Ki-Chul Sung, Ji Hye Huh, Seungho Ryu, Jong-Young Lee, Eleonora Scorletti, Christopher D Byrne, Jang Young Kim, Dae Sung Hyun, and Sang-Baek Ko

J Clin Med. 2019 Oct; 8(10): 1571.

PURPOSE:

To test the association between low-density lipoprotein cholesterol (LDL-C) and cardiovascular disease (CVD), cancer, and all-cause mortality in non-statin users.

PROCEDURES:

A total of 347,971 subjects in the Kangbuk Samsung Health Study were tested. To validate these associations, we analyzed data from another cohort (Korean genome and epidemiology study, KoGES, 182,943 subjects).

· All subjects treated with any lipid-lowering therapy and who died during the first 3 years of follow-up were excluded. Five groups were defined according to baseline LDL-C concentration (<70, 70–99, 100–129, 130–159, ≥160 mg/dL).

· A total of 2028 deaths occurred during follow-up in KSHS. The lowest LDL-C group (LDL < 70 mg/dL) had a higher risk of all-cause mortality, CVD mortality, and cancer mortality compared to the reference group (LDL 120–139 mg/dL).

· In the validation cohort, 2338 deaths occurred during follow-up. The lowest LDL-C group (LDL < 70 mg/dL) had a higher risk of all-cause mortality compared to the reference group.

· Low levels of LDL-C concentration are strongly and independently associated with increased risk of cancer, CVD, and all-cause mortality.

CONCLUSIONS:

More attention is needed for subjects without a statin-induced decrease in LDL-C.

IN PLAIN ENGLISH:

LDL-C < 70 mg/dL and > 160 mg/dL are unhealthy and associated with a higher risk of all-cause mortality and CVD risk. Therefore, it is prudent to possess an LDL-C at or near 120 to 139 mg/dL.