How low is safe? The frontier of very low (<30 mg/dL) LDL cholesterol

Abstract Low-density lipoprotein cholesterol (LDL-C) is a proven causative factor for developing atherosclerotic cardiovascular disease. Individuals with genetic conditions associated lifelong very low LDL-C levels can be healthy. We now possess the pharmacological armamentarium (statins, ezetimibe, PCSK9 inhibitors) to reduce an unprecedented extent. Increasing numbers of patients are expected achieve (<30 mg/dL) LDL-C. Cardiovascular event reduction increases log linearly in association lowering LDL-C, without reaching any clear plateau even when achieved. It still controversial whether lower significant clinical adverse effects (e.g. new-onset diabetes mellitus or possibly haemorrhagic stroke) and long-term data needed address safety concerns. This review presents familial characterized by analyses trials lipid-lowering agents where attained summarizes benefits potential achieving Given benefit short-term safe profile it may advantageous attain such specific high-risk populations. Further studies compare net non-LDL-C-lowering interventions approaches, addition comparing efficacy vs. current recommended targets.