ArticleJournal of advanced research2024
J-shaped association between LDL cholesterol and cardiovascular events: A longitudinal primary prevention cohort of over 2.4 million people nationwide.
Article in Journal of advanced research, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 19 citations in OpenAlex.
- Indirect comparison of the efficacy and safety of alirocumab and evolocumab on major cardiovascular events: a systematic review and network meta-analysis.Frontiers in pharmacology · 2025Pooled it
- Insulin resistance assessed by estimated glucose disposal rate and risk of coronary artery calcification in middle-aged participants without diabetes undergoing health check-ups.Frontiers in endocrinology · 2026Article
- Residual coronary atherosclerotic risk and low LDL-cholesterol in chronic coronary syndromes.European heart journal. Imaging methods and practice · 2026Article
- Low-density lipoprotein cholesterol and clinical outcomes in patients with liver cirrhosis: a nationwide cohort study.Annals of medicine · 2025Article
- Remnant cholesterol, low-density lipoprotein cholesterol and atherosclerotic cardiovascular disease in metabolic dysfunction-associated steatotic liver disease: a cohort study.Lipids in health and disease · 2025Article
- Unravelling the association of glycosylated haemoglobin A1c, blood pressure, and LDL-cholesterol (ABC) with all-cause mortality in Type 2 diabetes patients: insights from a middle-income country.Journal of diabetes and metabolic disorders · 2025Article
- Article
- Association of atherogenic index of plasma trajectory with the incidence of cardiovascular disease over a 12-year follow-up: findings from the ELSA cohort study.Cardiovascular diabetology · 2025Article
- A genome-wide association study of high-sensitivity C-reactive protein in a large Korean population highlights its genetic relationship with cholesterol metabolism.Scientific reports · 2025Article
- Real-world data lipid profiles in one million colombian adults: The LiPAC million person study.Atherosclerosis plus · 2024Article
- Inflammatory Trajectory of Type 2 Diabetes: Novel Opportunities for Early and Late Treatment.Cells · 2024Review
- Curcumin-Based Fixed Dose Combination Products for Cholesterol Management: A Narrative Review.ACS pharmacology & translational science · 2024Review
Corrections and comments
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionLow-density lipoprotein (LDL) cholesterol-lowering treatment is beneficial for the secondary or primary prevention of high-risk atherosclerotic cardiovascular disease (ASCVD). However, the prognostic implications of low LDL cholesterol levels in patients without previous ASCVD and without statin use remain elusive.
methodsFrom a nationwide cohort, 2,432,471 participants without previous ASCVD or statin use were included. For myocardial infarction (MI) and ischemic stroke (IS), participants were followed-up from 2009 to 2018. They were stratified according to 10-year ASCVD risk (<5 %, 5 %-<7.5 %, 7.5 %-<20 %, and ≥20 %) and LDL cholesterol level (<70, 70-99, 100-129, 130-159, 160-189, and ≥190 mg/dL).
resultsThe relationship between LDL cholesterol levels and ASCVD events exhibited a J-shaped curve for both MI and IS. After classification according to the ASCVD risk, this J-shaped relationship was consistently observed for the composite of MI and IS. Participants with an LDL cholesterol level <70 mg/dL showed a higher MI risk than those with a level of 70-99 mg/dL or 100-129 mg/dL in the low-ASCVD risk group. The J-shaped curve between LDL cholesterol levels and MI risk was attenuated across ASCVD risk groups. For IS, participants with an LDL cholesterol level <70 mg/dL demonstrated increased risks compared with those with a level of 70-99 mg/dL, 100-129 mg/dL, or 130-159 mg/dL in the borderline, intermediate, and high ASCVD risk groups, respectively. In contrast, a linear association was observed in participants taking statins. Interestingly, a J-shaped association was observed between LDL cholesterol and high-sensitivity C-reactive protein (hs-CRP) levels; the mean hs-CRP level and the proportion of individuals with increased hs-CRP levels were relatively high among individuals with an LDL cholesterol level <70 mg/dL.
conclusionsAlthough high LDL cholesterol levels increase the risk of ASCVD, low LDL cholesterol levels do not warrant safety from ASCVD. Therefore, individuals with low LDL cholesterol levels should be carefully monitored.
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