Abstract
Higher concentrations of LDL cholesterol (LDL-C) are causally linked to risk for cardiovascular disease (CVD). Correspondingly, lowering cholesterol leads to a proportional lowering of risk in randomized control trials. Thus, a key objective of CVD risk mitigation is lipid lowering—and the lower, the better. The Odyssey randomized control trial suggests that there is no LDL-C concentration too low for safety, and those achieving the lowest values displayed the greatest risk reduction. What complicates the matter is the multifaceted nature of lipid homeostasis. Although approximately half of cholesterol variability is controlled by genetic variability (other factors being diet and lifestyle), only a small percentage of risk has been linked to genetic variance. Furthermore, lipid screening is poor at identifying individuals with genetic lipidemias. For example, it …
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