In its “Controversies in Cardiovascular Medicine” section, the latest edition of Circulation features two editorials on a specific topic: “Is lowering low-density lipoprotein an effective strategy to reduce cardiac risk?” The first one by Robert Superko and Spencer King (“Lipid management to reduce cardiovascular risk: a new strategy is required”) reviewed the history of the most important trials on blood cholesterol lowering. They also reviewed the concept of “relative risk reduction” and its significance in clinical practice. The importance of treating targets other than LDL cholesterol was also examined. In their conclusion, the authors stressed the importance of combining LDL-lowering and HDL-rising therapies in order to improve other aspects of the lipoprotein-lipid metabolism, such as reverse cholesterol transport, potentially reduce the number of cardiovascular disease (CVD) events, including arteriographic regression, and improve efficiency. Another editorial written by Scott Grundy entitled “Promise of low-density-lowering therapy for primary and secondary prevention” addressed a similar topic. Though LDL cholesterol is “the driving force of atherosclerosis”, Grundy noted that the need to further reduce residual risk beyond LDL lowering deserves greater attention. This residual risk encompasses such CVD risk factors as cigarette smoking, the metabolic syndrome, and arterial wall factors. In order to target both LDL cholesterol and other CVD risk factors, Grundy called for a rethinking of medical and public health prevention models, which poses a great challenge for the medical and scientific community.
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