Monday, September 17, 2018

LDL More Than 160 Tied to Increased Mortality in Low-Risk Patients

Patients deemed at low-risk for cardiovascular disease (CVD) but with LDL levels above 160 face increased mortality risks over the long term, a Circulation study suggests.

Over 36,000 adults in Texas (median age, 42) with an estimated 10-year risk for atherosclerotic CVD events below 7.5% had their lipid levels measured and were followed for a median of 27 years. During that time, nearly 1100 CVD deaths and 600 coronary heart disease (CHD) deaths occurred.

After multivariable adjustment, participants with LDL levels of 160–189 mg dL had a 70% increased risk for CVD mortality and more than twice the risk for CHD mortality, relative to those with LDL below 100 mg dL. Increasing levels of non-HDL cholesterol were also associated with higher mortality risks.

The researchers note that 2013 cholesterol guidelines recommend statins for low-risk patients when LDL reaches 190 mg dL, with a class IIb recommendation for considering treatment at 160 mg dL. They say their current findings "suggest a stronger consideration of using the LDL-C greater than 160 mg dL cutoff."

My Take:
The medical norms for LDL are less than 130 mg dl. However, many labs list the medical norm as less than 100 mg dl as that is the goal of statin drug therapy. Many physicians like to drive the LDL level less than 60 mg dl, although the research indicates no additional benefit in cardiovascular risk is associated with this goal.

I took the risk assessment and unless you are in your early forties or younger, you can’t qualify below 7.5% anyway, regardless of your total cholesterol, LDL or HDL levels.

I’m a little confused about the purpose of this study. All I can think it that it’s another way to put younger and younger patients on statin drugs, but most physicians use 100 mg/dl for the cutoff rather than the suggested 160 mg/dl anyway.

Bottom Line:
I much prefer looking at the L(p)a, hs-CRP, homocysteine and fibrinogen for cardiovascular risk rather than the just LDL, HDL or total cholesterol. I suggest you do the same.

Source: August 20, 2018 NIH

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