LDL‐c lowering may be optimized by tailoring the treatment according to the baseline LDL‐c or by setting a dual‐target strategy (fixed dose statin plus achievement of target LDL‐c concentration).