Cholesterol: How Low Should LDL Go to Optimize Heart Health? Research Study Zeroes in on the Number
When it comes to cholesterol, how low should you go? If you feel like the target number for LDL cholesterol has changed, you’re right. The shift has a lot to do with research and how it impacts the recommendations your physician makes during clinic visits.
If your physician has talked to you about your cholesterol and prescribed a cholesterol-lowering statin medication, you probably know that LDL is the “bad” cholesterol and HDL is the “good,” cardio-protective cholesterol.
At one time, it was thought that raising HDL – the beneficial cholesterol – was a good approach to lowering risk of cardiovascular events. Research eventually showed that lowering LDL – the bad stuff — was more important than raising HDL to prevent heart disease.
Statin medications have long been used to achieve this result. More recently, a new class of injectable medications has been developed which are capable of bringing LDL levels even lower than previous targets. Called PCSK9 inhibitors (Repatha, Praluent), these injections make it possible to dramatically lower LDL cholesterol levels.
As a result, researchers are presented with a new question to study: What number is ideal for cardiovascular health?
To find the answer, researchers conducted a meta-analysis — “Cholesterol Treatment Trialists Collaboration (CTTC)” — which pooled data from multiple trials including two studies which involved CHI Health. In total, the meta-analysis analyzed data on more than 50,000 patients from three randomized trials of non-statin LDL-C–lowering therapies added to statins.
The results showed that further lowering LDL in patients with already low LDL was beneficial because the risk of major vascular events was reduced without serious adverse effects or events such as myalgias, new onset diabetes or cancer.
One study author stated that it’s desirable to get LDL below 70 and even down to 40. Whether to go lower than that is a question requiring more research.
So, if your physician recommends further lowering your LDL, it’s likely due at least in part to this meta-analysis. Similarly, when organizations such as the American Heart Association change their treatment recommendations, it’s largely due to this kind of wide-scale research.