In target therapy for high-risk patients, which lipid parameter should be optimized?

• A. HDL
• B. LDL
• C. VLDL
• D. TAG

Answer: (B)

Focus on LDL cholesterol. In patients at high risk for cardiovascular events, lowering LDL-C is the primary therapeutic target because LDL particles are the main carriers of cholesterol that accumulate in arterial walls to form atherosclerotic plaques. Reducing LDL-C with statins and other agents consistently lowers the risk of heart attacks and strokes, and guidelines emphasize achieving lower LDL-C levels as a main goal.

HDL is often thought of as “good cholesterol,” but raising it pharmacologically has not reliably reduced cardiovascular events in trials, so it isn’t the main target for therapy. VLDL and triglycerides (TAG) are important in conditions with very high triglycerides and pancreatitis risk, and they contribute to residual risk in some patients, but they are not the primary parameter to optimize for ASCVD risk reduction in most high-risk scenarios. Therefore, optimizing LDL-C is the best answer.