Although I have low LDL without statin therapy, I started a statin because of significant family history. Recent evidence seems to point to very low LDL (<70) being even better than low LDL (<100). More recently JUPITOR showed that <50 was better than <70. However, what is particularly interesting is that statins seem to reduce cardiovascular events through mechanisms other than LDL lowering. Such mechanisms may be anti-thrombotic, anti-inflammatory, and anti-oxidant. Do we understand what dose is necessary to get these non-LDL lowering benefits? For example, I take 5mg of Lipitor daily. The reason for the dose being so low is that my LDL was low to begin with (91) and I am very sensitive to it (i.e., just 10mg brought it down by 47% to 48).
The most recent studies are showing continued benefits of low LDL in reducing atherosclerosis formation as well as reversal of plaque build up after 18 months of having a LDL less than 70. There are may be other reasons why patients can develop cardiovascular disease. The fractionated lipid panel may help understand what type of LDL particles you have. The bigger particle sizes of LDL are associated with less build up than smaller LDL. Understanding these subtle differences in your cholesterol can better guide medical therapy. Furthermore, having your cardio CRP, homocysteine levels and insulin levels may help decrease other risk for heart disease.
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