Can Cholesterol be Too Low? New Study Shows Low LDL-C Cholesterol is Still Safe

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The risks associated with increased low-density lipoprotein cholesterol (LDL-C) have been discussed for decades. Big LDL-C numbers boost the chances of developing cardiovascular disease and/or having a stroke. While there are a number of medical approaches to help patients recover quality of life after one of these acute events, such as stents, bypass graft surgery, and clot-busting drugs, the best approach is preventing these conditions in the first place by lowering LDL-C and addressing other risk factors.

To get there, biopharmaceutical companies have developed statins, ezetimibe and PCSK9 inhibitors to successfully reduce LDL-C. However, that leads to another issue: Can LDL-C be too low? And could ultra-low LDL-C have harmful effects?

To answer that question, cardiologist Carl Orringer, M.D., a national lipid expert and associate professor of clinical medicine at the University of Miami Miller School of Medicine, and colleagues reviewed the medical literature on low LDL-C. The study was published in January in the European Heart Journal.

The paper reviewed literature on several genetic conditions that cause very low levels of LDL-C and confirmed that cardiovascular disease is very rare in these individuals.

“Sometimes, as part of our treatment, LDL-C cholesterol falls to very low levels, less than 30 milligrams per deciliter (mg/dl),” said Dr. Orringer. “Several studies have tried to find out if this is actually safe. Our paper shows that, in the vast majority of situations, lowering LDL-C to these levels seems to be quite safe.”

The authors note that, given advances in cholesterol-lowering drugs, physicians will encounter patients with such low LDL-C levels more frequently. While clinicians should always be vigilant, five-year follow-up data suggest treatments that produce very low LDL-C levels are generally safe and reduce both heart attack and stroke risk.

“While we currently reserve marked LDL-C lowering with cholesterol medication for the highest risk patients, we may be entering an era in which more patients will be offered such treatments,” said Dr. Orringer. “While we are cautiously optimistic about the beneficial effects of marked LDL-C lowering, patient safety will always be our first concern.”