Conundrum of Cholesterol Management and Health Implications of Low Cholesterol Levels: A Narrative Review

Lowering cholesterol for the health benefit of dyslipidemia is a well-known fact, but emerging evidence highlights risks associated with excessive lowering. The use of lipid-lowering agents to reduce cardiovascular risk is well-established; however, excessive cholesterol reduction has raised concerns about the potential health implications of excessively low cholesterol levels. This review explores the "cholesterol paradox," highlighting the dual nature of cholesterol as both a contributor to cardiovascular risk and an essential component for cellular integrity, hormone synthesis, brain function, and vitamin D production. A systematic search of PubMed, Google Scholar, JAMA, and Cochrane Library for eligible studies was conducted from 1980 until December 1, 2024. Evidence suggests that excessively low cholesterol levels may impair cell membrane integrity, neurotransmission, and immune function. This review underscores the need for balanced clinical approach to cholesterol management rather than solely aiming for aggressive reduction, ensuring both cardiovascular protection and broader systemic health.