Cholesterol Levels Can’t Be Too Low

Very low levels (40 mg/dL) of LDL cholesterol, the so-called “bad” cholesterol, seem to be safe for heart patients who are taking statins. Patients taking high doses of statins can see their LDL cholesterol drop from over 200 milligrams per deciliter past a target goal of 70 to 80 mg/dl to as low as 40 mg/dl. Whether such low cholesterol levels are safe has been a matter of conjecture.

"We looked at patients who got to ultra-low cholesterol levels, and wanted to make sure that was safe," says study co-author Dr.

Christopher P. Cannon, a cardiologist at Brigham and Women’s Hospital in Boston. "We found that it was not only safe, but it was better to have your cholesterol down in the range of 40 or 50 mg/dl than 70 or 80 mg/dl."

In their study, Cannon and his team collected data on 1,825 patients who were taking statins after having a heart attack or unstable angina. Patients were taking 80 milligrams daily of the drug brand-named Lipitor.

After four months of therapy, 91 percent of the patients saw their cholesterol drop below 100 mg/dl. Of these, 11 percent saw their cholesterol drop below 40 mg/dl, according to the report.

Compared with other groups, those with cholesterol levels of less than 40 mg/dl and those whose cholesterol was in the range of 40 to 60 mg/dl had fewer heart attacks, strokes, cardiac death, chest pain or additional heart procedures, the researchers found.
Moreover, there were no significant differences in adverse side effects from statins, such as muscle, liver or retinal abnormalities, bleeding in the brain or death.

"We can feel comfortable using high-dose statins in all high-risk patients, even if their cholesterol ends up at 40 mg/dl.
That’s actually a good thing," Cannon says. "The message is that lower is better and safe."

One expert believes these results will lower current cholesterol goals.

"I think this is an important direction of our therapy for the future — lowering the bar," says Dr. Eric J. Topol, chairman of the department of cardiovascular medicine and chief academic officer at The Cleveland Clinic. "And this study helps, validating its remarkable safety."

The Journal of the American College of Cardiology, Oct 18, 2005

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