LDL cholesterol
LDL cholesterol
Overview
Low-density lipoprotein cholesterol (LDL-C), often referred to as “LDL cholesterol,” is a major circulating cholesterol fraction and a central biomarker in cardiovascular medicine. It is widely used to assess atherosclerotic cardiovascular disease risk, and elevated LDL-C is considered a causal and modifiable risk factor for myocardial infarction and other ischemic events. In clinical practice, LDL-C is a primary treatment target in dyslipidemia, with goal attainment used to guide lipid-lowering therapy in patients with diabetes, pre-diabetes, normoglycaemia, familial hypercholesterolemia, and established cardiovascular disease.
Biologically, LDL particles transport cholesterol in the bloodstream, and excess LDL-C contributes to cholesterol deposition in arterial walls. This makes LDL-C a key endpoint in studies of statins, PCSK9 inhibitors, inclisiran, bempedoic acid, antisense therapies, and emerging genome-editing or peptide-based approaches. LDL-C is also frequently interpreted alongside apolipoprotein B, non-HDL cholesterol, triglycerides, remnant cholesterol, and inflammatory markers such as hs-CRP, because these measures together better characterize residual atherosclerotic risk.
Recent Publications Focus
Below is a summary of the newest research publications targeting LDL cholesterol (sorted by publication date).
Contemporary clinical practice demonstrates persistent management gaps despite guideline recommendations for aggressive LDL cholesterol lowering. Studies highlight suboptimal goal attainment across diverse patient populations, including those with diabetes and pre-diabetes [PMID 42373176], atherosclerotic cardiovascular disease across multiple vascular territories [PMID 42270564], and patients recovering from acute myocardial infarction [PMID 42047130]. These findings underscore challenges in translating evidence-based targets into routine clinical care. Structured clinical interventions, such as pharmacist-led lipid clinics with automated patient detection, have shown promise in improving LDL-C goal attainment, particularly among post-acute coronary syndrome patients, though outcomes may vary by sex, ethnicity, and socioeconomic status [PMID 42331567].
Emerging evidence suggests that LDL cholesterol measurement alone may not fully capture cardiovascular risk. Studies indicate that apolipoprotein B (apoB) represents a superior marker compared to LDL-C for residual atherosclerotic cardiovascular disease risk in patients on lipid-lowering therapy [PMID 41949879], and discordance between apoB and LDL-C levels is associated with impaired cognitive function, an effect partially mediated by intracranial atherosclerotic plaque burden [PMID 42396799]. Similarly, elevated remnant cholesterol with discordant LDL-C levels has been associated with increased metabolic dysfunction-associated steatotic liver disease risk in patients with type 2 diabetes [PMID 42303421]. Integration of LDL-C measurement with complementary biomarkers, such as lipoprotein(a) and high-sensitivity C-reactive protein, may enhance identification of individuals at coronary artery disease risk [PMID 41848465].
Intensive LDL-C lowering with PCSK9 inhibitors has expanded treatment options for high-risk populations. PCSK9 inhibitors have demonstrated efficacy for reducing LDL-C levels in patients with familial hypercholesterolemia [PMID 41906435], and evolocumab demonstrated cardiovascular benefit in patients with diabetes but without known significant atherosclerosis [PMID 41903215]. High-intensity statin therapy has been associated with improved outcomes following percutaneous coronary intervention in patients with chronic coronary syndrome [PMID 41905939]. Homozygous familial hypercholesterolemia registries have documented treatment patterns and cardiovascular outcomes in this rare population characterized by extremely elevated LDL-C levels [PMID 42229223].
At the population level, elevated LDL cholesterol confers differential cardiovascular risk depending on clinical presentation. Evidence indicates that high LDL-C levels confer greater risk of ST-segment elevation myocardial infarction than non-ST-segment elevation myocardial infarction among statin-treated patients with ischemic heart disease [PMID 41372774]. Beyond pharmacological approaches, dietary interventions such as Chardonnay grape marc and seed extract blends have been evaluated for their potential to modulate dyslipidemia-related risk factors [PMID 41894982].