CORRESPONDENCE: LETTER TO THE EDITOR
Reply
James H. O’Keefe, Jr, MD*,
Loren Cordain, PhD,
William H. Harris, PhD,
Richard M. Moe, MD, PhD and
Robert Vogel, MD
* Mid America Heart Institute, Cardiovascular Consultants, 4330 Wornall Road, Suite 2000, Kansas City, MO 64111 (Email: jhokeefe{at}cc-pc.com).
We thank Dr. Clendenning for his interest in our study (1). Dr. Clendenning’s suggestion that the systematic treatment of his patients to a low-density lipoprotein (LDL) cholesterol target of 2.0 mmol/l (77 mg/dl) over the past four years has markedly reduced cardiovascular event rate in his practice is fascinating and consistent with the hypothesis of our study. Several other physicians have communicated similar experiences to us that provide anecdotal support for the concept that the optimal LDL range for patients at risk for cardiovascular event is 50 to 70 mg/dl. One solo practitioner cardiologist from Idaho who has employed a similar strategy targeting the LDL to <70 mg/dl as part of a multimodal risk-factor intervention recently decided to stop performing percutaneous coronary interventions because he believed his volume of procedures has dropped too low to maintain adequate skills.
Aggressive LDL lowering has been shown to improve prognosis even in patients without coronary heart disease (CHD) who have average LDL levels at baseline, but who have CHD risks such as hypertension (2), diabetes (3), or low HDL cholesterol levels (4). This accumulating evidence suggests that achieving these lower LDL targets will improve CHD prognosis for many of our patients.
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1. O’Keefe JH, Cordain L, Harris WH, Moe RM, Vogel R. Optimal low-density lipoprotein is 50 to 70 mg/dl. Lower is better and physiologically normal J Am Coll Cardiol 2004;43:2142-2146.[Abstract/Free Full Text]
2. Sever PS, Dahlof B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA)a multicentre randomised controlled trial. Lancet 2003;361:1149-1158.[CrossRef][Web of Science][Medline]
3. Colhoun HM, Betteridge DJ, Durrington PN, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS) multicentre randomised placebo-controlled trial Lancet 2004;364:685-696.[CrossRef][Web of Science][Medline]
4. Gotto AM, Whitney E, Stein EA, et al. Application of the National Cholesterol Education Program and joint European treatment criteria and clinical benefit in the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS) Eur Heart J 2000;21:1627-1633.[Abstract/Free Full Text]
Related Article
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The Optimal Low-Density Lipoprotein Is 50 to 70 mg/dl
- Robert Clendenning
J. Am. Coll. Cardiol. 2005 45: 1732.
[Full Text]
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