The Importance of Mechanisms in the Relationship Between Low Cholesterol and Liver Health By Bertrand Cariou September 10, 2026 Jama Network Open Share Summary Takeaways Insight Report Clinical Scorecard Quiz Poll 1 Inhibiting PCSK9 has become essential for lowering LDL-C and reducing cardiovascular risk through various therapeutic approaches. 2 Carriers of rare PCSK9 loss-of-function variants showed no increased risk of liver-related complications over 15 years of follow-up. 3 Primary familial hypobetalipoproteinemia is associated with a more than 3-fold higher risk of liver complications compared to the control population. 4 The hepatic effects of low LDL-C concentrations depend on the underlying biological mechanism, distinguishing between FHBL forms. 5 Therapeutic strategies must balance LDL-C reduction with maintaining hepatic lipid homeostasis to avoid liver-related risks.