Are Very Low LDL Cholesterol Levels Safe?

The proprotein convertase subtilisin-kexin type 9 (PCSK-9) inhibitors (evolocumab [Repatha] and alirocumab [Praluent]) are potent lipid-lowering agents that can result in very low levels of LDL cholesterol. But can LDL cholesterol be driven so low that adverse events ensue? In two meta-analyses, researchers explore this possibility.

In an industry-sponsored analysis, data from 14 trials in which alirocumab was added to background lipid-lowering therapy were pooled. Treatment duration ranged from 8 to 104 weeks. Among 3340 alirocumab patients, 25% had two consecutive LDL cholesterol measurements <25 mg/dL, and 9% achieved levels of <15 mg/dL. Rates of any reported adverse event were similar in patients with LDL cholesterol levels <15 mg/dL, <…