Five years ago the “fire and forget approach” was proposed as a strategy for prescribing lipid lowering drugs.1 It involves prescribing a standard dose of statins to patients at high risk of cardiovascular disease without further testing or dose adjustment. This strategy was contrasted to the “treat to target strategy,” which aims to achieve target concentrations of low density lipoprotein by titrating drugs and other measures accordingly.

Since then, several trials have shown that high dose statins in a supposed treat to target approach are more effective than the standard dose. Accordingly, the United Kingdom quality and outcomes framework and the Scottish Intercollegiate Guidelines Network guideline number 97 emphasise the importance of measuring cholesterol and having targets.2 So, is the treat to target strategy now the best option?

None of the large statin trials used the treat to target strategy suggested by most lipid experts, and none was based on the targets suggested by current guidelines.3 They either used a fixed dose of statin throughout or made only minimal adjustments. Even the recent trials of high …