Low plasma levels of LDL cholesterols tied to increased COPD exacerbation and mortality

According to a study from ERJ Open Research entitled "Low-density lipoprotein cholesterol and risk of COPD: Copenhagen General Population Study", researchers have concluded that Low plasma levels of LDL cholesterol increase the risks of severe COPD exacerbation and mortality in the Danish general population.

The researchers have mentioned that individuals with severe COPD phenotypes have lower plasma LDL cholesterol levels due to wasting.

Previous research has shown that low-density lipoprotein (LDL) cholesterol-lowering statins increase lung function and possibly decrease the rate of COPD. The relationship between high levels of LDL cholesterol and susceptibility needs further clarification.

It is an essential consideration for doctors treating COPD because atherosclerotic cardiovascular disease is a major cause of morbidity and mortality in COPD patients.

Researchers in the present study tested the hypothesis that “High LDL cholesterol is related to increased risk, exacerbation and mortality of COPD and examined 107 301 adults.”

The study results include the following:

• Low plasma LDL cholesterol levels were tied to increased COPD risk having an odds ratio for 1st versus 4th quartile of 1.07.
• Low plasma LDL cholesterol levels were related to increased risk of COPD exacerbations with hazard ratios of 1.43, 1.21 and 1.01 for 1st versus 4th quartile, 2nd versus 4th quartile, and 3rd versus 4th quartile of LDL cholesterol, respectively.
• There was an increased rate of COPD-specific mortality with low LDL cholesterol.

The study result has highly pointed out how hypercholesterolaemia influences the prognosis of COPD. Higher LDL cholesterol levels have a less severe phenotype of COPD compared to the low plasma levels.

The study’s strength includes a large sample size, high statistical power, source of information from complete national Danish health registries, and no loss to follow-up.

The study’s limitations include the Caucasian population primarily, causality cannot be addressed, and unavailability of postbronchodilator spirometry.

Concluding further, Low plasma levels of LDL cholesterol increase the risk of severe COPD exacerbation and mortality (COPD specific) in the Danish general population.

Further reading:

Freyberg J, Landt EM, Afzal S, Nordestgaard BG, Dahl M. Low-density lipoprotein cholesterol and risk of COPD: Copenhagen General Population Study. ERJ Open Res. 2023 Mar 6;9(2):00496-2022. doi: 10.1183/23120541.00496-2022.