What if my LDL is very low?

SUMMARY AND COMMENT | LIPID MANAGEMENT February 23, 2017 Are Very Low LDL Cholesterol Levels Safe? Kirsten E. Fleischmann, MD, MPH Reviewing  Everett BM., J Am Coll Cardiol 2017 Feb 7; 69:483 Cataracts and adverse neurocognitive events might be more common with very low LDL cholesterol levels.

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 0.8="" 9="" achieved="" adverse="" alirocumab="" analyses="" analysis="" and="" any="" as="" at="" baseline="" but="" cataract="" cataracts="" cholesterol="" complications="" control="" diabetes="" different="" dl.="" dl="" effects="" event="" events="" for="" groups.="" higher="" in="" incidence="" incident="" its="" ldl="" levels="" low="" mg="" neurocognitive="" neurological="" not="" of="" or="" overall="" p="" patients="" presented.="" propensity-adjusted="" propensity="" rates="" reported="" significantly="" similar="" specific="" such="" than="" the="" those="" very="" vs.="" was="" were="" with="" without=""> A second meta-analysis, which was limited to studies with at least 6 months of follow-up, also showed no significant difference in serious adverse events; however, subgroup analysis of the larger outcome studies suggested excess incidence of neurocognitive adverse events in the very low cholesterol group (odds ratio, 2.85), although the overall incidence was low (<1 p=""> Comment In the first analysis, very low LDL cholesterol levels weren't associated with excess adverse events, except for a higher incidence of cataracts. (This finding has biological plausibility — an editorialist reminds us that the lens of the eye synthesizes cholesterol for structure and clarity.) The second analysis suggests excess neurocognitive adverse events in subgroup analysis only, but a low incidence overall, and authors note that the type and severity of these adverse events are unknown. Although these results are generally reassuring, longer-term monitoring and structured assessment of neurocognitive adverse events will be needed before the safety of very low LDL cholesterol levels with PCSK-9 inhibitors can be assessed fully.

Understanding Your BMI

You hear a lot about BMI. Health professionals often refer to you BMI as good, not so good, something you need to work on. News sources who usually know less about BMI than you will know when you finish this short article, often warn us about the consequences of our BMI being too high. Just what is BMI? What does BMI stand for and what does it tell me that I should know? 

BMI stands for Body Mass Index. BMI is a statistical measure developed by a Belgian astronomer and sociologist named Adoplhe Quetelet who referred to it as "social physics" and not body mass index. The term body mass index was not used until after it was referred to as such in an article by Ancel Keys in the seventies. 

Being a statistical measure, your BMI measurement actually tells little more than how you compare to an average of others. It is, nonetheless, a generally accurate indicator of your fat to lean mass ratio (your percentage of body fat) and thus an indicator of your general health risks. That said, depending on a persons body your lifestyle, your BMI can be completely misleading. Mr. Universe, for example, according to BMI charts, is obese. Ummmmmm, maybe not.

If you enjoy mathematical calculations, you can calculate your BMI using the formula W(lbs) divided by H(in.) squared times 703. Or you can simply search online for a BMI chart. 

Avoid the I have been overweight for years and I feel fine mindset. The health consequences of excess body fat are accumulative and often not realized until you 40s, 50s and beyond. Type II diabetes and heart disease, the two most consequences of failing to address a high BMI, are also two diseases most preventable by addressing your BMI through diet and exercise.  If you are not athletic and your BMI indicates that you are in the overweight/obese range, you are at a higher health risk and you should seek the counsel of a fitness specialist.