Abstract

‘Lower is better’ underpins the management of low-density lipoprotein cholesterol (LDL-C) in the 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) dyslipidaemia guidelines [1]. Recent trials in very high-risk patients with ezetimibe and PCSK9 monoclonal antibody therapy provide robust support, showing incremental reduction in cardiovascular events at lower LDL-C levels [2-4], with no evidence to suggest a threshold for clinical benefit from LDL-C lowering [5]. The available data also do not indicate safety issues associated with very low LDL-C levels attained with these efficacious therapies.

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