Low-density lipoprotein (“LDL”) cholesterol is known as bad cholesterol for a good reason. LDL cholesterol brings about fatty deposits that can clog arteries. The plaque build-up causes atherosclerosis, which impedes blood flow through arteries in the heart, brain, kidney, and extremities. The result can be carotid artery disease, peripheral artery disease, angina, chronic kidney disease, or coronary heart disease, the #1 killer of Americans.
Doctors and scientists have been working on lowering LDL cholesterol for decades. The first statin was approved by the FDA in 1986, which aims to block the HMG CoA Reductase enzyme the liver uses to make cholesterol. While statins have been successful for patients with high cholesterol, there is a large subgroup of patients who need more help. PCSK9 inhibitors (#4 in the Top 10 Medical Innovations: 2015), is the newest class of cholesterol-lowering drugs that block the enzyme from allowing the cleanup of LDL particles in the extracellular fluid. These new drugs are taking cholesterol to low levels never seen before. And when PCSK9 is taken along with a statin, LDL levels are being reduced by 75 percent. While this stat was extraordinary, there have been many patients and doctors wondering, how low is too low?
A number of trials have been in progress over the last few years testing this theory. So far, the floor has yet to be found. A study of 25,982 patients reported in August of 2017 a 20 percent reduction in the risk of cardiovascular death, myocardial infarction or stroke for those that took statins and PCSK9 inhibitors to reach ultra-low LDL levels. No adverse events were reported.
So what does this mean? Doctors now have the tools and the research to take the fight to LDL cholesterol. With over 400,000 coronary disease deaths per year, 785,000 coronary attacks per year, and 102 million Americans currently living with higher than healthy cholesterol levels, these new strategies hold the promise to turn the tide in 2018.
Where Are They Now
As the unprecedented reduction in LDL cholesterol is still so new, research continues in attempts to identify the low level at which LDL is considered too low. Thus far, studies have shown no signs of damage from the drastic reduction. In 2018, doctors and scientists continue their work with lowering LDL cholesterol, hoping to pinpoint the LDL level most beneficial for preventing heart disease.