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Lowering LDL ‐Cholesterol and CV Benefits: Is There a Limit to How Low LDL ‐C Needs to be for Optimal Health Benefits?
Author(s) -
Vani Anish,
Underberg James A.
Publication year - 2018
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt.1133
Subject(s) - kexin , pcsk9 , medicine , atherosclerotic cardiovascular disease , proprotein convertase , adverse effect , cholesterol , lipoprotein , ldl cholesterol , ldl receptor , disease
Atherosclerotic cardiovascular disease ( ASCVD ) is the number one cause of morbidity and mortality worldwide. Low‐density lipoprotein cholesterol ( LDL‐C ) has been implicated as one of the major risk factors causing ASCVD based on multiple hierarchical levels of evidence. The advent of powerful LDL‐C lowering therapies, such as the proprotein convertase subtilisin/kexin type 9 inhibitor, have raised the question of how low to target LDL‐C and whether there are any adverse safety events associated with a very low LDL‐C level. The present review summarizes the available evidence and concludes that even a very low LDL‐C is associated with cardiovascular benefit, although the magnitude of benefit depends on baseline ASCVD risk and the absolute change in LDL‐C with pharmacologic therapy. The safety data in patients treated for very low LDL‐C is reassuring, although it is inconsistent and requires longer term follow‐up.