LDL-C: How Low Can You Go?

When it comes to low-density lipoprotein cholesterol (LDL-C), lower levels are always best. Moreover, results of a new study showed that further reducing LDL-C levels in patients with already low LDL-C is even better for cardiovascular health.

To evaluate the efficacy and safety of further lowering LDL-C in patients with already low levels, the researchers evaluated statin data from the Cholesterol Treatment Trialists Collaboration, in which patients started with a median LDL-C level of 70 mg/dL or less.  

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For nonstatin therapy, the researchers used data from Medline from 2015 to April 2018. Studies were included in the analysis if they were randomized, double-blind, controlled cardiovascular outcome trials and included patients with baseline LDL-C levels of 70 mg/dL or less.

Results showed that patients taking statins had a 0.78 relative risk for major vascular events for every 38.7-mg/dL reduction in LDL-C. Patients on nonstatin therapies had a similar relative risk (0.79).

“There is a consistent relative risk reduction in major vascular events per change in LDL-C in patient populations starting as low as a median of 1.6 mmol/L (63 mg/dL) and achieving levels as low as a median of 0.5 mmol/L (21 mg/dL), with no observed offsetting adverse effects,” the researchers wrote. “These data suggest further lowering of LDL-C beyond the lowest current targets would further reduce cardiovascular risk.”

—Amanda Balbi

Reference:

Sabatine MS, Wiviott SD, Im KA, Murphy SA, Giugliano RP. Efficacy and safety of further lowering of low-density lipoprotein cholesterol in patients starting with very low levels: a meta-analysis. JAMA Cardiol. 2018;3(9):823-828. doi:10.1001/jamacardio.2018.2258.