cardiology cholesterol heart disease prevention statins

LDL cholesterol below 60 mg/dL: the plaque reversal threshold?

For years, “normal” LDL cholesterol has been treated as if it were the same thing as “safe.” It is not.

LDL cholesterol is one part of the atherosclerosis story, but the important exposure is cumulative. The longer arterial walls are exposed to atherogenic lipoprotein particles, the more opportunity there is for particles to enter the arterial wall, become retained, and contribute to plaque formation.

That is why the question is changing. Instead of asking only whether an LDL result is high enough to treat, we should also ask whether it is low enough for the person’s lifetime cardiovascular risk.

The evidence does not support the simplistic claim that an LDL below 60 mg/dL guarantees that a person has no heart disease. It does support a more useful conclusion: lower LDL-C is generally associated with lower atherosclerotic risk, and people with established atherosclerotic cardiovascular disease often benefit from intensi...