There is a scarcity of real-world population data to determine the ideal low density lipoprotein–cholesterol (LDL-C) level for preventing cardiovascular disease (CVD) in extremely high risk populations. To address this, Jeong et al. analysed data between 2009 and 2012, from 26,922 individuals aged 40 years or older with type 2 diabetes mellitus, who had previously undergone percutaneous coronary intervention (PCI). All participants were categorised based on their LDL-C levels: <55mg/dl, 55–69mg/dl, 70–99mg/dl, 100–129mg/dl, 130–159mg/dl and ≥160mg/dl.

In individuals under 65 years of age, there was a linear increase in the hazard ratios (HRs) for recurrent PCI and stroke with rising LDL-C levels, compared with those whose LDL-C levels were below 55mg/dl. However, for individuals aged 65 and older, the HRs for recurrent PCI and stroke in the 55–69mg/dl LDL-C range were 0.97 (95% CI: 0.85–1.11) and 0.96 (95% CI: 0.79–2.23) respectively. The most favourable range, associated with the lowest HR for heart failure, was an LDL-C level of 70–99mg/dl, while for all-cause mortality, it was an LDL-C level of 55–69mg/dl, irrespective of age (HR: 0.99, 95% CI: 0.91–1.08 and HR: 0.91, 95% CI: 0.81–1.01).

For individuals with type 2 diabetes and established CVD who are under 65 years of age, maintaining an LDL-C level below 55mg/dl seems to be optimal. In contrast, individuals aged 65 and older may benefit from an LDL-C level of 55–69mg/dl in preventing recurrent PCI and stroke.

Read the full article in Endocrine Connections 12 e230142