Statins are a staple of secondary prevention for individuals with stable cardiovascular disease. However, there is controversy on how to determine the right statin dose, and whether it should be based on low-density lipoprotein cholesterol (LDL-C) levels. Guidelines for secondary prevention in individuals with stable cardiovascular disease differ in recommending a statin intensity goal or a particular LDL-C level (typically <70 mg/dL).1,2 In this issue of JAMA Internal Medicine, Leibowitz et al3 report on more than 31 000 Israeli adults with stable cardiovascular disease and the association between their LDL-C levels with statin use and cardiovascular outcomes. After adjusting for multiple potential confounders, the authors observed that individuals who achieved an LDL-C level of 70 mg/dL or less were no less likely to have major adverse cardiovascular events compared with those who achieved an LDL-C between 70 and 100 mg/dL. Using nonlinear modeling, the authors found that achieving lower LDL-C levels was associated with a decreased risk of cardiovascular events, but only to an LDL-C of roughly 90 mg/dL.
Ascher SB, Charlton BR, Redberg RF. Low-Density Lipoprotein Cholesterol Levels and Statin Treatment—A Moving Target?. JAMA Intern Med. 2016;176(8):1113. doi:10.1001/jamainternmed.2016.2784