In terms of the evidence for intensification of drug therapy to an LDL goal <100 mg/ dL, is this sufficient? This raises the issue of the limits of cholesterol lowering therapy in general. As discussed in Figure 6, above, long-term statin treatment in FH patients can lower their atherosclerotic burden (as assessed by cIMT) and CHD risk to that in the general population, which would ostensibly have to count as “success.” On the other hand, population statistics reveal that the general population still has a very high risk of CHD. This suggests that in all patients at increased risk, with ≥2 risk factors, and certainly in FH patients, an LDL goal of <100 mg/dL represents a reasonable target to be achieved with intensification of treatment.
It was apparently a sense among the FNLA committee that promulgated the new recommendations that it was not necessary to recommend or even suggest optional, more aggressive goals of serum LDL <70 mg/dL (or non HDL <100 mg/dL), simply because it is almost impossible to achieve these levels in most patients with existing therapies. As new drugs become available it may become possible, but certainly at this time an LDL goal <100 mg/dL is a very reasonable target in the higher risk patient. J Clin Lipidol. 2011; 5(6).
