From the Guidelines
High LDL cholesterol significantly increases your risk of cardiovascular disease, particularly atherosclerosis, where plaque builds up in your arteries, and the higher your LDL level, the greater your risk, as supported by recent guidelines 1. The risks associated with high LDL cholesterol include:
- Increased risk of coronary artery disease, heart attack, stroke, and peripheral artery disease
- Increased inflammation in blood vessels
- Endothelial dysfunction (damage to the inner lining of blood vessels)
- Higher likelihood of developing metabolic disorders like diabetes To manage high LDL, doctors typically recommend lifestyle changes such as:
- A heart-healthy diet low in saturated fats
- Regular exercise
- Weight management
- Quitting smoking If these measures aren't sufficient, medications like statins (such as atorvastatin or rosuvastatin), ezetimibe, PCSK9 inhibitors, or bile acid sequestrants may be prescribed depending on your specific situation and risk factors, with recent guidelines suggesting upfront lipid-lowering combination therapy in patients with established pre-event atherosclerotic CVD and in specific populations of patients with metabolic disorders and statin intolerance 1. It is essential to note that the goal for LDL-lowering therapy in high-risk patients is an LDL-C level <100 mg/dL, and when risk is very high, an LDL-C goal of <70 mg/dL is a therapeutic option, as recommended by the International Lipid Expert Panel (ILEP) 1.
From the FDA Drug Label
To reduce the risk of: Myocardial infarction (MI), stroke, revascularization procedures, and angina in adults with multiple risk factors for coronary heart disease (CHD) but without clinically evident CHD MI and stroke in adults with type 2 diabetes mellitus with multiple risk factors for CHD but without clinically evident CHD. Non-fatal MI, fatal and non-fatal stroke, revascularization procedures, hospitalization for congestive heart failure, and angina in adults with clinically evident CHD.
The risks of high LDL include:
- Myocardial infarction (MI)
- Stroke
- Revascularization procedures
- Angina
- Hospitalization for congestive heart failure 2 2
From the Research
Risks of High LDL
- High levels of low-density lipoprotein (LDL) cholesterol are associated with an increased risk of coronary heart disease and stroke 3, 4, 5.
- Elevated LDL cholesterol is a major cardiovascular risk factor, and statins have been proven to effectively reduce the risk of atherosclerotic cardiovascular disease (ASCVD) 3.
- However, statins may not be sufficient in decreasing LDL cholesterol levels, and pose a significant on-treatment residual risk of major cardiovascular events 3.
- The risk of myocardial infarction and atherosclerotic cardiovascular disease is augmented with increased LDL cholesterol levels, particularly in individuals aged 70-100 years 5.
- High LDL cholesterol levels are also associated with an increased risk of cardiovascular events in individuals with co-morbidities such as diabetes or peripheral artery disease 6.
Cardiovascular Risks
- The risk of cardiovascular events, including myocardial infarction and atherosclerotic cardiovascular disease, is increased with high LDL cholesterol levels 3, 6, 4, 5.
- The risk of cardiovascular events is particularly high in individuals with very high cardiovascular risk, such as those with co-morbidities or a history of cardiovascular disease 6, 4.
- Aggressive LDL cholesterol lowering is recommended for individuals at highest risk, with a goal of achieving very low LDL cholesterol levels [<55 mg/dL or even <40 mg/dL] 6, 4.
Treatment and Management
- Statins are the most potent drugs for lowering LDL cholesterol and are well tolerated in most patients 3, 7.
- The addition of ezetimibe or a bile acid sequestrant to a statin can produce additional LDL cholesterol reduction, allowing many patients to reach LDL cholesterol targets 3, 7.
- Monoclonal antibodies, such as alirocumab and evolocumab, have been approved to lower LDL cholesterol levels and reduce the risk of cardiovascular events 3.