An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia

Doses of rosuvastatin, atorvastatin and simvastatin that induce equal reductions in LDL-C and non-HDL-C: Results from the VOYAGER meta-analysis

“…The concentration of non-HDL-C has been found in several analyses to be a robust and independent predictor of coronary heart disease 4,15 with a predictive power greater than that of LDL-C. Non-HDL-C levels are thought to provide a more accurate reflection of atherogenicity, especially in certain patient groups, such as those with diabetic dyslipidaemia or metabolic syndrome in whom there is frequently an elevated concentration of triglyceriderich lipoproteins and their atherogenic remnants. 8 Indeed, a number of guidelines now recommend non-HDL-C as a primary or alternative treatment target. 5,7,8,16 In conclusion, these results highlight the fact that the reductions in levels of LDL-C and non-HDL-C achieved by treatment with statins are dependent on both the choice and dose of statin administered.…”

“…[4][5][6] Increasingly, guidelines recommend non-HDL-C as an additional therapeutic target to reduce cardiovascular risk. 5,7,8 Each doubling of statin dose has been shown to result in an approximately 5-6% greater reduction in LDL-C, 9 and as statin doses increase, a greater percentage of high-risk patients achieve recommended LDL-C goals, 10 as defined by the 2011 European Society of Cardiology/European Atherosclerosis Society guidelines. 5 However, it is well established that equal doses of different statins are not equipotent in their ability to reduce atherogenic lipids.…”

2013 ACC/AHA cholesterol treatment guideline: Paradigm shifts in managing atherosclerotic cardiovascular disease risk

“…Therefore, the current guidelines have refocused the target of therapy from specific LDL-C levels to overall ASCVD risk reduction, with LDL-C monitoring as an important component of ensuring appropriate response and adherence to statin therapy. This is in stark contrast to other published guidelines, including the prior United States cholesterol management guidelines, ATP III, as well as recent guidelines from other societies including the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS), Canadian Cardiovascular Society (CCS), and the International Atherosclerosis Society (IAS) [2,[8][9][10]. This paradigm shift has been the most radical change, and one that has been the center of several commentaries [3,4,11].…”

Moving Toward the Next Paradigm for Cardiovascular Prevention

“…Notably, both of these patients would be considered at goal before statin initiation, and have average on-statin LDL-C levels of 51 mg/dL and 75 mg/dL, respectively, and so would not be treated under treat-to-goal primary prevention guidelines. 9 It should also be noted that statin eligibility based on clinical trial inclusion criteria and a hybrid approach using clinical trial inclusion criteria performed worse than both the 2013 ACC/AHA cholesterol guideline and the ARR-based individualized net benefit approach. Inclusion criteria overidentified low-risk individuals for statin eligibility, and a hybrid approach applying inclusion criteria after 10-year ASCVD risk estimation failed to identify a large proportion of those who would likely experience a net benefit from statin therapy.…”