title: A review of low-density lipoprotein cholesterol, treatment strategies, and its impact on cardiovascular disease morbidity and mortality.
abstract: Cardiovascular (CV) disease is a leading cause of death worldwide, accounting for approximately 31.4% of deaths globally in 2012. It is estimated that, from 1980 to 2000, reduction in total cholesterol accounted for a 33% decrease in coronary heart disease (CHD) deaths in the United States. In other developed countries, similar decreases in CHD deaths (ranging from 19%-46%) have been attributed to reduction in total cholesterol. Low-density lipoprotein cholesterol (LDL-C) has now largely replaced total cholesterol as a risk marker and the primary treatment target for hyperlipidemia. Reduction in LDL-C levels by statin-based therapies has been demonstrated to result in a reduction in the risk of nonfatal CV events and mortality in a continuous and graded manner over a wide range of baseline risk and LDL-C levels. This article provides a review of (1) the relationship between LDL-C and CV risk from a biologic, epidemiologic, and genetic standpoint; (2) evidence-based strategies for LDL-C lowering; (3) lipid-management guidelines; (4) new strategies to further reduce CV risk through LDL-C lowering; and (5) population-level and health-system initiatives aimed at identifying, treating, and lowering lifetime LDL-C exposure.
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: rwadhera@partners.org.
authors.forename: Rishi K
authors.initials: RK
authors.lastname: Wadhera
authors.affiliation: Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Dylan L
authors.initials: DL
authors.lastname: Steen
authors.affiliation: Global Health Economics and Outcomes Research, Sanofi, Bridgewater, NJ, USA.
authors.forename: Irfan
authors.initials: I
authors.lastname: Khan
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Giugliano
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: JoAnne M
authors.initials: JM
authors.lastname: Foody
mesh_terms: D000818:Animals; D000924:Anticholesteremic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000453:epidemiology* / Q000378:metabolism / Q000401:mortality; D008078:Cholesterol, LDL / Q000378:metabolism*; D019317:Evidence-Based Medicine; D006801:Humans; D008019:Life Style; D012306:Risk
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL
keywords: Cardiovascular disease; Epidemiology; Guidelines; LDL-C; Lipid-lowering therapy; Morbidity; Mortality; Risk