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In the multinational L-TAP 2 survey only 30% of coronary heart disease patients achieved an optimal LDL cholesterol goal of tiospirone These are limitations of the study, however previous studies have shown that most high-risk patients are not prescribed a high intensity statin regimen. In a study of 9950 coronary artery disease patients in the United States, only 17% were on a high intensity statin regimen and 27% on combination lipid-lowering therapy [18]. Wang and colleagues found that the majority of metabolic syndrome patients fell into a very high or high-risk category and one explanation for why patients with the metabolic syndrome fail to achieve their optimal lipid goals is that they are assigned more aggressive lipid goals because of their higher risk. So what are the clinical implications of the study by Wang and colleagues and how do we interpret their results in light of the current guidelines in cholesterol management? The study by Wang and colleagues highlights the fact that the metabolic syndrome and achieving optimal lipid goals in these patients are global health problems. Selleckchem 17-AAG We need a better understanding as to why patients with the metabolic buy Docetaxel syndrome are not achieving their optimal lipid goals and there are several possible reasons for this. Clinicians may underestimate the increased CV risk associated with the metabolic syndrome, patients may be intolerant to higher intensity statin drugs, and the lack of positive clinical outcome studies evaluating combination lipid-lowering therapy in high-risk patients may dissuade clinicians from using multiple lipid-lowering drugs in combination. Many patients with the metabolic syndrome will be considered high-risk and their LDL and non-HDL cholesterol goals may be difficult to achieve with statin therapy alone. Patient and physician awareness regarding the dyslipidemia and increased CV risk associated with the metabolic syndrome is needed. In patients with the metabolic syndrome, non-HDL cholesterol may be a better predictor of CV risk than LDL cholesterol. Among individuals with a discordantly high non-HDL compared to LDL cholesterol, CV risk may be underestimated when only LDL cholesterol is considered [19]. To this point the recent NLA cholesterol guidelines have placed non-HDL ahead of LDL cholesterol as a therapeutic target [12].