Eddy Edson
Well-Known Member
- Relationship to Diabetes
- Type 2
Nope. Risks largely disappear on further analysis, and "the benefit outweighs any possible risk". In line with recommendations from the international expert bodies that net beneifts of lowering serum LDL are continuous and have no practial lower limit. The Internet-level commentary that "you need LDL for whatever" is just wrong, when it comes to serum LDL - your cells make enough, and what appears in the blood is essentially waste product.
academic.oup.com
Abstract
Although some observational studies suggest a potential association of low levels of low-density lipoprotein cholesterol (LDL-C) with intracerebral hemorrhage (ICH), these analyzes have issues of confounding where other factors (e.g., older age, frailty) that likely explain the findings, and the number of events was very low.
More recent results from randomized clinical trials have not found an increased risk in ICH, most notably trials using PCSK9 inhibitors that achieve very low levels of LDL-C, but also in the long-term follow-up of the IMPROVE-IT trial. Also, other statin-associated safety issues, including new onset diabetes (NOD) and the cancer risk should not be the reason of statin discontinuation, especially for the former the benefits highly outweigh the risk (even 5x), and for the latter there is no confirmed link suggesting any increased risk, in opposite, data exist suggesting benefits of statin therapy in cancer prevention.
Furthermore, use of intensive lipid lowering strategies with statins, and non-statin drugs lead to decrease of ischemic major adverse cardiac events (MACE), without safety concern, in a large population of atherosclerotic cardiovascular disease (ASCVD) patients. These data should promote the concept “the earlier, the lower, the longer, the better” for the lipid management of ASCVD patients.
While few uncertainties remain in several populations that have been underrepresented in clinical trials (African American and Asian patients, low weight individuals), the most recent data with intensive LDL-C lowering with PCSK9 inhibitors are reassuring that the benefit outweighs any possible risk.
Low levels of low-density lipoprotein cholesterol, intracerebral haemorrhage, and other safety issues: is there still a matter of debate?
Abstract. Although some observational studies suggest a potential association of low levels of low-density lipoprotein cholesterol (LDL-C) with intracerebr
academic.oup.com
Abstract
Although some observational studies suggest a potential association of low levels of low-density lipoprotein cholesterol (LDL-C) with intracerebral hemorrhage (ICH), these analyzes have issues of confounding where other factors (e.g., older age, frailty) that likely explain the findings, and the number of events was very low.
More recent results from randomized clinical trials have not found an increased risk in ICH, most notably trials using PCSK9 inhibitors that achieve very low levels of LDL-C, but also in the long-term follow-up of the IMPROVE-IT trial. Also, other statin-associated safety issues, including new onset diabetes (NOD) and the cancer risk should not be the reason of statin discontinuation, especially for the former the benefits highly outweigh the risk (even 5x), and for the latter there is no confirmed link suggesting any increased risk, in opposite, data exist suggesting benefits of statin therapy in cancer prevention.
Furthermore, use of intensive lipid lowering strategies with statins, and non-statin drugs lead to decrease of ischemic major adverse cardiac events (MACE), without safety concern, in a large population of atherosclerotic cardiovascular disease (ASCVD) patients. These data should promote the concept “the earlier, the lower, the longer, the better” for the lipid management of ASCVD patients.
While few uncertainties remain in several populations that have been underrepresented in clinical trials (African American and Asian patients, low weight individuals), the most recent data with intensive LDL-C lowering with PCSK9 inhibitors are reassuring that the benefit outweighs any possible risk.
