Very low LDL targets lead to other risks

The aggressive cholesterol targets set for the primary prevention of cardiovascular disease (CVD) could see most adults taking statins, US researchers have claimed.

The team said US guidelines to lower low-density lipoprotein (LDL) cholesterol to below 1.81mmol/l in high-risk individuals would require statins to be used at doses as high as 80mg of atorvastatin daily.

The US recommendations mirror those of the UK's Joint British Societies' Guidelines, which stated that people at high risk of CVD should optimally have LDL cholesterol levels below 2mmol/l, with a minimally acceptable level of 3mmol/l or less. The researchers warned that the risks of the high doses of statins needed to achieve these targets could outweigh the benefits.

Potential adverse effects of aggressively lowering cholesterol could include heart failure neurological damage and cancer, they said.

Kent GP and CHD lead Dr Rubin Minhas said: 'GPs are under pressure to aggressively target a single risk factor using statins for fewer and fewer benefits, when there are many other things they could be focusing on.'

Promoting smoking cessation, for example, would have a bigger impact on CHD than achieving low cholesterol levels, he said.

He added that the safety of very aggressive statin treatment for primary care patients was unproven.

'We need to interpret the ultra-low targets with a degree of caution,' he said.

rachel.liddle@haynet.com

BMJ 2006; 332: 1,330-2

Live links at GPonline.com.

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