Low Target LDL Cholesterol May Not Decrease Cardiovascular Risk in All Patients

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Reducing LDL lower than 70 mg/dL did not translate into any further decreased cardiovascular risk.
Reducing LDL lower than 70 mg/dL did not translate into any further decreased cardiovascular risk.

(HealthDay News) – Very low target low-density lipoprotein (LDL) cholesterol levels may not benefit all patients with preexisting heart disease, according to a study published in JAMA Internal Medicine.

Morton Leibowitz, MD, senior physician with the Clalit Research Institute in Tel Aviv, Israel, and colleagues tracked 31 619 patients, ranging in age from 30 to 84, all of whom had been diagnosed with ischemic heart disease between 2009 and the end of 2013. All had been taking statins for at least 1 year. Twenty-nine percent were found to have LDL cholesterol levels of 70 mg/dL or less; 53% had a moderate LDL level of between 70.1 and 100 mg/dL; and 18% had high levels exceeding 100.1 and as high as 130 mg/dL.

 

Patients were followed for an average of 1.6 years, and during that time 9035 either died or faced a MACE, including myocardial infarction, unstable angina, stroke, percutaneous coronary intervention, and coronary artery bypass grafting. The researchers determined that the risk for such events was significantly lower among patients with moderate LDL levels, compared to patients with high LDL levels. However, additional reduction into the 70 mg/dL range did not translate into any further decrease in risk.

"I think these findings suggest a major shift away from our current assumptions of 'lower is better' for LDL lowering in patients with known heart disease," Rita Redberg, MD, editor-in-chief of JAMA Internal Medicine and coauthor of an accompanying editorial, told HealthDay. "It is important not to assume that more is better."

Reference

  1. Leibowitz M, Karpati T, Cohen-Stavi CJ, et al. Association between achieved low-density lipoprotein levels and major adverse cardiac events in patients with stable ischemic heart disease taking statin treatment. JAMA Intern Med. 2016; doi:10.1001/jamainternmed.2016.2751.
  2. Ascher SB, Charlton BR, Redberg RF. Low-density lipoprotein cholesterol levels and statin treatment: A moving target? JAMA Intern Med. 2016; doi:10.1001/jamainternmed.2016.2784.
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