COVID-19 and treatment guided by biochemical and molecular diagnostic tests to reduce myocardial damage and cardiotoxicity

treatment. Looking at a larger database and without taking diabetes or CVR into consideration, a similar percentage of patients would have to be treated. In light of the possibility of a huge increase in lipid-lowering treatments, I delved more deeply into the recent recommendations (p. 22). The LDL-C value of < 116 in low-risk individuals is based on reference 36, from 2012, by Mihaylova et al. (also an author of the 2019 guidelines). Hence, the current guidelines used an article from 2012 to support recommendations for 2019. The study by Mihaylova did not propose any LDL-C target goal, much less 116. It was focused on avoidable events in populations with different CVR levels by decreasing LDL-C by 1 mmol (38 mg/ dL), which, parenthetically, yielded a nonnegligible number of patients that would have to be treated. Where did the authors of the current guidelines get this value of 116? Is there a reference for the article from 2012 in the 2016 guidelines by the same authors? Remember, in 2016 the recommendation was not to intervene if the LDL-C concentration was between 155 and 190 mg/dL (p. 13, Table 5). As the article states: ‘‘Low-risk people should be given advice to help them maintain this status’’ (references 61-71). Furthermore, on page 17 the text says: ‘‘. . . the task force accepts that the choice of any given target goal for LDL-C may be open to debate. . . (references 65 and 66). As it turns out, reference 66, which contributes to sustaining these 2 statements, is the same as reference 36 in the 2019 guidelines: the study by Mihylova et al. In summary, the 2019 European guidelines cite a study from 2012 to recommend LDL-C target goals for low-risk patients, but in 2016 they use the same reference to support very different recommendations. What does this mean? And if it were really appropriate to attempt a goal of < 116 mg/dL in low-risk patients, which would imply medicating around 70% of the population, could any health system sustain it? Juan Carlos Aguirre Rodrı́guez