Non-HDL cholesterol - how low to go?

In your cholesterol article you write: For individuals who are generally healthy, a non-HDL cholesterol less than 130 mg/dL is a reasonable goal. There is further benefit at even lower levels, and there is no blood level that is “too low”.

Would it be advisable to get non-HDL as low as possible (assuming no side effects from drugs)?

My Lp(a) is very high. Statins and ezetimibe have reduced non-HDL cholesterol to 70 and LDL to 58. I’m generally healthy, including diet and exercise. Would it be worth increasing the statin dosage to see if levels will go lower?

We can’t provide medical advice here, e.g. you should or shouldn’t increase a medication for a particular outcome and we do offer consultations to discuss matters like this.

In any case, a non-HDL cholesterol of 70 while on two medications is low and within the target range.

Ignoring my specific case, the BBM cholesterol article includes “There is further benefit at even lower levels”, so I’m wondering if there is a point of diminishing or zero returns from lowering non-HDL cholesterol, even if it is within the target range.

Thank you.

There has not been an identified threshold below which there are 0 additional returns. In other words: yes, there is additional risk reduction from lower levels, since this results in a lower cumulative lifelong exposure to these lipoproteins. For example: https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.122.063399

The absolute risk reduction for you from a primary prevention standpoint from taking these levels from 70 to 40, for example, is likely to be quite small, but whether that’s “worth it” (in terms of medication burden/tolerance, etc.) is ultimately up to you.

I’ve since found “Is the clinical benefit of low-density lipoprotein cholesterol (LDL-C) lowering preserved in patient populations starting with LDL-C levels averaging 1.8 mmol/L (70 mg/dL) or less, and is LDL-C lowering safe in such patients? In this meta-analysis, for statins and nonstatins, the risk of major vascular events was significantly reduced by 21% for each 1-mmol/L (38.7-mg/dL) reduction in LDL-C …No adverse safety signal was detected for LDL-C lowering.” Efficacy and Safety of Further Lowering of LDL Cholesterol in Patients Starting With Very Low Levels While 21% sounds good, that’s a relative risk reduction.

If there are noticeable tolerance issues, it doesn’t sound worthwhile.

I wonder about “Low cholesterol was related to high mortality even after excluding deaths due to liver disease from the analysis. High cholesterol was not a risk factor for mortality” which seems inconsistent with other research Low Cholesterol is Associated With Mortality From Stroke, Heart Disease, and Cancer: The Jichi Medical School Cohort Study - PMC What do you think?

Right. This is a trade-off that will ultimately be up to you.

We have discussed this in some detail:

See: Cholesterol Myths & Misconceptions , starting with section 3

Here is another good summary: https://www.youtube.com/watch?v=a3lHHnOHyr8

Finally, our friends at Sigma have addressed it as well: Low Cholesterol & Increased Mortality Risk?: Clarifying the Confusion | Sigma Nutrition