From the Guidelines
LDL does not repair arterial damage, and instead, high levels of LDL cholesterol can contribute to arterial damage and increase the risk of cardiovascular events. The 2024 recommendations on the optimal use of lipid-lowering therapy in established atherosclerotic cardiovascular disease and following acute coronary syndromes, as outlined in the position paper of the International Lipid Expert Panel (ILEP) 1, emphasize the importance of achieving target LDL-C values to reduce the risk of cardiovascular events. According to the ILEP recommendations, LDL-C levels should be regularly monitored, and target LDL-C values of < 55 mg/dL (< 1.4 mmol/L) should be achieved in patients who have had a myocardial infarction (heart attack) 1.
To achieve this goal, the ILEP recommends taking the highest possible doses of potent statins, such as atorvastatin or rosuvastatin, and considering combination therapy with ezetimibe or proprotein convertase subtilisin/kexin type 9 protein inhibitors (PCSK9Is) if LDL-C levels remain elevated 1. Additionally, lifestyle changes, such as a healthy diet, regular physical activity, and control of other atherosclerosis risk factors, are crucial for protecting arterial health 1.
Key points to consider in managing LDL levels and reducing arterial damage include:
- Achieving target LDL-C values of < 55 mg/dL (< 1.4 mmol/L) in patients with established atherosclerotic cardiovascular disease or following acute coronary syndromes 1
- Using potent statins, such as atorvastatin or rosuvastatin, as first-line therapy 1
- Considering combination therapy with ezetimibe or PCSK9Is if LDL-C levels remain elevated 1
- Implementing lifestyle changes, such as a healthy diet and regular physical activity, to control other atherosclerosis risk factors 1.
By following these recommendations and maintaining healthy LDL levels, individuals can reduce their risk of cardiovascular events and protect their arterial health 1.
From the Research
LDL and Arterial Damage
- The relationship between LDL and arterial damage is complex, with some studies suggesting that elevated LDL cholesterol is associated with increased risk of myocardial infarction and atherosclerotic cardiovascular disease 2.
- However, other studies argue that LDL-C does not cause cardiovascular disease, and that the mechanisms are more complicated than previously thought 3.
- Intensive low-density lipoprotein cholesterol lowering has been shown to lead to further reduction in cardiovascular events compared with more moderate lipid lowering, with no associated safety concerns 4.
LDL Repair and Arterial Damage
- There is no direct evidence to suggest that LDL repairs arterial damage.
- Statin therapy, which lowers LDL levels, has been shown to improve endothelial functions in hyperlipidemic subjects, but its effect on normolipidemic hypertensive patients is less clear 5.
- The use of statins in combination with other treatments, such as ACE inhibitors, may have beneficial effects on blood pressure control and endothelial functions, but more research is needed to fully understand these effects 5.
Current Understanding
- The current understanding of the relationship between LDL and arterial damage is based on a large body of evidence, including studies on the effects of statin therapy and other lipid-lowering treatments 2, 4, 6.
- However, there is still some debate and controversy in the field, with some researchers arguing that the cholesterol hypothesis is unable to satisfy any of the Bradford Hill criteria for causality 3.