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Very Low Cholesterol Is Safe

Researchers Say Statin Users Need Not Worry That LDL Is Too Low
By
WebMD Health News
Reviewed by Louise Chang, MD

Oct. 11, 2005 -- Just how low can you safely go when it comes to reducing your LDL "bad" cholesterol? Even lower than current guidelines say you should, a new study shows.

Patients taking high doses of cholesterol-lowering drugs need not worry that their LDL will drop too low, researchers from Harvard Medical School's Brigham and Women's Hospital report.

"It is clear that the LDL levels we are able to achieve with treatment are not dangerous," researcher Stephen D. Wiviott, MD, tells WebMD.

Don't Fear Low LDL

Guidelines released last year by the nation's top heart groups lowered target LDL cholesterol levels for people with a high risk for having a heart attack or stroke.

The move sparked concerns that the new target level of under 70 mg/dL might be too low, however. The researchers note that some other studies of people with low cholesterol -- but not on treatment -- have suggested an association between very low cholesterol levels and higher risk of death.

But the Harvard analysis found no relationship between cholesterol levels and these complications in recent heart attack patients taking the maximum dose (80 milligrams) of the cholesterol-lowering drug Lipitor.

More than 90% of the roughly 1,800 study participants saw their LDL levels drop below 100 mg/dL within four months of starting the treatment. Almost half of the patients achieved levels of 60 mg/dL or lower.

Those who achieved LDL levels of 60 and less had decreased major events such as second heart attack or stroke; they also had no more increase in serious side effects from the cholesterol medication than those with a goal of cholesterol levels between 80 and 100.

The findings are reported in the Oct. 18 issue of the Journal of the American College of Cardiology.

The finding "suggests the possibility that further LDL lowering beyond the new guideline optimal goal of less than 70 mg/dL may translate into an additional clinical benefit," the Harvard researchers wrote.

Statins Not the Only Option

American Heart Association president Robert H. Eckel, MD, says it is now clear that heart patients benefit from aggressive treatment to lower their cholesterol to target levels.

But he adds that high-dose statin therapy may not be the best way to achieve cholesterol goals.

In his lipid clinic at the University of Colorado, Eckel treats many of his patients with a combination of low to moderate doses of statins and other types of drugs that lower cholesterol.

He says this combination approach is often more effective and has fewer side effects than high doses of statins alone. The most widely reported side effects of statin treatment are muscle weakness and liver problems.

"Certainly, some people do need high doses of statins to lower their cholesterol to appropriate levels, but that is not true of everyone," he says.

While most people with heart disease can't achieve these target levels without drug therapy, Eckel says that doesn't mean that diet and exercise are not important.

"There are other ways to go about skinning the cat," he says. "Reducing saturated fats and trans fats in the diet is a good place to start, and a combination of drugs may be better for many patients than statins alone."

Is This Normal? Get the Facts Fast!

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Desirable
0-199
Borderline
200-239
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240+

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Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is optimal.

Congratulations! Your total cholesterol level is in the Desirable range, and your level of "bad" LDL cholesterol is near optimal.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is borderline high. If your LDL goes higher, your total cholesterol level could become Borderline High. Consider reducing the amount of foods you eat with saturated fats and increasing physical activity. If you get more exercise, your level of "good" HDL cholesterol may increase, which could also help to keep your levels of LDL and total cholesterol in check.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL. The HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is in the Desirable range, but your level of "bad" LDL cholesterol is Very High. This may mean that your level of high-density lipoprotein (HDL), or "good" cholesterol, is too low. It is best to have a high level of "good" HDL and a low level of "bad" LDL because the HDL helps keep your LDL level in check. Ask your doctor for your HDL level. If your HDL is low, increasing your physical activity can increase it, which may help reduce your LDL level.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High, but fortunately your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have other non-measured increases in LDL-like particles that can increase heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is Borderline High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. Your level of "bad" LDL cholesterol is High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is Borderline High. But your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol is High, but your level of "bad" LDL cholesterol is optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol is High, but your level of "bad" LDL cholesterol is near optimal. This could mean you have a high level of high-density lipoprotein, or "good" HDL cholesterol, which protects against heart disease. Or you could have elevated secondary lipids, such as non-HDL particles that increase the risk of heart disease. Your LDL level also could be optimal if you are taking a statin medication. Please check with your doctor to get your complete lipid profile and see if you may need additional treatment. In the meantime, find more information on WebMD's Cholesterol Health Center.

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is Borderline High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels!

Your total cholesterol level is High. Your level of "bad" LDL cholesterol is High, too. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe medication, such as statins. Following medication, dietary, and exercise instructions should result in improvements.

Your total cholesterol level is High, and your level of "bad" LDL cholesterol is Very High. Working to bring down your total cholesterol decreases your LDL cholesterol level. You can do this by exercising more and eating less food with saturated fats. Check food labels! If you are struggling to bring down your total cholesterol and LDL cholesterol levels, your doctor may prescribe statins or other cholesterol-lowering medications.

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