Moderate 'bad cholesterol' levels tied to early death

Healthy adults who don't keep their LDL-C, or "bad cholesterol," in check are more likely to die prematurely from cardiovascular disease than peers with lower cholesterol levels, a US study suggests.
Researchers examined data on 36,375 adults with no history of heart disease or diabetes and a low 10-year risk for events like heart attacks or strokes. Most had levels of the type of cholesterol that builds up in blood vessels and can lead to blood clots and heart attacks, known as low-density lipoprotein cholesterol (LDL-C), below the threshold that usually leads doctors to prescribe cholesterol-lowering drugs.
During the study follow-up period of about 27 years, 1,086 people died of cardiovascular disease and 598 died from coronary heart disease.
Compared to people with very low LDL-C levels under 100 milligrams per deciliter (mg/dL) of blood, individuals with LDL-C levels ranging from 100 to 159 mg/dL had a 30 to 40 percent higher risk of dying of cardiovascular disease. With LDL-C levels of 160 mg/dL to 189 mg/DL, people had a 90 percent higher risk of death from cardiovascular causes. LDL-C levels of at least 190 mg/DL, which is where guidelines suggest statin use even for otherwise healthy people, carried 70 percent greater risk.
Compared to people with LDL-C levels below 100 mg/dL, people with LDL-C of 100 to 129 mg/DL died of cardiovascular disease about 1.8 years sooner and people with LDL-C of 160 mg/dL or higher died around four years sooner, the researchers calculate.
"The biggest take-home message from this study is that it demonstrates that having a low 10-year estimated cardiovascular risk does not eliminate the risk posed by elevated LDL cholesterol or (other forms of bad cholesterol) over a course of a lifetime," said lead study author Dr. Shuaib Abdullah, of the University of Texas Southwestern Medical Center in Dallas and VA North Texas Health Care System.
"Life-style interventions, such as avoiding diets high in saturated and trans-fatty acids, increasing fiber intake, maintaining ideal weight, and engaging in regular aerobic activity may lower LDL cholesterol and have been associated with improved cardiovascular outcomes," Abdullah said by email.
"In those individuals in whom LDL cholesterol or (other forms of bad cholesterol) remain elevated despite these interventions, statins may be considered after discussion with the health care provider about their risks and benefits," Abdullah advised.
Prescribing statins, or cholesterol-lowering drugs, to healthy people at low risk for death from heart attacks or strokes has been controversial partly because these drugs were tested primarily in intermediate- and high-risk groups, the study authors note in Circulation.