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Invited Commentary
August 2018

Measuring Low-Density Lipoprotein Cholesterol: When Is More Accurate Better?

Author Affiliations
  • 1Feinberg School of Medicine, Northwestern University, Chicago, Illinois
JAMA Cardiol. 2018;3(8):754-755. doi:10.1001/jamacardio.2018.1575

Low-density lipoprotein (LDL) is vital in the pathogenesis of atherosclerotic cardiovascular disease (ASCVD). Not surprisingly, LDL cholesterol (LDL-C) level is a key measurement in the American College of Cardiology/American Heart Association 2013 cholesterol guidelines.1 Four statin benefit groups require knowledge of LDL-C level.2 Measurement of LDL-C identifies those with a very high lifetime risk of ASCVD if LDL-C level is 190 mg/dL (to convert to millimoles per liter, multiply by 0.0259) or greater. In adults with or without diabetes aged 40 to 75 years seen for primary prevention, the lower boundary of LDL-C level for statin treatment is 70 mg/dL or greater. Moreover, LDL-C is important to consider after global ASCVD risk estimation is accomplished. Knowledge of a patient’s age, sex, race/ethnicity, blood pressure (treated or untreated), total cholesterol (TC) level, high-density lipoprotein cholesterol (HDL-C) level, cigarette smoking, and diabetes help clinicians estimate ASCVD risk. If the 10-year ASCVD risk is 7.5% or greater, this leads to the recommended clinician-patient risk discussion to determine if statin prescription is appropriate for the individual. Additional factors to be considered if a statin decision is uncertain include LDL-C level of 160 mg/dL or greater as well as family history of premature ASCVD, coronary artery calcium score of 300 or greater or higher than the 75th percentile, ankle-brachial index lower than 0.9, high-sensitivity C-reactive protein level of 2.0 mg/L (to convert to nanomoles per liter, multiply by 9.524) or greater, and very high lifetime risk of ASCVD.

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