A review of low-density lipoprotein cholesterol, treatment strategies, and its impact on cardiovascular disease morbidity and mortality

J Clin Lipidol. 2016 May-Jun;10(3):472-89. doi: 10.1016/j.jacl.2015.11.010. Epub 2015 Nov 25.


Cardiovascular (CV) disease is a leading cause of death worldwide, accounting for approximately 31.4% of deaths globally in 2012. It is estimated that, from 1980 to 2000, reduction in total cholesterol accounted for a 33% decrease in coronary heart disease (CHD) deaths in the United States. In other developed countries, similar decreases in CHD deaths (ranging from 19%-46%) have been attributed to reduction in total cholesterol. Low-density lipoprotein cholesterol (LDL-C) has now largely replaced total cholesterol as a risk marker and the primary treatment target for hyperlipidemia. Reduction in LDL-C levels by statin-based therapies has been demonstrated to result in a reduction in the risk of nonfatal CV events and mortality in a continuous and graded manner over a wide range of baseline risk and LDL-C levels. This article provides a review of (1) the relationship between LDL-C and CV risk from a biologic, epidemiologic, and genetic standpoint; (2) evidence-based strategies for LDL-C lowering; (3) lipid-management guidelines; (4) new strategies to further reduce CV risk through LDL-C lowering; and (5) population-level and health-system initiatives aimed at identifying, treating, and lowering lifetime LDL-C exposure.

Keywords: Cardiovascular disease; Epidemiology; Guidelines; LDL-C; Lipid-lowering therapy; Morbidity; Mortality; Risk.

Publication types

  • Review

MeSH terms

  • Animals
  • Anticholesteremic Agents / adverse effects
  • Anticholesteremic Agents / pharmacology
  • Anticholesteremic Agents / therapeutic use
  • Cardiovascular Diseases / drug therapy*
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / metabolism
  • Cardiovascular Diseases / mortality
  • Cholesterol, LDL / metabolism*
  • Evidence-Based Medicine
  • Humans
  • Life Style
  • Risk


  • Anticholesteremic Agents
  • Cholesterol, LDL