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This is an archive article published on February 27, 2023

Why even low LDL cholesterol levels can pose a risk to your heart: New study sheds light

‘The most important takeaway is that this link isn’t seen in people who are taking statins to lower their LDL level. Those who have been prescribed the medicine should continue to take it,’ said Dr VK Bahl, Principal Director of Cardiac Sciences at Max Hospitals

diabetesThe study said that a smaller study had first indicated the existence of this reverse link between LDL levels and sudden cardiac arrest that has been emphasised by the findings in a large sample size of 2.6 million people. (Pic source: Pixabay)
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Why even low LDL cholesterol levels can pose a risk to your heart: New study sheds light
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If you thought high levels of bad cholesterol, or what we call low density lipoprotein (LDL), increased the risk of sudden cardiac arrest among diabetics, think again. Even low levels of LDL up that risk just as much, says a new study. A large-scale study, based on over 2.6 million patient records from a Korean government health insurance database, found a ‘U-shaped’ correlation, which means the diabetics at the extreme ends with highest and lowest levels of LDL were at the highest risk of cardiac arrests outside a hospital.

The study, however, cautions doctors that this association between the LDL level and cardiac arrest may be secondary, both caused by an underlying malnutrition, infection, inflammatory disease or cancer. It says that the use of cholesterol-lowering drugs such as statins should not be stopped. People living with high LDL levels over long periods are associated with formation of plaque in the blood vessels, heart attacks and other cardiac diseases.

“The researchers have found a link between low LDL and cardiac arrest, but even they are saying that the link could be because of other reasons. The most important takeaway is that this link isn’t seen in people who are taking statins to lower their LDL level. Those who have been prescribed the medicine should continue to take it,” said Dr VK Bahl, Principal Director of Cardiac Sciences at Max Hospitals and former head of the Cardio-thoracic Centre at the All India Institute of Medical Sciences (AIIMS), Delhi. He explained that not taking statins when needed can actually increase the risk of heart attacks, which is one of the major causes of cardiac arrests.

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So who should have statins? He said statins are prescribed to four groups of people – those who have already had a heart attack, those over the ages of 40 or 50 years with multiple risk factors, those with diabetes and high cholesterol levels, and those with a very high LDL levels of over 190mg/dL. “We have a very high population of diabetics; India is the diabetes capital of the world. And these people must be prescribed and should take the statins,” said Dr Bahl.

By gender, the study from Korea shows that incidence of sudden cardiac arrest was significantly higher in men across all LDL level groups; both followed the “U-shaped” risk pattern but it was diluted among women. Another interesting find  was that the incidence of cardiac arrest was lower among the obese group regardless of their LDL level; whereas, obesity is one of the major risk factors of heart attacks and other cardio-vascular diseases.

The study said that a smaller study had first indicated the existence of this reverse link between LDL levels and sudden cardiac arrest that has been emphasised by the findings in a large sample size of 2.6 million people.

With this inverse relation being more pronounced among the non-obese and those who did not take statins, the researchers have posited four probable explanations.

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One, those with low LDL levels may anyway be in the sub-group that is more susceptible to sudden cardiac arrest such as people with pre-existing conditions like malnutrition, respiratory disease, inflammatory disease or cancers. Two, since the risk of cardiac arrest did not increase with the low LDL levels among the obese, the researchers think that a low LDL level could be a surrogate marker for malnutrition. Third, the researchers say that the low LDL level may be affecting the body’s immune system and leading to higher cardiac arrests among those who get infections. Previous studies have shown that cholesterol plays a protective role in bacterial and viral infection. Fourth, the researchers say that there could be an undiscovered genetic susceptibility causing both low LDL-cholesterol and cardiac arrest.

“In this regard, the result of this study should not change the current therapeutic measurements, including statin use and other potent lipid-lowering strategies. However, clinicians should be aware about the increased risk of sudden cardiac arrest in the low LDL cholesterol group. They should reconsider whether low LDL is a surrogate marker of other systemic illness, such as malnutrition or inflammatory disease,” the study says about the clinical implications of the findings.

Anonna Dutt is a Principal Correspondent who writes primarily on health at the Indian Express. She reports on myriad topics ranging from the growing burden of non-communicable diseases such as diabetes and hypertension to the problems with pervasive infectious conditions. She reported on the government’s management of the Covid-19 pandemic and closely followed the vaccination programme. Her stories have resulted in the city government investing in high-end tests for the poor and acknowledging errors in their official reports. Dutt also takes a keen interest in the country’s space programme and has written on key missions like Chandrayaan 2 and 3, Aditya L1, and Gaganyaan. She was among the first batch of eleven media fellows with RBM Partnership to End Malaria. She was also selected to participate in the short-term programme on early childhood reporting at Columbia University’s Dart Centre. Dutt has a Bachelor’s Degree from the Symbiosis Institute of Media and Communication, Pune and a PG Diploma from the Asian College of Journalism, Chennai. She started her reporting career with the Hindustan Times. When not at work, she tries to appease the Duolingo owl with her French skills and sometimes takes to the dance floor. ... Read More

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