The traditional view regarding cholesterol and its impact on health and longevity is the perception of an associated increase in risk, with recommendations to reduce such risk by reducing blood cholesterol levels with a cholesterol lowering agent. (a statin drug).
Contrary to this widespread and popular perception, is the finding from many clinical studies, that higher cholesterol levels predict longevity, rather than mortality, especially in elderly persons.
In other words, older people are more likely to live longer if their blood levels of cholesterol are higher rather than lower !
THE PROTECTIVE ROLE OF CHOLESTEROL:
One important finding is that high cholesterol protects against infections which are often the cause of death in the elderly. Infections of the respiratory and/or gastro-intestinal tract are often associated with a poor outcome for hospital admitted patients.
One study showed that total cholesterol levels below 5.5 mMol/L in +80 year old people shortened their lives significantly, (Age & Ageing 2010;39 (6):674-682) while another study, looking at over 30,000 patients in 81 acute care units, found that hospitalised people over the age of 65 years recovered faster if their cholesterol levels were high.
(J Gerontol A Biol Sc Med 2006; 61: 736-742).
Two separate studies published in the Lancet in 1997 showed that for every INCREASE in total cholesterol by 1 mMol/L there was a corresponding DECREASE of 15% in mortality. (Lancet 1997; 350:1119-23) ( Lancet 1997;350:1178-9).
THE IMPORTANCE OF CHOLESTEROL FOR SURVIVAL:
Cholesterol is vital for human health and survival, and plays an essential role in normalising brain function, stabilising cell membranes and protecting against numerous infections, especially as we grow older.
The harmful adverse effects of cholesterol lowering drugs (statins) has largely been under-reported in trial reports, and their interference with many drugs, like atorvaststin (lipitor) and simvastatin , that are metabolised via the same (CYP3A4) pathway, may lead to their accumulation and increased propensity for damage to the muscles and nerves.
Most patients are not given Coenzyme Q10 by their doctors, while taking a prescribed statin, and are thus at great risk of harm to heart muscle (cardiomyopathy) and heart failure.
The risk of dying from congestive heart failure as a result is increased, if your total cholesterol has been lowered in this way, (Am J Cardiology 82, 323-8, 1998) while those with higher cholesterol levels are likely to live longer ! (J Am Coll Cardiol 42, 1933-40, 2003).
A study conducted in the UCLA Dept.of Medicine and Cardiomyopathy Centre in Los Angeles involving 1,134 patients, who had severe heart failure, found that after 5 years 62% of the patients who had lower cholesterol levels had died, whereas there were 50% fewer deaths amongst those who had high cholesterol blood levels. (J Cardiol Failure, 202; 8, 216-224).
Further studies by Rauchaus et al confirmed the survival advantage of high cholesterol in patients with chronic heart failure, with a 25% survival rate for each 1 mMol/L of increase in total cholesterol, irrespective of age, left ventricular function, exercise capacity, or any other cause of the heart failure.
While the question must be raised as to whether low cholesterol is the CAUSE of heart failure, or the CONSEQUENCE of heart failure, there are several studies which show that low cholesterol is a PREDICTOR OF HEART FAILURE, independent of cachexia, body mass index or other variables associated with the malnourished state. ( J Am Coll Cardiol 2003; 42: 1933-40, Rauchaus et al ).
Further investigation into the mechanisms which underlie these observations are warranted.
NO BENEFIT FOR STATINS IN PRIMARY CARE:
In a meta-analysis of 65,229 high risk patients of all ages, without a history of established heart disease, Dr. Kausik Ray et al found no mortality benefits for statins, compared with placebo, and concluded that statin therapy is less beneficial than is generally perceived, and is even of less usefulness in low risk patients. (Arch Intern Med 2010, June 28; 170 (12): 1024-31).
A critical review of the JUPITER STUDY by French researchers, likewise concluded that there is no justification for the use of statins in healthy persons, and that the outcomes for cardiovascular death was the same for Crestor as it was for placebo.
In 22 out of 27 studies with cholesterol lowering treatment, the projected benefit after 5 years might be 1 patient out of 100. In other words, 99 patients out of 100 are not likely to benefit after 5 years, and will be exposed to the potential for irreversible nerve or muscle damage during that period. (BMJ vol.305, 14 Nov, 1992).
Researchers at Yale University reported that elderly people with low cholesterol levels died twice as often from a heart attack than did those with high levels. ( JAMA 272, 1355-40, 1994).
In his review of 11 studies involving the elderly Dr. U. Ravnskov found that high cholesterol did not predict all-cause mortality. (QJM 96, 927-934, 2003), and Dr. David Jacob, in a review of 19 large studies, in which the cause of 68,000 deaths was assessed, found that low cholesterol predicted an increased risk of dying from gastrointestinal and respiratory diseases. (Circ. 86,1046-60, 1992).
At the other end of the generation scale children with the Smith-Lemli-Opitz Syndrome have very low cholesterol levels, and as a result are either still – born, or have serious brain malformations causing early death. When these children are treated with high doses of pure cholesterol and eggs their cholesterol levels increase and also their chances of survival.
Critical care literature provides strong evidence for a survival advantage associated with high cholesterol levels in critically ill people (Crit Care Med 1994; 22:1437-1439), heart failure patients ( J.Card Failure 2002; 8:216-224), and the elderly. (Lancet 2001; 358: 351-355).
The conventional view that high cholesterol levels are associated with increased risk of dying is not based on solid scientific evidence and represents a paradigm that is in urgent need of review.
Dr. Neville S. Wilson.