Understanding cholesterol

IN the last month, during my interactions with members of the public and doctors after the educational talks I had given, the impression was that many thought that there are no target levels of cholesterol that need to be adhered to.

Since the release of the 2013 American College of Cardiology and American Heart Association (ACC/AHA) Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults, there has been a major paradigm shift from the past practice of focusing on target levels of cholesterol levels to be achieved, to one where cholesterol lowering was considered adequate or not depending on the percentage of cholesterol lowering from the baseline after commencement of medication. Not surprisingly, one doctor asked me: "So does it mean that as long as the patient is given cholesterol medication, it does not matter what the final cholesterol level is?"

Despite the major paradigm shift, what is not known to many people is that although the new 2013 approach varied substantially from the previous 2006 cholesterol guideline where absolute levels of target cholesterol were recommended, the evidence upon which the 2013 guideline was based was substantially the same as that on which the 2006 guideline was based.