Drug treatment to reduce cholesterol to new target levels is now recommended in four moderate- to high-risk patient populations: patients who have already sustained a cardiovascular event, adult diabetic patients, individuals with low density lipoprotein cholesterol levels ≥190 mg/dL and individuals with an estimated 10-year cardiovascular risk ≥7.5%. Achieving these cholesterol target levels did not confer any additional benefit in a systematic review of 35 randomised controlled trials. Recommending cholesterol lowering treatment based on estimated cardiovascular risk fails to identify many high-risk patients and may lead to unnecessary treatment of low-risk individuals. The negative results of numerous cholesterol lowering randomised controlled trials call into question the validity of using low density lipoprotein cholesterol as a surrogate target for the prevention of cardiovascular disease.
- cardiovascular diseases
- public health
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Correction notice This article has been corrected since it appeared Online First. In the Discussion, the sentence "a 4-year long RCT of a low-fat diet" has been corrected to "a 4-year long RCT that replaced saturated fat with vegetable oil rich in linoleic acid".
Contributors The general thesis of this manuscript was conceived jointly. RDB was responsible for data collection, data verification and writing the initial draft. AM and MdL provided critical review and corrections to the manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Author note AM is a co-author of the ‘Pioppi Diet’ a lifestyle plan book that advocates for the benefits of a Mediterranean diet low In refined carbohydrates to to reduce heart disease risk and improve metabolic health. AM is also co-producer of documentary, The Big Fat Fix.
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