Treatment goals for total cholesterol and low-density lipoprotein have been lowered in recent years in America and the United Kingdom. Despite these reductions in the targets the authors of this review found no high-quality evidence to support the targets. They also conclude that there is no reason that evidence could not be produced very quickly from a cohort analysis of large clinical trials such as the Heart Protection Study (HPS).
Aggressively pursuing lower lipid targets is not supported by high quality evidence at this time. In the first instance clinicians should ensure that patients are prescribed a cost-effective statin as per previous recommendations. The targets specified in the GP contract will remain important because they are income related but caution should be exercised when considering reducing lipid levels further.
Action: Clinicians should carefully consider the risks and benefits of treating patients to lower lipid targets when there is no high quality evidence to support these targets.