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J Am Coll Cardiol, 2004; 43:2142-2146, doi:10.1016/j.jacc.2004.03.046
© 2004 by the American College of Cardiology Foundation
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EXPEDITED REVIEW

Optimal low-density lipoprotein is 50 to 70 mg/dl

Lower is better and physiologically normal

James H. O'Keefe, Jr, MD*,*, Loren Cordain, PhD{dagger}, William H. Harris, PhD*, Richard M. Moe, MD, PhD* and Robert Vogel, MD{ddagger}

* Mid America Heart Institute, Cardiovascular Consultants, Kansas City, Missouri, USA
{dagger} Department of Health and Exercise Science, Colorado State University, Fort Collins, Colorado, USA
{ddagger} University of Maryland, University of Maryland Hospital, Baltimore, Maryland, USA

Manuscript received March 14, 2004; accepted March 15, 2004.

* Reprint requests and correspondence: Dr. James H. O'Keefe, Jr., Mid America Heart Institute, Cardiovascular Consultants, 4330 Wornall Road, Suite 2000, Kansas City, Missouri 64111, USA.
jhokeefe{at}cc-pc.com

The normal low-density lipoprotein (LDL) cholesterol range is 50 to 70 mg/dl for native hunter-gatherers, healthy human neonates, free-living primates, and other wild mammals (all of whom do not develop atherosclerosis). Randomized trial data suggest atherosclerosis progression and coronary heart disease events are minimized when LDL is lowered to <70 mg/dl. No major safety concerns have surfaced in studies that lowered LDL to this range of 50 to 70 mg/dl. The current guidelines setting the target LDL at 100 to 115 mg/dl may lead to substantial undertreatment in high-risk individuals.

Abbreviations and Acronyms
  CHD = coronary heart disease
  LDL = low density lipoprotein
  NCEP-ATP-III = Natural Cholesterol Education Program-Adult Treatment Panel-III




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