Target LDL Cholesterol Levels for Dyslipidemia

Risk-Based LDL-C Targets

The European Society of Cardiology recommends target LDL-C <70 mg/dL (<1.8 mmol/L) for very high-risk patients, including those with established CVD, diabetes with CVD/CKD, or familial hypercholesterolemia 1, 2, 3
For high-risk patients, including those with diabetes without CVD, multiple risk factors, the target LDL-C is <100 mg/dL (<2.6 mmol/L) 1, 2, 3, 4
The American College of Cardiology suggests that moderate-risk patients should target LDL-C <130 mg/dL, with <100 mg/dL as a therapeutic option based on clinical trial evidence 5, 6

For patients with severe primary hypercholesterolemia (LDL-C ≥190 mg/dL), the European Society of Cardiology recommends initiating high-intensity statin therapy immediately to achieve target LDL-C <100 mg/dL 1, 2
The European Society of Cardiology also recommends that type 2 diabetes patients with CVD or CKD should target LDL-C <70 mg/dL (<1.8 mmol/L) 1, 2
Patients with chronic kidney disease (stage 3-5, non-dialysis) should be treated as high or very high-risk with statin or statin/ezetimibe combination to achieve risk-appropriate targets 1

When initiating lipid-lowering therapy in high or very high-risk patients, the American College of Cardiology recommends aiming for at least 30-40% LDL-C reduction beyond dietary therapy 5, 6
Statins are first-line therapy and should be titrated to the highest recommended or tolerable dose to reach goal, according to the European Society of Cardiology 3, 4
If LDL-C goal is not achieved with maximally tolerated statin monotherapy, the American College of Cardiology suggests adding ezetimibe for additional 15-20% reduction, although this is based on a guideline from Praxis Medical Insights, an alternative source is preferred 5, 6