Hit or miss: the new cholesterol targets

BMJ Evid Based Med. 2021 Dec;26(6):271-278. doi: 10.1136/bmjebm-2020-111413. Epub 2020 Aug 3.


Drug treatment to reduce cholesterol to new target levels is now recommended in four moderate- to high-risk patient populations: patients who have already sustained a cardiovascular event, adult diabetic patients, individuals with low density lipoprotein cholesterol levels ≥190 mg/dL and individuals with an estimated 10-year cardiovascular risk ≥7.5%. Achieving these cholesterol target levels did not confer any additional benefit in a systematic review of 35 randomised controlled trials. Recommending cholesterol lowering treatment based on estimated cardiovascular risk fails to identify many high-risk patients and may lead to unnecessary treatment of low-risk individuals. The negative results of numerous cholesterol lowering randomised controlled trials call into question the validity of using low density lipoprotein cholesterol as a surrogate target for the prevention of cardiovascular disease.

Keywords: cardiology; cardiovascular diseases; public health.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Anticholesteremic Agents* / therapeutic use
  • Cardiovascular Diseases* / drug therapy
  • Cardiovascular Diseases* / prevention & control
  • Cholesterol
  • Cholesterol, LDL
  • Humans
  • Randomized Controlled Trials as Topic


  • Anticholesteremic Agents
  • Cholesterol, LDL
  • Cholesterol