Recommendation
We recommend a treat-to-target approach in the management of dyslipidemia to mitigate CVD risk (Strong Recommendation, Moderate Quality Evidence).

Recommendation 1
We recommend a target LDL-C consistently <2.0 mmol/L or >50% reduction of LDLC for individuals for whom treatment is initiated to lower the risk of CVD events and mortality (Strong Recommendation, Moderate-Quality Evidence). Alternative target variables are apoB <0.8 g/L or non-HDL-C <2.6 mmol/L (Strong Recommendation, Moderate Quality Evidence).

Recommendation 2
We recommend a >50% reduction of LDL-C for patients with LDL-C > 5.0 mmol/L in individuals for whom treatment is initiated to decrease the risk of CVD events and mortality (Strong Recommendation, Moderate Quality Evidence).

Values and Preferences
Based on the IMPROVE-IT trial, for those with a recent acute coronary syndrome and established coronary disease consideration should be given to more aggressive targets (LDL-C <1.8 mmol/L or >50% reduction). This might require the addition of ezetimibe (or other non-statin medications) to maximally tolerated statin. This would value more aggressive treatment in higher risk individuals.

Recommendation
All risk groups: We recommend a target LDL-C consistently <2.0 mmol/L or >50% reduction of LDLC in individuals for whom treatment is initiated to lower the risk of CVD events (Strong Recommendation, Moderate Quality Evidence). Alternative target variables are apoB <0.8 g/L or non-HDL-C <2.6 mmol/L (Strong Recommendation, Moderate Quality Evidence).

Values and preferences
From randomized trials in primary prevention, achieving these levels will reduce CVD events. The mortality reduction is statistically significant but modest (NNT =250). Treatment in primary prevention values morbidity reduction preferentially.