Clinical Practice Guidelines on the Management of Dyslipidemia Recognize That Lower Is Better in Patients with ASCVD1,2

Recognizing the need for further LDL-C reductions in very high-risk patients, lipid-lowering trials have achieved lower LDL-C levels over time, resulting in further reductions in CV risk and guideline recommendations for more intensive LDL-C lowering in patients with established CVD.1-3

Over Time, Lipid-Lowering Trials Have Achieved Lower LDL-C Levels3


Arrows indicate the mean LDL-C decrease obtained in the study. LDL-C values from the Lipid Research Clinics (LRC) are extrapolated from total cholesterol. LDL-C, low-density lipoprotein cholesterol.


View the American College of Cardiology/American Heart Association Task Force guidelines for the management of blood cholesterol.

View the 2019 European Society of Cardiology and European Atherosclerosis Society Task Force guidelines for the management of dyslipidemia.

The importance of achieving further LDL-C reductions to reduce the risk for recurrent events in secondary prevention patients is reflected in the updated, widely endorsed ACC/AHA 2018 clinical practice guidelines on the management of blood cholesterol. The updated guidelines recognize that lower is better, and that an LDL-C of 70 mg/dL or higher, in very high-risk patients, is a threshold for additional, more aggressive therapy.1

Clinical Guidelines Advise LDL-C Lowering Based on CV Risk1,2

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*MI or UA. †PCI, CABG, and other arterial revascularization procedures. ‡Unequivocally documented ASCVD on imaging includes those findings that are known to be predictive of clinical events, such as significant plaque on coronary angiography or CT scan (multivessel coronary disease with two major epicardial arteries having > 50% stenosis), or on carotid ultrasound.

ACC, American College of Cardiology; ACS, acute coronary syndrome; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; CABG, coronary artery bypass grafting; CKD, chronic kidney disease; CT, computed tomography; DM, diabetes mellitus; EAS, European Atherosclerosis Society; ESC, European Society of Cardiology; FH, familial hypercholesterolemia; HF, heart failure; heFH, heterozygous familial hypercholesterolemia; HTN, hypertension; IS, ischemic stroke; LDL-C, low-density lipoprotein cholesterol; MI, myocardial infarction; PAD, peripheral artery disease; PCI, percutaneous coronary intervention; PCSK9i, proprotein convertase subtilisin/kexin type 9 inhibitor; SCORE, Systematic Coronary Risk Estimation; UA, unstable angina.

How Have Cholesterol Guidelines Changed?

Watch how LDL-C levels recommended by multiple cholesterol guidelines have decreased over time and understand current recommendations for very high-risk patients.

  1. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol. Circulation. 2019;139(25):e1046-e1081. doi:10.1161/CIR.0000000000000624.
  2. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-188. doi:10.1093/eurheartj/ehz455.
  3. Masana L, Girona J, Ibarretxe D, et al. Clinical and pathophysiological evidence supporting the safety of extremely low LDL levels – the zeroLDL hypothesis. J Clin Lipidol. 2018;12(2):292-299.e3. doi:10.1016/j.jacl.2017.12.018.

Lipid Management in Patients With Recent MI

Why It’s Time to Reassess LDL-C Goals in Patients With Recent MI

Learn how you can better manage cholesterol in high-risk patients and help reduce the risk of subsequent CV events.

Patient Management and Optimizing the Recent MI Journey

Guidelines, Discharge Protocol, and Routine Follow-up to Optimize Treatment in Patients
With Recent MI

Watch a webinar on guidelines, discharge protocol, and routine follow-up in patients with recent MI.