Optimal lipid targets (OLT) should be the goal for all individuals treated in the new era of cardiovascular (CV) disease prevention. Evidence supports that average LDL cholesterol (LDL-C) values in Westernized populations are not optimal. Lessons from nature and science support a physiologic LDL-C target of <70 mg/dL. Clinical trial evidence further supports optimal LDL-C targets, although several critical questions remain unanswered. Using a calculated LDL-C may have limitations in clinical practice. Non-HDL-C cholesterol may be a better predictor of outcomes, and should therefore be provided on all laboratory reports. Specific HDL cholesterol (HDL-C) targets are significantly more complicated. Although a low HDL-C predicts a less favorable outcome independent of LDL-C level, an HDL-C level > 50 mg/dL is associated with lower CV risk. Clinical trials on HDL-C have thus far been disappointing. OLT should be the goal for all individuals as an important part of addressing global CV risk.
© 2012 New York Academy of Sciences.