Low-density lipoprotein cholesterol (LDL-C) lowering before a first cardiovascular event is often discussed as if “primary prevention” were a single clinical setting. It is not. The term includes people with markedly different baseline cardiovascular risk, age, comorbidity, life expectancy, and competing causes of morbidity and death. It also increasingly includes populations selected by diabetes, inflammatory disease, HIV infection, statin intolerance, or imaging findings. This heterogeneity matters because the relative efficacy of LDL-C lowering and its absolute clinical value are different questions.
