Clinical inquiries. What does the evidence tell us about treating very-high-risk patients to an LDL <70 mg/dL?

No studies directly compare low-density lipoprotein (LDL) levels <70 mg/dL to levels of 71 to 100 mg/dL in very-high-risk patients. However, no evidence suggests a "floor" for LDL cholesterol levels beyond which further reductions of heart disease risk cannot be achieved. The target LDL cholesterol of <70 mg/dL is based on data extrapolated from RCTs. Comparing larger (80 mg) with smaller doses of atorvastatin shows that larger doses reduce LDL and major cardiac events more than smaller doses. No studies report patient-oriented outcomes of treatments for patients who fail to reach target LDL levels <100 mg/dL.