Reaching target levels may be better than relative reductions

Not so very long ago many of us did not realise the importance of cholesterol lowering in patients with coronary disease. After the World Health Organisation's clofibrate trial1 many patients with hyperlipidaemia, with or without manifest coronary disease, were left without cholesterol lowering treatment. Now, after several large placebo controlled trials, the message is clear: patients with coronary disease and high or normal serum cholesterol concentrations benefit from cholesterol lowering treatment, by a 20-40% reduction in coronary events. 2 3 What remains less clear is by how much to lower those concentrations and whether it is the absolute concentration or the percentage reduction that matters most.

Current guidelines recommend a treatment goal for low density lipoprotein cholesterol of 2.6 mmol/l in patients with coronary disease. 4 5 However, statins, the most widely used drugs for cholesterol lowering, reduce cholesterol values not to a specific level but in proportion to pretreatment values. Thus the absolute reduction in concentration will be greater in patients with high initial values, but in these patients …