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Cholesterol Goals: Moving from Numbers to Treatment

From its inception in 1987, the focus of the National Cholesterol Education Program (NCEP) has been achieving numerical lipid goals, especially low-density lipoprotein cholesterol (LDL).1 Now, 7 years since its last major iteration, evolving data suggest that such goals are fundamentally flawed. Treating patients with coronary heart disease (CHD) to a generally achievable LDL goal of <100 mg/dl does not result in minimal risk.2 Lowering LDL <70 mg/dl further reduces CHD risk, but is not achievable in the average patient.3 Drugs which raise high-density lipoprotein cholesterol (HDL) have not consistently reduced CHD risk.4 Biomarkers of CHD risk, such as C-reactive protein and coronary artery calcium, appear to add useful risk stratification, but are not adequately detailed in the existing guidelines. As a consequence of these shortcomings, the next NCEP iteration ought to consider 6 fundamental questions: