Very Low LDL Cholesterol Levels Can Decrease CVD Risk

Lowering the levels of low-density lipoprotein cholesterol (LDL-C) to 50 mg/dL or lower can significantly reduce the risk of heart disease, heart attack, and stroke, according to new research.

Although previous research has established the health benefits of LDL-C levels at 54 mg/dL, the cardiovascular effects of cholesterol levels of 50 mg/dL and below are controversial.
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To determine the safety of lower LDL-C levels, the researchers analyzed data from 10 double-blind trials that were part of the ODYSSEY trials.

Trials included in the analysis compared alirocumab (n = 3182) with a control group taking either ezetimibe (n = 618) or placebo (n = 1174), mainly as an additional therapy to statin.

Participants were randomly assigned to alirocumab 75/150 mg every 2 weeks or to control for 24 to 104 weeks, added to background statin therapy in 8 trials.

Pooled results showed that 33.1% of the participants had achieved an average LDL-C of 50 mg/dL or less, and 104 had experienced a major cardiovascular event, with a median time to event of 36 weeks.

For every 39 mg/dL lower achieved LDL-C, the risk of major cardiovascular event was 24% lower.

“In a post hoc analysis from 10 ODYSSEY trials, greater percentage reductions in LDL-C and lower on-treatment LDL-C were associated with a lower incidence of [major adverse cardiovascular events], including very low levels of LDL-C (<50 mg/dL),” the researchers concluded. “These findings require further validation in the ongoing prospective ODYSSEY OUTCOMES trial.”

—Amanda Balbi


Ray KK, Ginsberg HN, Davidson MH, et al. Reductions in atherogenic lipids and major cardiovascular events: a pooled analysis of 10 ODYSSEY trials comparing alirocumab with control. Circulation. 2016;134(24):1931-1943.