Risk of Major Cardiovascular Events by LDL-Cholesterol Level (mg/dL): Among those treated with high-dose statin therapy, more than 40% of patients failed to achieve an LDL-cholesterol target of less than 70 mg/dL.

July 29, 2014 by 2012pharmaceutical

Risk of Major Cardiovascular Events by LDL-Cholesterol Level (mg/dL): Among those treated with high-dose statin therapy, more than 40% of patients failed to achieve an LDL-cholesterol target of less than 70 mg/dL.

Reporter: Aviva Lev-Ari, PhD, RN

UPDATED on 9/15/2025

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“The Importance of Being Ernest” about #LDL Cholesterol

Our latest paper out in JACC Journals, led by Dr. Peng & Dr. Eugenia Gianos.
LINK: https://lnkd.in/gNqrjzSv

⚡ We asked if cumulative LDL-Cholesterol exposure in individuals with a Coronary artery Calcium hashtag#CAC of 0 associated with higher rates of long-term cardiovascular events?
⚡ We found that despite CAC of 0, long-term cumulative LDL-C exposure is associated with significantly higher CVD risk, highlighting hashtag#early individualized risk factor optimization and hashtag#CVDprevention across the hashtag#lifecourse.
⚡ Although patients with CAC = 0 have overall low CVD risk, their risk is not zero, and that risk increases with cumulative LDL-C exposure.
⚡ Cumulative LDL-C exposure during early adulthood starting in one’s teens to early 20s contributes to increased risk.
⚡ I have started to use the term hashtag#LDLYears more and more. From lifestyle to so many pharmaceutical therapy options, focusing primary prevention is still better than secondary prevention, as many patients do not survive their 1st heart attack!

Original Article

JACC Journals › JACC › Archives › Vol. 86 No. 9

25 August 2025

Impact of LDL-Cholesterol When the Coronary Artery Calcium Score Is 0: Long-Term Cardiovascular Events

Authors: Allison W. Peng, Alexander C. Razavi, John T. Wilkins, Norrina B. Allen, Laurence S. Sperling, Jamal S. Rana, Tia Bimal, Seamus P. Whelton, Michael J. Blaha, Roger S. Blumenthal, and Eugenia Gianos egianos@northwell.edu Authors Info & Affiliations

Publication: JACC, Volume 86, Number 9

https://www.jacc.org/doi/abs/10.1016/j.jacc.2025.06.053

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Lower LDL Still Best: Very Low Levels of LDL Linked with Reduced CV Events

Michael O’Riordan

July 28, 2014

http://www.medscape.com/viewarticle/828967?nlid=62503_2562&src=wnl_edit_medp_card&uac=93761AJ&spon=2

AMSTERDAM, THE NETHERLANDS — The question of how low LDL-cholesterol levels should be in the present statin era, recently addressed with the new US clinical guidelines, is once again questioned with the new publication of a patient-level meta-analysis of eight clinical trials investigating statin therapy^[1].

The new meta-analysis, published July 28, 2014 in the Journal of the American College of Cardiology, suggests that lowering LDL-cholesterol levels to very low levels results in a significant reduction in cardiovascular events. Individuals with LDL-cholesterol levels <50 mg/dL had a significantly lower risk of major cardiovascular events compared with individuals who had higher LDL-cholesterol levels, including those with LDL levels 50 to <75 mg/dL and 75 to <100 mg/dL.

The Results From the Meta-analysis

The investigators, including first author Dr Matthijs Boekholdt (Academic Medical Center), analyzed eight trials and 38 153 patients treated with statin therapy. The studies included some of the landmark statin trials, including AFCAPS-TexCAPS , 4S , LIPID , SPARCL , TNT , IDEAL , and JUPITER .

The investigators observed a large degree of interindividual variability in the reductions of LDL cholesterol, non-HDL cholesterol, and apolipoprotein B (apoB) levels with statin therapy. Among those treated with high-dose statin therapy, more than 40% of patients failed to achieve an LDL-cholesterol target of less than 70 mg/dL.

Compared with individuals with LDL-cholesterol levels >175 mg/dL, which served as the reference group, individuals who achieved lower levels of LDL cholesterol had a significantly lower risk of major cardiovascular events. For those with LDL-cholesterol levels <50 mg/dL, 50 to <75 mg/dL, and 75 to <100 mg/dL, the relative reduction in risk was 56%, 49%, and 44%, respectively. Regarding the end point of major coronary events and cerebrovascular events, a similar trend was observed with lower LDL cholesterol levels.

Risk of Major Cardiovascular Events by LDL-Cholesterol Level (mg/dL)

Outcome	LDL <50	50 to <75	75 to <100	100 to <125	125 to <150	150 to <175	> 175
Major cardiovascular events	0.44 (0.35–0.55)	0.51 (0.42–0.62)	0.56 (0.46–0.67)	0.58 (0.48–0.69)	0.64 (0.53–0.79)	0.71 (0.56–0.89)	1.00 (ref)

References

Boekholdt SM, Hovingh GK, Mora S, et al. Very low levels of atherogenic lipoprotein and the risk for cardiovascular events. J Am Coll Cardiol 2014; DOI:10.1016.j.jacc.2014.02.615. Available at:http://content.onlinejacc.org/journal.aspx
Ben-Yehuda O, DeMaria AN. LDL-cholesterol after the ACC/AHA 2013 guidelines. J Am Coll Cardiol 2014; DOI:10.1016.j.jacc.2014.05.020. Available at: http://content.onlinejacc.org/journal.aspx

SOURCE

http://www.medscape.com/viewarticle/828967?nlid=62503_2562&src=wnl_edit_medp_card&uac=93761AJ&spon=2