Reliability of LDL cholesterol: How low can we go and when are we fooling ourselves?

Aggressive low-density lipoprotein cholesterol (LDL-C) lowering strategies are recommended for prevention of cardiovascular events in high-risk populations. Guidelines recommend a 30-50% reduction in at risk patients even when LDL-C concentrations are between 70 – 130 mg/dL (1.8 – 3.4 mmol/L). Novel PCSK9 inhibitors reduce LDL-C well below previously attainable levels. Calculation of LDL-C by the Friedewald equation is the primary laboratory method for routine LDL-C measurement. However, no recommendations have addressed the appropriate lower reportable limit for calculated LDL-C. This presentation will cover recently published data regarding the accuracy and precision of calculated LDL-C values <130 mg/dL (3.4 mmol/L).