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Can LDL cholesterol be too low? Possible risks of extremely low levels
A G Olsson1, B Angelin2, G Assmann3
1Department of Medicine and Health, Linköping University, Linköping, Sweden.
Journal of Internal Medicine
|March 16, 2017
Summary
Extremely low low-density lipoprotein cholesterol (LDL-C) levels are generally safe, as the body maintains essential functions. However, potential drug side effects require further investigation.
Area of Science:
- Cardiovascular Medicine
- Lipid Metabolism
- Human Physiology
Background:
- Evidence supports reducing low-density lipoprotein cholesterol (LDL-C) for cardiovascular disease prevention.
- Therapeutic options now allow LDL-C reduction to levels seen in newborns.
Purpose of the Study:
- To evaluate potential adverse effects of extremely low LDL-C levels in humans.
- To review evidence from cellular physiology, genetic diseases, and clinical trials.
Main Methods:
- Review of human cellular and organ physiology.
- Phenotypic characterization of genetic lipid metabolism disorders.
- Analysis of clinical trial data.
Main Results:
- Robust regulatory systems preserve cholesterol homeostasis at cellular and organismal levels.
- Steroid hormone and bile acid production remain adequate even at very low LDL-C.
- A cholesterol blood-brain barrier protects the central nervous system.
Conclusions:
- Extremely low LDL-C levels per se do not appear to provoke significant adverse effects.
- Observed associations between low LDL-C and other diseases are likely secondary.
- Further evaluation of potent LDL-lowering drugs, like PCSK9 inhibitors, and cognitive function is needed.
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