Heart disease is one of the leading causes of death around the world. It often develops slowly over many years as fatty deposits build up inside the arteries.
These deposits are called plaques, and they can narrow or block blood flow. When this happens, it can lead to serious problems such as heart attacks or strokes.
One of the key factors in this process is a type of cholesterol called low-density lipoprotein cholesterol, or LDL-C. This is often called “bad cholesterol” because high levels can lead to plaque buildup in the arteries.
For many years, doctors have focused on lowering LDL-C to reduce the risk of heart disease. However, there has been ongoing debate about how low LDL-C should go.
A new study has now provided clearer answers. The research was presented at the American College of Cardiology’s Annual Scientific Session and helps guide doctors on how aggressively they should lower cholesterol levels in patients who already have heart disease.
The study focused on people with a condition known as atherosclerotic cardiovascular disease, or ASCVD. This condition includes people who have already had problems such as heart attacks, strokes, or blocked arteries. These patients are at high risk of having more serious events in the future.
In the study, researchers followed 3,048 patients across 17 hospitals in South Korea. The average age of the participants was 64, and about one in five were women. All of them had a history of heart disease and were considered high-risk.
The patients were divided into two groups. One group aimed for a lower LDL-C level of less than 55 mg/dL. The other group aimed for a slightly higher target of less than 70 mg/dL, which has been the traditional goal in many treatment guidelines.
Doctors adjusted treatments for each patient to reach these targets. They used common medications such as statins and added other drugs when needed. These included medicines like ezetimibe and newer therapies that help lower cholesterol even further.
After three years, the results showed a clear benefit for the group with the lower LDL-C target. About 6.6% of patients in this group experienced major heart-related problems, compared to 9.7% in the group with the higher target. This means the risk was reduced by about one-third in those who lowered their cholesterol more aggressively.
The improvement was mainly due to fewer heart attacks and fewer procedures to reopen blocked arteries. There was also a reduction in the combined risk of heart attack, stroke, and cardiovascular death.
Importantly, lowering cholesterol more aggressively did not lead to more side effects. The two groups had similar safety outcomes. There were no major differences in muscle pain, diabetes risk, or blood sugar control. In fact, some measures of kidney function appeared slightly better in the lower LDL-C group.
These findings suggest that aiming for a lower cholesterol target can provide extra protection for people with heart disease. The results were consistent across different types of patients, which means the benefits are likely to apply to many people.
However, the study also had some limitations. It was conducted only in South Korea, and all participants were from East Asia. This means the results may not apply equally to all populations. In addition, some patients in the intensive treatment group did not reach the target level, partly because certain newer drugs were not widely available.
Overall, this study provides strong evidence that “lower is better” when it comes to LDL cholesterol in high-risk patients. It supports current guidelines that recommend more aggressive treatment.
In simple terms, for people who already have heart disease, reducing bad cholesterol to very low levels can significantly lower the risk of future heart problems. This finding may help doctors make better treatment decisions and improve patient outcomes.
The findings were presented at the American College of Cardiology’s Annual Scientific Session.
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Source: Yonsei University College of Medicine.
