Cholesterol plays an essential role in the body, but not all types affect health in the same way. Two major forms are commonly measured in blood tests: HDL cholesterol, often called “good” cholesterol, and LDL cholesterol, known as “bad” cholesterol.

HDL helps remove excess cholesterol from the bloodstream and transport it to the liver for processing. LDL, by contrast, can accumulate along artery walls when present at high levels. Over time, this buildup forms plaques that narrow blood vessels, a process known as atherosclerosis. These changes increase the risk of serious conditions collectively referred to as atherosclerotic cardiovascular disease (ASCVD), including coronary artery disease, stroke, and peripheral artery disease.

Treatment for elevated LDL cholesterol typically includes lifestyle changes such as improving diet and increasing physical activity, along with medications when needed. New evidence now suggests that lowering LDL cholesterol more aggressively than previously recommended may provide additional protection for people already living with cardiovascular disease.

Comparing Two LDL Cholesterol Targets

Researchers evaluated whether reducing LDL cholesterol to below 55 mg/dL offered greater benefit than the long-standing target of below 70 mg/dL in people with ASCVD. The study, known as the Ez-PAVE trial, included more than 3,000 adults in South Korea with an average age of 64.

Participants were randomly assigned to one of the two LDL treatment goals and followed for three years. Investigators tracked major cardiovascular outcomes, including:

  • cardiovascular death
  • nonfatal heart attack
  • nonfatal stroke
  • procedures to restore blood flow
  • hospitalizations for unstable angina

At the end of follow-up, these events occurred in 6.6% of participants in the lower-LDL group, compared with 9.7% in those treated to the conventional target.

This difference represents about a one-third reduction in major cardiovascular events, largely driven by fewer heart attacks and fewer procedures to reopen blocked arteries.

Why LDL Targets Matter

For many years, clinicians aimed to reduce LDL cholesterol to 70 mg/dL or lower in patients who had already experienced a heart attack, stroke, or related condition. That threshold was based on earlier studies showing meaningful reductions in repeat events.

However, newer therapies have made it possible to lower LDL levels further. Researchers have increasingly explored whether additional reductions provide extra benefit, particularly for people at highest risk.

The results of the Ez-PAVE trial support this approach. Investigators reported that lowering LDL cholesterol below 55 mg/dL reduced cardiovascular risk without introducing new safety concerns during the study period.

Implications for Patients With Established Heart Disease

Cardiovascular disease remains the leading cause of death worldwide. Even with standard treatment, many patients continue to face elevated risk for future events, especially those with diabetes, obesity, or chronic kidney disease.

The findings suggest that more intensive LDL-lowering strategies may help reduce this risk in selected patients with existing ASCVD. Recent clinical guidelines already recommend LDL targets below 70 mg/dL for these individuals, with lower goals considered for those at particularly high risk.

Experts note that the study applies specifically to people who already have cardiovascular disease. It does not mean that everyone should aim for the same cholesterol targets.

Closing the Gap Between Guidelines and Practice

Despite strong evidence supporting cholesterol control, many patients with ASCVD do not reach recommended LDL levels. Earlier registry data suggest that fewer than one in three patients achieve LDL values below 70 mg/dL.

Newer oral and injectable therapies are expanding treatment options and may help more people reach lower targets safely. However, specialists emphasize that improving awareness among both clinicians and patients remains essential.

Taken together, the study adds support to a growing body of research suggesting that, for individuals with established cardiovascular disease, lower LDL cholesterol levels are associated with fewer serious heart-related events.