Every 1.0 mmol/L (∼40 mg/dL) reduction in LDL-C is associated with a corresponding 22 % reduction in CVD mortality and morbidity Extrapolating from the available data, an absolute reduction to an LDL-C level, <1.8 mmol/L (less than ∼70 mg/dL) or at least a 50 % relative reduction in LDL-C provides the best benefit in terms of CVD reduction [13]. In the majority of patients, this is achievable with statin monotherapy. Therefore, for patients with very high CV risk, the treatment target for LDL-C is, <1.8 mmol/L (less than 70 mg/dL) or a ≥50 % reduction from baseline LDL-C. LDL-C is the primary target. Although elevated triglyceride rich lipoproteins and low HDL are markers of cardiovascular risk, interventional studies have resulted in conflicting results. Therefore they are not primary targets of therapy. Non HDL cholesterol or ApoB is a secondary target of therapy in combined hyperlipidaemias, diabetes, the metabolic syndrome or CKD.

To make it easier for the physician, guidelines have a table to calculate the percentage reduction of LDL-C required to achieve goals as a function of starting value (Table 2). According to this table, treatment decisions can be made. Before starting any treatment, it is important to exclude secondary caused such as nephrotic syndrome, hypothyroidism, excessive alcohol consumption, pregnancy, corticosteroid excess, anorexia, and use of immunosuppressive agents.