LDL cholesterol and major vascular events – should we aim for lower?

This study investigated if lowering LDL cholesterol (LDL-C) beyond the threshold reduces the risk of major cardiovascular events (MCEs). 

They found that reducing LDL-C levels was associated with lower MCE risks. 

LDL cholesterol (LDL-C) is a type of fat. It is found in the blood. High levels of LDL-C can lead to blockages in the blood vessels. This is called atherosclerotic disease (ATSD). LDL-C levels can be managed by a healthy diet. Medication can also be used to lower LDL-C levels. Statins are one type of drug that can lower LDL-C. Newer LDL-C- lowering drugs have been developed recently. These include ezetimibe (Zetia) and PCSK9 inhibitors (PCSK9i).

The American College of Cardiology and American Heart Association (ACC/AHA) recommended than LDL-C levels should be lower than 1.8 mmol/L. However, if lowering LDL-C levels independent of baseline levels helps in reducing MCE is still under investigation.

This study analyzed data from 52 studies on LDL-C management. 327,037 patients were included in this analysis. A number of factors were analyzed. These included medication and LDL-C levels. MCE risk was measured. MCEs included stroke, heart attack, and brain clots. 

Each 1 mmol/L reduction in LDL-C reduced the risk of MCEs by 19%. All drugs had similar effects on reducing LDL-C levels. This risk reduction was seen in patients with different baseline LDL-C levels (in those with baseline LDL-C of 2.6 mmol/L, between 2.61-3.4 mmol/L, between 3.41-4.1 mmol/L and in those with LDL-C levels higher than 4.1 mmol/L).

This risk reduction was the same for men and women, patients with and without diabetes and in those with and without kidney disease.

The authors concluded that reducing LDL-C levels was associated with a lower MCE risk.

If you have any concerns regarding CAD please consult with your physician.