The role of early LDL lowering to prevent the onset of atherosclerotic disease

Curr Atheroscler Rep. 2013 Apr;15(4):312. doi: 10.1007/s11883-013-0312-1.


Coronary atherosclerosis is a chronic progressive disease that begins early in life and progresses slowly over several decades before becoming clinically manifest. The causal relationship between low-density lipoprotein cholesterol (LDL-C) and the risk of coronary atherosclerosis is well established. Multiple randomized trials have demonstrated that lowering LDL-C levels during treatment with a statin reduces the risk of major atherosclerotic coronary events. However, individuals being treated with a statin continue to experience a high residual risk of events. Here we review the evidence that lowering LDL-C levels beginning earlier in life, and therefore earlier in the atherosclerotic disease process, can prevent or substantially delay the development of atherosclerosis and thereby substantially improve the clinical benefit of therapies that lower LDL-C levels. We focus on providing a critical appraisal of the naturally randomized evidence that is emerging from recently conducted genetic association studies.

Publication types

  • Review

MeSH terms

  • Atherosclerosis / prevention & control*
  • Cholesterol, LDL*
  • Coronary Artery Disease / prevention & control*
  • Early Medical Intervention
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Primary Prevention


  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors