2023-09-19 02:58:56
The American Heart Association (AHA) issued a statement urging people to participate in efforts to lower low-density cholesterol (LDL-C) levels.
Although it is common knowledge in the medical community that the lower LDL-C is, the better, this is a rebuttal to the fact that aggressive cholesterol lowering led to negative research results in some studies.
On the 14th, the AHA issued a scientific statement regarding the impact of active LDL-C lowering on the risk of dementia and hemorrhagic stroke (doi.org/10.1161/ATV.0000000000000164).
The brain is the organ richest in cholesterol in the body. Some studies have made waves by showing that aggressive lowering of LDL-C induces abnormal structural and functional changes, including cognitive function and dementia.
In particular, as it is known that the cumulative total amount of LDL-C over a lifetime has a close impact on prognosis, there are voices calling for active efforts to lower LDL-C even in healthy people. In light of the conflicting views on LDL-C, This is a situation that needs to be sorted out.
The American Heart Association issued a scientific statement refuting the findings of some studies suggesting that active LDL-C reduction causes cognitive dysfunction.
The AHA determined whether aggressive LDL-C reduction efforts were realistic by evaluating the evidence for the conclusion that they lead to toxic effects on the brain, causing cognitive impairment, dementia, or hemorrhagic stroke.
AHA researchers examined the evidence by reviewing the literature, consulting published clinical and epidemiological studies, clinical and public health guidelines, and expert opinion.
“Some retrospective, case-control, and prospective longitudinal studies suggest that lowering LDL-C with statins is associated with cognitive impairment or dementia,” the AHA said. “However, data from a variety of observational studies and randomized trials do not “It does not support this conclusion,” he said.
A trend across several studies, including trials with a mean follow-up of up to 6 years, has shown no evidence that statins are associated with causing dementia.
He continued, “In patients without a history of cerebrovascular disease, the increased risk of hemorrhagic stroke associated with statin treatment is not significant,” and emphasized, “The risk does not increase even if LDL-C levels are very low.”
The AHA’s position is that data on the increased risk of hemorrhagic stroke through lipid-lowering treatment in patients with a history of hemorrhagic stroke are uncertain and that additional intensive research is needed.
The AHA explained that it found no evidence that ezetimibe, which is added as a combination therapy to PCSK9 inhibitors and statins, which are effective drugs for lowering LDL-C, also increases the risk of bleeding.
“There is no indication that hemorrhagic stroke is increased in patients or groups with low lifetime LDL-C levels,” the AHA said, adding, “There is little evidence of an increased risk even at very low LDL-C levels.”
“What is clear is that lower LDL-C levels are associated with a lower overall risk of stroke and stroke relapse, and are primarily associated with a reduction in ischemic stroke,” the AHA said. “Degradation treatment should not be hindered,” he added.
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