How low should cholesterol go? And is it safe to reduce cholesterol levels to as low as doctors can take it?
New research just released provides the answer.
The guidelines for cholesterol goals have shifted over the years, gradually decreasing. An LDL, or bad cholesterol number of 130 was the cholesterol goal a decade or so ago. That then fell to 100. And now it’s fallen even further to about 70? Is it worth the effort?

Mahendra Radhamohan had a heart attack ten years ago, and needed bypass surgery. His cholesterol level was certainly partly to blame. “It was high. My cholesterol level might in fact have been the thing that was responsible for the heart attack,” says Mahendra.
Mahendra has had no heart attacks since and his heart condition has been classified as “stable”. That made him a candidate to participate in an important study, just presented at the American College of Cardiology Annual Meeting and published in the latest New England Journal of Medicine.
It looked at whether patients like Mahendra- with stable coronary artery disease- would benefit from getting their bad, or LDL cholesterol level low, as low in fact as 70.
Dr. John Larosa is the SUNY Downstate researcher who led the study. “This was the first study to look at the issue of how low cholesterol levels, particularly LDL cholesterol, can go and still be beneficial and safe. This is the first study to use two doses of the same drug. The first dose to get LDL cholesterol level down to what we think they should be, and another dose to get the cholesterol level considerably lower than we had imagined would be beneficial,” says Dr. Larosa.
Everyone started at LDL level of 160. Half the patients got 10 milligrams of Atorvastatin, or Lipitor, their LDL got down to 100. The other half received 80 milligrams of Lipitor; they got their LDL down to on average, 77.
The question was, did the substantially lower cholesterol levels make any difference in terms of heart attacks, strokes or other vascular events?
“The study found that both coronary events and strokes could be lowered substantially by lowering LDL cholesterol level below the currently recommended level of 100 mg/dl. So in a sense it validated the options the National Cholesterol Education Program presented to lower some patients down to 70 or in that range at least,” Dr. Larosa states.
Currently, only those with unstable heart disease--those, for example who have just had a heart attack-- are recommended to get their LDL cholesterol level down to 70.
The researchers emphasize that this is the first study to argue in favor of lowering the bad cholesterol down to 70 in those with stable heart disease. They consider that this should automatically be policy. There are two other big trials looking at the same thing coming out soon, and they reserve final judgment based on the results of those studies. But, if they show similar findings, then that would boost the argument for an LDL goal of 70 in this patient group.
“This is the first study that I know of where in ten thousand patients with stable coronary disease followed for five years, the most common cause of death was not coronary disease,” says Dr. Larosa.
The study on cholesterol levels proves that medical science can win the war against heart disease.

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