Should we lower cholesterol as much as possible?

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New US recommendations for lowering cholesterol levels would increase the risk of harmful side effects with no overall reduction in deaths, warn experts in this week’s BMJ.

The American National Cholesterol Education Program has said that people at high risk of heart disease should be treated more aggressively.

By aggressively, it means that LDL-cholesterol concentrations should be lowered to less than 1.81 millimoles per litre of blood (mmol/l) in high-risk individuals. Current guidelines generally recommend 2.56 mmol/l as a healthy reading.

To achieve this new goal, most of the Western world’s adult population would be on Statins, and doses would have to be more than eight times higher than currently used, say the authors. This would increase both the number and seriousness of side effects.

But clinical trials suggest that higher doses of Statins do not lower overall mortality and side effects are generally under-reported.

The authors conclude that any reduction in non-fatal events may be outweighed by more numerous and more severe adverse effects.

British Medical Journal

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