LDL Cholesterol-How Low Can We Go?

Jonathan A Tobert

doi:10.1016/j.ecl.2022.01.005

LDL Cholesterol-How Low Can We Go?

Endocrinol Metab Clin North Am. 2022 Sep;51(3):681-690. doi: 10.1016/j.ecl.2022.01.005. Epub 2022 Jul 4.

Author

Jonathan A Tobert¹

Affiliation

¹ Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK. Electronic address: jonathan.tobert@cantab.net.

PMID: 35963635
DOI: 10.1016/j.ecl.2022.01.005

Abstract

Combinations of lipid-lowering agents can often bring LDL cholesterol down to around 40 mg/dL (1 mmol/L). Randomized controlled trials indicate that this reduces the risk of atherosclerotic vascular events with minimal adverse effects. This has raised the question of whether there is any concentration of LDL cholesterol below which further lowering is futile and/or a source of new adverse effects. This article examines several lines of evidence that lead to the conclusion that there is no known threshold below which lowering LDL cholesterol is harmful, but reduction of LDL cholesterol below 25 mg/dL may provide little if any further benefit.

Keywords: Cardiovascular risk reduction; Guidelines; Hypocholesterolemia; LDL cholesterol; Safety.

Publication types

Review

MeSH terms

Atherosclerosis* / etiology
Atherosclerosis* / prevention & control
Cholesterol, LDL
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors* / adverse effects
Hypolipidemic Agents

Substances

Cholesterol, LDL
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hypolipidemic Agents