LDL-cholesterol control in the primary prevention of cardiovascular diseases: An Expert Opinion for clinicians and health professionals

Open AccessPublished:October 13, 2022DOI:
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      • Subjects in primary prevention with hypercholesterolemia are often not well managed.
      • Algorithms and risk charts are the main tool to assess cardiovascular risk in these.
      • Additional risk factors may impact the individual’s cardiovascular risk.
      • Dietary approach, nutraceuticals, or drugs may be considered in primary prevention.
      • Achieving therapeutic goals increases adherence to therapy and reduces CV risk.



      Although adequate clinical management of patients with hypercholesterolemia without a history of known cardiovascular disease is essential for prevention, these subjects are often disregarded. Furthermore, the scientific literature on primary cardiovascular prevention is not as rich as that on secondary prevention; finally, physicians often lack adequate tools for the effective management of subjects in primary prevention and have to face some unsolved relevant issues. This document aims to discuss and review the evidence available on this topic and provide practical guidance.

      Data synthesis

      Available algorithms and risk charts represent the main tool for the assessment of cardiovascular risk in patients in primary prevention. The accuracy of such an estimate can be substantially improved considering the potential contribution of some additional risk factors (C-reactive protein, lipoprotein(a), family history of cardiovascular disease) and conditions (environmental pollution, sleep quality, socioeconomic status, educational level) whose impact on the cardiovascular risk has been better understood in recent years. The availability of non-invasive procedures to evaluate subclinical atherosclerosis may help to identify subjects needing an earlier intervention. Unveiling the presence of these conditions will improve cardiovascular risk estimation, granting a more appropriate intervention.


      The accurate assessment of cardiovascular risk in subjects in primary prevention with the use of algorithms and risk charts together with the evaluation of additional factors will allow physicians to approach each patient with personalized strategies, which should translate into an increased adherence to therapy and, as a consequence, a reduced cardiovascular risk.