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No Clear Evidence for Ultra-Low Cholesterol Targets?

., director of the VA Center for Health Services Research and Development and professor of internal medicine at the U-M Medical School. “Current practice guidelines and recommendations often focus on getting LDL as low as possible, but the literature to date doesn’t demonstrate that low LDL is what is truly important – but it does show that statins save lives in high cardiac risk patients regardless of a person’s LDL level.”

In fact, Hayward and his colleagues say, it may be that the other effects of statin drugs help reduce the risk of heart disease and heart attacks as much or more than the drugs’ LDL-lowering power does. Statins inhibit inflammation and clotting, as well as reduce cholesterol, attributes that can be important for preventing heart attacks.

People who have survived a heart attack or have risk factors that put them at high risk of future heart problems should probably be on a moderate or high dose of a statin and stay on it no matter what happens to their exact LDL level, Hayward says.

However, the benefits and safety of using multiple medications to get LDL levels low is open to debate, and is not supported by valid clinical evidence, he adds. Still, many physicians recommend using statins in combination with medications such as niacin, gemfibrozil, fenofibrate and newer drugs to try to bring LDL levels down to low levels.

“Going beyond statin therapy is becoming more common, but when you do that you are also going beyond the current evidence,” Hayward says. “Neither the benefit nor the long-term safety of using multiple medicines to lower LDL cholesterol has been studied to date. There is a temptation to believe that lower cholesterol is always good, but recently two treatments that improve cholesterol profiles, hormone replacement therapy and muraglitazar, were found to actually harm people. We would never have known this if we hadn’t insisted on scientifically rigorous assessments of these treat
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