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July 14, 2015

Cholesterol Lowering in 2015: Still Answering Questions About How and in Whom

Author Affiliations
  • 1Departments of Preventive Medicine and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Senior Editor, JAMA
  • 3Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
JAMA. 2015;314(2):127-128. doi:10.1001/jama.2015.7434

Following the first convincing trials in humans on the benefits of cholesterol lowering for prevention of atherosclerotic-related events, in 1985, then-Director of the National Heart, Lung, and Blood Institute Robert Levy asserted that the cholesterol “question” was no longer whether to treat high cholesterol levels, but rather when, in whom, and how.1 For 30 years, it has been well known that lowering blood cholesterol concentrations by a variety of drugs and other approaches reduces cardiovascular disease (CVD) risk.2 With more trials in patient groups with lower risk, including those with relatively low levels of low-density lipoprotein cholesterol (LDL-C),3 it has become clear that atherosclerotic cardiovascular disease (ASCVD) can be prevented by lowering LDL-C levels, especially with statin drugs,2,3 in broad segments of the general population. However, the critical questions—when, in whom, and how to lower cholesterol—still remain. This Editorial, with new evidence from 2 reports in this issue of JAMA, addresses 2 of these questions: in whom and how to treat cholesterol levels in 2015.