"Just make it lower" is an alternative strategy of lipid-lowering therapy with statins in Japanese patients: LDL-cholesterol: the lower, the better; is it true for Asians? (Con).

It is well known that statins improve the prognosis of cardiovascular diseases (CVD). Recent randomized control trials (RCTs) of statins conducted in Western countries revealed greater avoidance of cardiovascular events if low-density-lipoprotein cholesterol (LDL-C) reached lower levels. However, it is obvious that this evidence cannot be unconditionally extrapolated to Asians because there are great differences between Japanese and Caucasians in the absolute onset rate of CVD. Results of RCTs with Japanese for primary or secondary prevention of cardiovascular events indicate that we could benefit from statins with a relatively higher target LDL-C as compared with Western populations. In this situation, not only strong but also standard statins are still advantageous and the so-called pleiotropic effects of the drugs come to the fore. In this review, we first discuss differences in the absolute event rate in different populations, and then the lack of evidence for recommended LDL-C treatment targets, particularly in Japanese, although there is reliable evidence for reductions in plaque volume in coronary arteries from RCTs recently conducted in Japan with aggressive lipid-lowering therapy with strong statins. Finally, based on recent data, we propose a new concept regarding the secondary prevention of CVD for current Japanese populations.