Stop the Madness - Its Time to Abandon LDL Targets

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recent editorial and "open letter" published in the journal Circulation: Cardiovascular Quality and Outcomes questions the continued use of LDL targets to guide treatment decisions. Similar to an iForumRx commentary entitled "Is It Time To Stop Titrating Statin Doses" published nearly two years ago, the editorial by Hayward and Krumholz provides three powerful reasons to abandon LDL targets in favor of a "tailored treatment" approach based on risk stratification.  In addition to the arguments articulated in these commentaries, titrating and adjusting statin therapy based on LDL monitoring is costly and inconvenient.   Perhaps the best argument in favor of the LDL monitoring model: feedback enhances treatment adherence.  We know that patients who receive feedback about weight loss, blood glucose, blood pressure, LDL cholesterol, etc, etc are more likely to achieve and MAINTAIN their goal.  This likely explains why adherence rates are so dismal with treatments for which there is no ongoing feedback.   What are your thoughts?   Do you support a "tailored treatment" approach or the "LDL target" approach?

Reference:

Hayward RA, Krumholz HM.  Three reasons to abandon low-density lipoprotein targets.  An open letter to the Adult Treatment Panel IV of the National Institutes of Health.  Circulation: Cardiovascular Quality and Outcomes 2012; 5: 2-5.