Lowering LDL to <1.4 mmol/L reduces events in known CVD

Evidence from randomised trials on optimal LDL cholesterol targets for secondary prevention in known atherosclerotic cardiovascular disease is limited. In an open trial, 3048 patients with known CVD disease were randomised to an LDL target of below 1.4 mmol/L or below 1.8 mmol/L.¹

The primary outcome was a composite of cardiovascular death, nonfatal myocardial infarction or stroke, revascularisation, or hospitalisation for unstable angina over 3 years. The median achieved LDL levels were 1.4 mmol/L in the intensive group and 1.7 mmol/L in the conventional group. Primary events occurred in 6.6% of the intensive target group versus 9.7% of the conventional group (NNT = 32). Safety outcomes were similar.

Targeting LDL below 1.4 mmol/L reduced cardiovascular events more than targeting below 1.7 mmol/L. 

Reference:

Intensive LDL Cholesterol Targeting in Atherosclerotic Cardiovascular Disease N Engl J Med. (2026)

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