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Very Low Cholesterol Is Safe

Researchers Say Statin Users Need Not Worry That LDL Is Too Low

Medically Reviewed by Louise Chang, MD on October 11, 2005
From the WebMD Archives

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."

Show Sources

SOURCES: Wiviott, S.D., Journal of the American College of Cardiology, Oct. 18, 2005; vol. 46: online edition. Stephen D. Wiviott, MD, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston. Robert H. Eckel, MD, president, American Heart Association; professor of medicine, University of Colorado.
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