In patients with established atherosclerotic cardiovascular disease, the goal is to lower LDL-C to less than 55 mg/dL, with optimal LDL-C around 30 mg/dL or lower.

“in the highest risk patients with ascbd you know we want to obviously get as low as possible as quickly as possible lower for longer for faster and so we do a lot of disservice by starting these really low dose statins and they don't come back for six months to a year and then they never get intensified and patients don't get to goals so in the highest risk patients starting with a high intensity Statin if you start up front that's more likely the dose that they'll stay on and use of combination therapy early so you know just like blood pressure if it's above 160 you know we're thinking combination therapy for blood pressure and I have the same approach really for lipids for very high risk patients such as the ones with the recent coronary syndrome that you know we know what they're a starting LDL is and where we want to go and I always try to aim for at least then less than 55 optimal LDL is probably you know around 30 or lower in these patients”