The GP's View: When low cholesterol may be harmful
I AM a great believer in statins – I take one myself due to considerably raised cholesterol levels. But a recent study makes me wonder if too many people are having their levels pushed too low.
We know for certain that high levels of low-density lipoprotein (LDL) – ‘bad’ cholesterol – is a risk factor for cardiovascular disease, and you’re more likely to have a heart attack or die prematurely. The current guidance is that your LDL level should not be above 3mmol/l.
For that reason, anybody diagnosed with coronary heart disease – confirmed by scans showing that the coronary arteries are furred – will need to take a statin for life. That is referred to as secondary prevention, and it saves lives.
In people with this diagnosis, there is no controversy about pushing the LDL to the lowest possible level. We aim for 2mmol/l. What we do not know with the same degree of certainty is the benefit of prescribing statins for people who are apparently well (known as primary prevention).
There are other measures that can be taken to encourage good health, such as exercise, and the level of LDL needed to minimise the risk of premature death is not certain: lowest may not be best.
Cholesterol is, after all, the raw material needed to make many aspects of our body – our sex hormones, for example.
Last December a study in The BMJ showed that an LDL level of 3.6 is linked to the lowest all-cause risk of mortality.
This throws a cat among the pigeons. Could it be that many people put on statins for primary prevention are overtreated, their LDL being pushed too low?
For those who are otherwise healthy, aiming for very low LDL levels may be not be ideal.
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