Is extreme lowering of LDL cholesterol appropriate

Clinicians are frequently in the position of not only having to decide which patients would benefit the most from statins, but also the degree to which lipids should best be lowered.

To the question, whether the mortality effect size associated with lipid lowering therapy varies according to the extent of LDL reduction, a meta analysis of 60 randomized controlled studies was published in the January edition of the Journal of Cardiovascular Pharmacology.

In summary:

  1. They did not find a significant trend for all cause mortality reduction according to the percentage of LDL reduction.
    2.Risk reduction was not significant in trials with > 50% LDL reduction.
  2. Similar to all cause mortality, CV mortality risks did not decrease in trials with > 50% LDL reduction.
  3. Risk based intervention strategies recommended by guidelines suggests that the higher baseline CV risk, the greater the absolute reduction in risk.
  4. The absolute risk reduction of 0.5% in studies with baseline LDL’s <100and 1.2% with LDL’s > 158.
  5. Benefits found with LDL lowering therapies are indeed modest when compared with… smoking cessation, regular exercise, and obesity prevention.

The study authors were by no means negating the benefits of lipid lowering in the appropriate patients and using appropriate dosing.

They also admit that the studies did not look at ApoB or non HDl.