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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2008;28:1582.)
© 2008 American Heart Association, Inc.

Editorials

Is LDL-C Passed Its Prime?

The Emerging Role of Non-HDL, LDL-P, and ApoB in CHD Risk Assessment

Michael H. Davidson

From the University of Chicago Pritzker School of Medicine, Ill.

Correspondence to Michael H. Davidson, The University of Chicago, 515 North State Street, Suite 2700, Chicago, IL 60654. E-mail michaeldavidson@radiantresearch.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Recently, my son, an internal medicine resident of a major academic medical center, called to ask my advice about a patient in the hospital. The case involved a 52-year-old female with type 2 diabetes mellitus, cigarette smoker with an LDL-C of 95 mg/dL, an HDL of 32 mg/dL, and triglycerides of 300 mg/dL. He wanted to initiate statin therapy, but both his senior residents and attending physician were adamant that pharmacological therapy was not indicated because her LDL-C was already below the 100 mg/dL goal according to the ATP III guidelines. This case, along with the tragic death of Tim Russert with an "optimal level" of LDL-C of 68 mg/dL (but a low HDL and elevated triglycerides), highlight the need for a different paradigm to better assess CHD risk and guide treatment.

See accompanying article on page 1666

Targeting LDL-C as the primary goal of therapy was established by the NCEP ATP I guidelines and reinforced in ATP II and ATP III.¹ ATP III added non–HDL-C as a secondary goal in patients at their LDL-C target with triglycerides 200 mg/dL, but according to surveys, non-HDL goal achievement has significantly lagged behind that of LDL-C goals.² The recommendation to focus on LDL-C has been largely successful with a marked improvement in goal achievement over the past several years that has led to a significant reduction in CHD mortality in the United States.³

However, two major trends are affecting the ability of LDL-C to serve as the best lipoprotein to target for . . . [Full Text of this Article]

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