{"doi":"10.1161/circulationaha.123.064041","title":"How Low Can You Go? New Evidence Supports No Lower Bound to Low-Density Lipoprotein Cholesterol Level in Secondary Prevention","abstract":"Reducing low density lipoprotein cholesterol (LDL-C) has been a cornerstone of atherosclerotic cardiovascular disease (ASCVD) risk reduction for over three decades. 1Guidelines from the US and Europe have delineated algorithms for LDL-C targeting, generally advocating for progressively lower values over time, tracking with the development of new therapies and evolving trial data. 2, 3However, along with the ability to achieve substantially lower LDL-C values has emerged a critical question-what are the benefits and safety of very low (10-40 mg/dL) LDL-C?Since their FDA approval in the late 1980's, statins have been the primary LDL-C reducing therapy in clinical practice.A central tenet that has emerged from over 20 statin randomized trials evaluated in a Cholesterol Treatment Trialists (CTT) meta-analysis is that for every 39 mg/dL (1mmol/L) LDL-C reduction with statins there is a 21% relative risk reduction in major adverse cardiovascular events (MACE). 4Early statin clinical trials largely applied low and moderate-intensity statins, with the first two trials achieving LDL-C values of 122 mg/dL and 98 mg/dL, respectively. 5,6 ccordingly, the US National Cholesterol Education Program Adult Treatment Panel (NCEP-ATP) revised recommendations for LDL-C goals from <130 mg/dL in secondary prevention in ATP I published in 1998 to <100 mg/dL in ATP II published in 1993.","journal":"Circulation","year":2023,"id":391761,"datarank":0.29188652235829704,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"self_citation_contribution":0.29188652235829704,"citation_network_contribution":0.0,"self_endowment_contribution":0.29188652235829704,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9562,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":259507,"name":"Amit Khera","orcid":"0000-0001-7255-6874","position":1,"is_corresponding":false},{"id":277074,"name":"Fátima Rodríguez","orcid":"0000-0002-5226-0723","position":0,"is_corresponding":true}],"reference_count":17,"raw_metadata":{"citation_network_status":"fetched"},"created_at":"2026-07-19T01:18:47.408273Z","pmid":"37068134","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}