Chapter 2: Pharmacological cholesterol-lowering treatment in adults INTRODUCTION Therapeutic lifestyle measures to reduce serum cholesterol levels have been broadly recommended by prior guide- Although clinically appealing, such measures typically reduce serum cholesterol to only a small extent, and have not been shown to improve clinical outcomes (Supplemental Tables 1 5 online). The Work Group therefore chose to focus the recommendations for treatment on pharmacological interventions. However, it is important to note that many of these measures may improve general health (independent of any effect on lipid levels). The primary rationale for pharmacological cholesterol- lowering treatment is to reduce morbidity and mortality from atherosclerosis. Although limited clinical data support a link between treatment of dyslipidemia and better renal more recent trials have not confirmed this Although several different medications lower LDL-C, only regimens including a statin (including statin/ezetimibe) have been convincingly shown to reduce the risk of adverse cardiovascular events in CKD populations. Therefore, the recommended approach for pharmacological cholesterol- lowering treatment in CKD focuses on the use of statins (with or without ezetimibe) in people at risk of future cardiovascular events. BACKGROUND LDL-C is not suitable for identifying CKD patients who should receive pharmacological cholesterol-lowering treatment LDL-C is strongly and independently associated with risk of atherosclerotic events in the general population;15 knowledge of this association facilitated the discovery that statins reduce coronary risk. Initially, statin use was limited to those with substantially elevated LDL-C (44.5 mmol/l [4174 mg/dl]), but subsequent work indicated that the relative risk (RR) reduction associated with statin use is relatively constant across a broad range of baseline LDL-C levels, suggesting that absolute benefit from statin treatment is proportional to baseline coronary risk rather than baseline LDL-C. Associations between LDL-C and coronary artery disease in dialysis patients. 