PROVE-IT proved it: lower is better--pro.

Data from prospective epidemiological studies and randomized controlled trials have clearly demonstrated that lower low density lipoprotein cholesterol (LDL-C) concentrations are associated with the greatest reduction in cardiovascular events. Coronary artery disease mortality is lowest in epidemiological studies in those individuals with the lowest cholesterol concentrations. In angiographic studies, patients who had their cholesterol lowered had less angiographic worsening of their atherosclerosis, with those trials that had the lowest on-treatment LDL-C, and especially those that had the greatest percentage of LDL-C lowering, showed the least progression of atherosclerosis. Clinical trials have also highlighted the fact that lower LDL-C concentrations are associated with reduced risk for both a first and a subsequent coronary event with analyses showing that event rates in both primary and secondary prevention trials are directly proportional to on-treatment LDL-C concentrations. An aggressive approach to LDL-C lowering, especially in the high-risk patient, seems warranted.