I’ll bet two days don’t go by before I face a new patient whose chief health concern is their cholesterol level.
One day, a healthy, vibrant 74-year-old woman came to see me. She was really distraught. Why? Because her LDL cholesterol was so much higher than the drug companies think it ought to be.
She did not want to take a cholesterol drug. But her doctor had told her that if she didn’t, she was placing herself in a very risky situation.
I didn’t understand his thinking. With so many more important issues such as metabolism, fitness, toxicity, and hormone levels (to name a few), why is it that people seem to be so obsessed with something like cholesterol levels?
Why do we even refer to some cholesterol fractions as “good” and some as “bad”? Did God have a mental lapse all those years ago and simply forget to take out the “bad” cholesterol?
For the past 20 years, there has been perhaps the world’s greatest marketing campaign ever to convince us that cholesterol levels are important. And no wonder. Big Pharma is making in excess of $20 billion each year to lower cholesterol.
How ironic. Because at the same time that many people are so convinced that high cholesterol levels are risky, there is an abundance of information that says just the opposite.
These studies conclude that it’s more dangerous to have a low cholesterol level than a high one. And that’s not even considering the perils of the drugs used to lower cholesterol.
Cholesterol Causing Heart Problems
Case in point – a study came out a few years ago adding a new risk to the list of why it’s dangerous to have a cholesterol level that’s too low. In this case, the danger is atrial fibrillation, which is an irregular heart disorder.
Researchers from the University of Minnesota recruited 15,792 men and women between the ages of 45 and 64. They studied the group over an average span of 18 years between 1987 and 2007. They measured everyone’s cholesterol levels initially, and three more times during the course of the study.
During the 18 years 1,433 new cases of atrial fibrillation occurred. Then they looked to see if there was any statistical association between who developed atrial fibrillation and what their cholesterol levels were.
I don’t know for sure, but I’m betting that they were expecting to see that the higher the cholesterol levels were, the more cases of atrial fibrillation developed. And if my assumption is right, the researchers certainly had a big shock when they looked at the data.
Compared with those who had an LDL cholesterol level below 100 mg/dL, the people who had an LDL level greater than 160 mg/dL had 15% fewer cases of atrial fibrillation.
Now keep in mind that according to Big Pharma, having a level of the “bad” LDL cholesterol below 100 is good for you. And if you go to the average doctor with a level of LDL over 160, they are going to get this very worried look on their face. Then they’ll tell you that you have a serious risk of dying unless you get that level below 100. But there’s more to the story.
Leaving the LDL cholesterol aside, when the researchers looked at the men and women with a total cholesterol reading over 240 mg/dL, they found that this group had a whopping 22% fewer cases of atrial fibrillation than those with cholesterol levels less than 200. That’s right, I said fewer. So let me see if I get this straight.
In terms of developing the most common heart arrhythmia, it’s much better to have LDL cholesterol over 160 and total cholesterol over 240 than to have LDL less than 100 or total cholesterol less than 200.
Wow! Who would have guessed? By the way, atrial fibrillation is no trivial matter. It can lead to weakness, dizziness, and intolerance to even mild exertion. It confers an increased risk of developing a stroke, and it also can lead to congestive heart failure. And people with it are subject to one or more medications for the rest of their lives. But the data gets even more interesting. There is an age-related effect of low cholesterol levels.
Age Does Matter
Atrial fibrillation is a disorder that primarily happens to those over the age of 60. And it turns out that the study showed that those in this age bracket had an even greater association between low cholesterol and atrial fibrillation than the younger crew.
In this age bracket there was an additional increase in risk of between 10-11%. So for those over 60, the chance of developing atrial fibrillation was a full 32% greater for those with cholesterol levels less than 240, and 25% greater for those with LDL levels less than 100. I think those numbers are astounding. So here’s the question. If cholesterol is so bad for the heart, why is it so protective against developing atrial fibrillation?
The answer to that question eluded the senior author of the study, Alonso Alvaro, MD, PhD. He was at a loss to explain the results. He said it was especially confusing considering the reduced risks from higher cholesterol levels were present regardless of lifestyle factors, clinical factors, and history of cardiovascular disease.
The best that the researchers could come up with is that this protective effect of LDL cholesterol is not a completely new discovery. According to one of the authors, Faye L. Lopez, MS, MPH, similar results were “previously seen in an analysis of the Cardiovascular Health Study, which included individuals ages 65 and older.” Again, it’s the age effect.
But, actually, we shouldn’t be too surprised that higher cholesterol levels are protective. You won’t hear the talking heads bring it up. Nor will you see it in drug company ads. Nor will the average doctor mention it. But more than a few studies published over the past 20 years have already documented the protective effect of cholesterol in a number of disorders.
One, published in 2005, summarizes many of these previous studies.
Researcher Harumi Okuyama, out of the Graduate School of Pharmaceutical Sciences in Nagoya City University, Japan wrote a paper entitled, “The need to change the direction of cholesterol-related medication – a problem of great urgency.” Okuyama, whose study was not funded by a pharmaceutical company selling statin drugs, sites no less than 59 references to reach his conclusions.
In his review of the high vs. low cholesterol debate, he uses science to refute the false assertions promoted by Big Pharma marketing. He states unequivocally that, “High total cholesterol is not positively associated with high coronary heart disease mortality rates among general populations more than 40-50 years of age.”
He goes on to explain that the science shows that there is a distinct difference between the importance of high cholesterol levels in people younger than 40-50 and those with the same high levels who are older.
In younger men and women, there is indeed a small increase in risk. But in those over 45 there is no increased risk. According to Okuyama’s findings, there is little benefit in lowering cholesterol levels below 260 mg/dL in people older than 60.
He concludes by stating that, “Based on the data reviewed here, it is urgent to change the direction of current cholesterol-related medication for the prevention of coronary heart disease, cancer, and all-cause mortality.” This is quite different from what we are told in those 60-second anti-cholesterol TV ads.
And, in fact, the overall data supports what the atrial fibrillation study showed – there is actually an even higher risk from having cholesterol too low as we get older. Okuyama points out that the studies collectively show that higher cholesterol levels in the over-50 group are associated with decreased cancer incidence overall, and decreased death rates in general. And he’s not alone.
A 2005 report out of the Columbia University College of Physicians and Surgeons in New York also looked at this issue. Their results were shocking when you consider how common it is for doctors to prescribe cholesterol-lowering therapies to their older patients.
They looked at 2,277 men and women between the ages of 65 and 98. They found that the people with the lowest cholesterol and LDL levels (lowest quartile) were twice as likely to die within three years compared to those with the highest levels. These results were the same regardless of body weight, diabetes, heart disease, hypertension, stroke, cancer, and even smoking.
Apparently, for this age group, it’s safer to have high cholesterol and smoke than it is to have low cholesterol and not smoke. Amazing!
Another study out of the University of Hawaii School of Medicine further underscores the risks of low cholesterol levels. These researchers measured cholesterol concentrations over a 20-year period in 3,572 Japanese/American men aged 51-73 years. The men with the lower cholesterol levels had a 28% greater death rate from all causes than those with the higher levels. I love what the authors said. “We have been unable to explain our results.”
They must have been in shock because as everybody knows, cholesterol is bad for you. Remember the story “The Emperor’s new clothes?” Well, maybe they can’t explain the results, but I can.
Why You Need Cholesterol as You Age
Your body needs cholesterol, especially your brain and nervous system. They are roughly 25% cholesterol. Cholesterol is the most abundant steroid in the body by far. Obviously not having enough of something that important is not going to be conducive to health or longevity.
The authors of the Hawaii study, even though they don’t understand how it can happen, agree. They stated in their conclusion that, “These data cast doubt on the scientific justification for lowering cholesterol to very low concentrations in elderly people.”
But surely the lower your cholesterol and LDL levels are, the less likely you are to die from a heart attack, right? Well, it is true for people who already have coronary heart disease that there is a modest reduction in the death rate when you lower their cholesterol and LDL levels. But for people who don’t already have coronary heart disease, there is no benefit at all.
An article in the prestigious Archives of Internal Medicine demonstrated something that I shared with you a few years ago. It described the results of the JUPITER study. The JUPITER study looked at the effect of using statin drugs to lower cholesterol levels in people who had high cholesterol, but who had never had a heart attack. The results showed that there were absolutely no differences in heart disease rates between the people taking the statins and the lucky ones who received the placebo.
So if you’re over the age of 50, unless you already have a history of coronary artery disease, the only thing about cholesterol levels you should be concerned about is whether or not they are too low. The healthiest levels are those between 180 and 240, and the healthiest LDL between 130 and 160. You not only don’t need to treat these levels with anything natural or otherwise, you shouldn’t treat them. Relax. Ignore the TV ads, and enjoy the rest of the program.
de Lorgeril, M., P. Salen, J. Abramson, S. Dodin, et al. “Cholesterol lowering, cardiovascular diseases, and the rosuvastatin-JUPITER controversy: a critical reappraisal.” Arch Intern Med. 2010 June 28;170(12):1032-6.
Kaiser, Chris. “Higher LDL Level Linked to Lower Incidence of Afib,” Cardiology Editor, MedPage Today. Published: January 12, 2012.
Lopez, F.L., S.K. Agarwal, R.F. Maclehose, et al. “Blood lipid levels, lipid lowering medications, and the incidence of atrial fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study,” Circ Arrhythm Electrophysiol. 2012 January 6. [Epub ahead of print]
Okuyama, H. “Need to change the direction of cholesterol-related medication — a problem of great urgency.” Yakugaku Zasshi. 2005 November;125(11):833-52.
Schatz, I.J., K. Masaki, K. Yano. et al. “Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study.” The Lancet. 2001 August 4;358(9279):351-5.
Schupf, N., R. Costa, J. Luchsinger, et al. “Relationship between plasma lipids and all-cause mortality in nondemented elderly.” J Am Geriatr Soc. 2005 February;53(2):219-26.