Elevated cholesterol is a risk factor for heart disease. Lowering LDL by 1% will also lower heart disease risk by 1%. But what level of LDL should we target?
Primary prevention would have us lower LDL to 130 or less in patients without other risk factors for heart disease. In patients with metabolic syndrome, we are no longer using primary prevention but instead secondary prevention to halt the spread of atherogenesis. In these patients, our goal should be an LDL of 100 or less. Then finally, in patients who have already suffered a myocardial infarction or have had a stroke, we are using tertiary prevention to prevent another event. These patients should have LDLs of 70 or less.
As a refresher, primary prevention aims at helping patients never develop a disease or condition. Secondary prevention helps detect a disease and stop its spread. Tertiary prevention helps reduce the impact of a disease in a patient who already has it.