Which asymptomatic hypercholesterolaemic patients benefit from lipid-lowering therapy? What cholesterol level should I aim for?

Recently two major primary prevention trials with statins, WOSCOPS1 in hypercholesterolaemic men and AFCAPS/TEXCAPS2 in healthy men and women with average cholesterol and below average HDL cholesterol, have demonstrated highly significant reductions in CHD events. Although benefit extends to those at low absolute risk of an event it is sensible to reserve pharmacological therapy for those at highest risk. Recent joint recommendations of the British Cardiac Society, British Hyperlipidaemia
Association and British Hypertension Society3 suggest treatment (as a minimum) for an absolute risk of 30% or greater over 10 years with the ultimate objective of treating those with risk exceeding 15%. Goals of therapy are total cholesterol less than 5.0mmol/l (LDL-cholesterol <3.0mmol/l). Risk charts based on the Framingham prospective population data taking into account blood pressure, age, smoking status, diabetes and total cholesterol to HDL ratio are provided. These charts do not apply to individuals with severe hypertension, familial dyslipidaemia or diabetic patients with associated target organ damage who should receive statin therapy.