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Very high LDL cholesterol: The power of zero passes another test

  • Marcio Sommer Bittencourt
    Affiliations
    Center for Clinical and Epidemiological Research, University Hospital, University of Sao Paulo, Sao Paul, Brazil
    Hospital Israelita Albert Einstein, Sao Paulo, Brazil
    DASA, Sao Paulo, Brazil
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  • Khurram Nasir
    Affiliations
    Division of Cardiovascular Prevention and Wellness Houston Methodist DeBakey Heart & Vascular Center & Center for Outcomes Research Houston Methodist Hospital, Houston, TX, USA
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  • Raul D. Santos
    Affiliations
    Hospital Israelita Albert Einstein, Sao Paulo, Brazil
    Heart Institute (InCor) University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
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  • Mouaz H. Al-Mallah
    Correspondence
    Corresponding author. Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, 6565 Fannin Street, Smith-19, Houston, TX, 77030, USA.
    Affiliations
    Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
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      In the current issue of Atherosclerosis, Sandesara et al. [
      • Sandesara P.B.
      • Mehta A.
      • O'Neal W.T.
      • Kelli H.M.
      • Sathiyakumar V.
      • Martin S.S.
      • et al.
      Clinical significance of zero coronary artery calcium in individuals with LDL cholesterol >/=190mg/dL: The multi-ethnic study of Atherosclerosis.
      ] shed additional light on the understanding of risk in individuals with very high LDL-C and no previous cardiovascular event identified in the Multiethnic Study of Atherosclerosis (MESA). Primary prevention strategies to reduce cardiovascular risk are mostly based on non-pharmacologic lifestyle modifications and pharmacologic management of individual risk factors such as hypertension, diabetes and, most importantly, hypercholesterolemia. However, the objective of those prevention strategies is the reduction of cardiovascular events and mortality, not the sole change in values of biomarkers, such as LDL-C levels. Thus, all guidelines on risk stratification recommend the estimation of individual cardiovascular risk using some validated tool to define the use of lipid lowering medications [
      • Mortensen M.B.
      • Nordestgaard B.G.
      Comparison of five major guidelines for statin use in primary prevention in a contemporary general population.
      ].

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