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

Reference:

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. https://doi.org/10.1161/CIRCULATIONAHA.116.024604.