Why I decided to lower my LDL below 55 mg/dL.

LDL causes atherosclerotic cardiovascular disease, and the effect is cumulative. People genetically exposed to lower LDL throughout life have an 88% lower cardiovascular risk. [1,2]

Coronary imaging studies show that an LDL lower than 55 mg/dL prevents plaque progression and can even lead to regression for most people. Cardiovascular outcomes continue to improve well below 55, without an identified threshold where benefit disappears. [3,4]

PCSK9 inhibitors have been studied in large randomized trials at very low achieved LDL levels without an increase in major safety events. Human genetics also provides long-term evidence that very low LDL from reduced PCSK9 activity provides protection without negative effects. [4,5] I know that statins are commonly used before PCSK9 inhibitors. However, I do not want to risk muscle side effects, and I do not want to take pills every day.

Guidelines set a reactive line: when cardiovascular risk or disease burden is high enough that treatment should be recommended based on short-term risk and on a population level.

An LDL below 55 is my proactive line: where I am choosing to minimize plaque progression and my lifetime risk of heart attack and stroke. I do not want my plaque to continue to build until it is too late.

I understand that guidelines may not suggest treatment at my current level of LDL or 10-year risk. I am taking a lifetime perspective and do not want to start treatment when it is too late.

I have weighed that fact against the cumulative risk of lifelong LDL exposure and the strong safety profile of PCSK9 inhibitors. I would rather lower my LDL now than wait until it is too late and disease has already formed.

I want you alongside me to make sure I do this safely.