Emerging risks of lipid-lowering therapy and low LDL levels: implications for eye, brain, and new-onset diabetes

Abstract Atherosclerotic cardiovascular disease remains a major global health burden. Current guidelines emphasize aggressive lipid-lowering strategies, particularly those that reduce low-density lipoprotein cholesterol (LDL-C) levels. While effective in lowering cardiovascular risk, excessively low LDL-C may have unintended health consequences. LDL-C plays a critical physiological role in cellular structure and hormone synthesis. Emerging evidence links low LDL-C and high HDL-C with increased glaucoma risk. Statins, which are commonly used to lower LDL-C, may further increase this risk, raising concerns for patients with coronary artery disease. Low LDL-C has also been associated with gestational diabetes and intracranial hemorrhage, while statin therapy may contribute to new-onset diabetes mellitus. These findings highlight the need to reassess the “lower is better” paradigm. A patient-centered, risk-based approach to statin therapy is recommended. Large-scale randomized controlled trials are urgently needed to establish safe lipid thresholds and optimize therapeutic strategies.