Is there a low Low-Density Lipoprotein (LDL) level?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: April 3, 2025View editorial policy

Personalize

Help us tailor your experience

Which best describes you? Your choice helps us use language that's most understandable for you.

From the Guidelines

Yes, LDL cholesterol can be too low, though this is uncommon, and levels below 30 mg/dL may be concerning, as suggested by recent studies 1.

Key Points to Consider

  • Generally, very low LDL levels have been linked to increased risk of hemorrhagic stroke, neurological problems, mood disorders, and complications during pregnancy.
  • Some people naturally have very low LDL due to genetic factors without apparent problems, while others experience low LDL due to medications like high-dose statins, PCSK9 inhibitors, or certain health conditions.
  • Recent European and American Cholesterol Management guidelines have adopted a more aggressive lipid-lowering approach in high-risk patients, but it is still unclear whether very low LDL-C per se is associated with significant clinical adverse effects 1.

Recommendations

  • If you have extremely low LDL levels, discuss this with your healthcare provider, especially if you're experiencing symptoms like weakness, fatigue, or mood changes.
  • They can evaluate whether your low LDL is causing problems or if it's simply a reflection of your individual physiology or treatment regimen.
  • Most people should focus on maintaining LDL levels within recommended ranges rather than worrying about LDL being too low, as the benefits of lowering LDL-C continue to increase even when very low LDL-C is attained 1.

Important Considerations

  • The safety of very low LDL-C levels in the long-term is still being evaluated, and more research is needed to fully understand the potential risks and benefits.
  • Therapeutic lifestyle changes (TLC) remain an essential modality in clinical management, and any person at high risk or moderately high risk who has lifestyle-related risk factors is a candidate for TLC to modify these risk factors regardless of LDL-C level 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

LDL Levels and Cardiovascular Risk

  • The relationship between low-density lipoprotein (LDL) cholesterol levels and cardiovascular risk has been extensively studied, with evidence suggesting that lower LDL levels are associated with reduced cardiovascular risk 2, 3, 4.
  • Clinical trials have demonstrated that aggressive LDL-lowering therapies, including statins, ezetimibe, and proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, can significantly reduce cardiovascular events and mortality 2, 3, 4.
  • The idea that "lower is better" for LDL cholesterol levels is supported by recent randomized controlled trials, which have shown that LDL levels as low as 30 mg/dl are associated with reduced cardiovascular risk 2, 4.

Optimal LDL Levels

  • The optimal range for LDL cholesterol levels is still a topic of debate, with some studies suggesting that levels as low as 50-70 mg/dl may be beneficial for reducing cardiovascular risk 4, 5.
  • Mendelian randomization studies and data from other primates suggest that "normal" LDL cholesterol levels may be too high, and that lower levels may be more optimal 2.
  • However, it is also important to consider the potential risks and benefits of very low LDL levels, including the potential for increased risk of certain complications such as cancer and hemorrhagic stroke 5.

Safety of Low LDL Levels

  • Clinical trials have generally not demonstrated correlations between on-treatment LDL cholesterol levels and safety, suggesting that low LDL levels are not associated with significant adverse effects 3, 4, 5.
  • However, more robust outcome and safety data are required, particularly for very low LDL levels (e.g., down to 25 mg/dl) and for certain patient populations such as those with statin intolerance 4, 6.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.