The great cholesterol con?

For something that hardly anyone had heard of 20 years ago, cholesterol has become something of a phenomenon. We are encouraged to keep a lid on our cholesterol levels  the recommended amount of which in the blood seems to be in perpetual decline. And this is there is quite a lot of political pressure put on individuals to bring their cholesterol levels into line. This week, for instance, saw the publication of a report which highlighted the fact that only 47 percent of women with a history of heart problems had their cholesterol ‘under control’, compared to 56 percent of men. Tut tut.

Despite our collective neurosis about cholesterol, there is a considerable body of evidence to suggest that this fat is not the killer it is so often made out to be. While there is indeed some evidence that high cholesterol levels are associated with an increased risk of heart disease and death, a close look at the available evidence shows that this association only seems to be true for individuals up to the age of about 50 or so. After that time, plenty of evidence shows ‘raised’ cholesterol levels in later life are not associated with adverse effects on health [1-15]. Indeed, there is even some evidence that higher cholesterol is actually associated with enhanced longevity and survival [16-19].

Now it’s worth bearing in mind that the vast majority of cases of conditions said to be related to raised cholesterol levels (namely heart attacks and strokes) occur in middle age and beyond. As the science shows that cholesterol is not a risk factor, and indeed may even be beneficial, in people of this age, then this should perhaps cause us to question the current appetite to paint cholesterol as the culprit.

As with saturated fat, if we really want to make a judgment of the true impact cholesterol has on health, we need intervention studies ” studies in which cholesterol levels are lowered and the effect of this assessed. In 2005 a meta-analysis which combined the results of 17 similar studies in which subjects made dietary changes explicitly to reduce blood cholesterol levels was published in the Archives of Internal Medicine [20]. Overall, these studies brought about a 10 per cent lowering of cholesterol levels. Despite this, the amassed results showed no reduced risk of death, neither in healthy individuals, nor even in high-risk individuals who had a history of heart attack or stroke. Basically, taking dietary steps to reduce cholesterol levels simply does not seem to save lives  yet more evidence that cholesterol is not as important a factor in health as it is so often said to be.

Apart from diet, the other major way to quell cholesterol levels is through drug therapy. Currently, the most popular type of medication used for this purpose are known as the ‘statins’ which include atorvastatin (Lipitor), rosuvastatin (Crestor) and simvastatin (Zocor). A huge stash of cash has been made out of these drugs, but is their life-saving reputation deserved?

Statins do seem to have the capacity to save lives, though the benefits of them seem to be largely confined to individuals who already have diagnosed cardiovascular disease (e.g. heart disease or previous stroke). This evidence is often used to support the notion that cholesterol causes heart disease. However, in additional to reducing cholesterol, statin drugs also have other effects in the body that would be expected to reduce the risk of cardiovascular disease. For instance, it is well recognised that statins have anti-inflammatory effects, and current evidence suggests that inflammation is an important underlying process in the development of cardiovascular disease. This has raised the question that statins’ apparent ability to reduce the risk of cardiovascular disease may have nothing at all to do with cholesterol.

I suppose this wouldn’t matter too much if the recommendations to lower cholesterol upper limits were based on good science. However, a review in the Annals of Internal Medicine published in 2006 concluded that there was no high-quality clinical evidence to support current treatment goals for cholesterol. The authors of this review went on to say that the recommended practice of adjusting statin dose to achieve recommended cholesterol levels was not scientifically proven to be beneficial or safe [21].

It is perhaps interesting to note that the most recent recommendations regarding cholesterol levels in the USA came from a panel of nine scientists, eight of whom had financial links with drugs companies making statin drugs. And this clear conflict of interest only emerged after their report had been published.

It seems that the impact of cholesterol on health might have been seriously overstated. For those of you keen to learn more, I heartily recommend to you a The Great Cholesterol Con by British medic Malcolm Kendrick. Read it, and I reckon it’s unlikely that you may find the interest in your cholesterol and any fear you have about this wanes somewhat.

References:

1. Scientific steering committee on behalf of the Simon Broome Register group. Risk of fatal coronary heart disease in familial hypercholesterolaemia. British Medical Journal,1991; 303: 893-896

2. Forette F, et al. The prognostic significance of isolated systolic hypertension in the elderly. Results of a ten year longitudinal survey. Clinical and Experimental Hypertension. Part A, Theory and Practice, 1982; 4: 1177-1191

3. Siegel D, et al. Predictors of cardiovascular events and mortality in the Systolic Hypertension in the Elderly Program pilot project. American Journal of Epidemiology 1987; 126: 385-389

4. Nissinen A, et al. Risk factors for cardiovascular disease among 55 to 74 year-old Finnish men: a 10-year follow-up. Annals of Medicine, 1989; 21: 239-240

5. Krumholz HM, et al. Lack of association between cholesterol and coronary heart disease mortality and morbidity and all-cause mortality in persons older than 70 years. Journal of the American Medical Association, 1994; 272: 1335-1340

6. Weijenberg MP, et al. Serum total cholesterol and systolic blood pressure as risk factors for mortality from ischemic heart disease among elderly men and women. Journal of Clinical Epidemiology, 1994; 47: 197-205

7. Simons LA, et al. Diabetes, mortality and coronary heart disease in the prospective Dubbo study of Australian elderly. Australian and New Zealand Journal of Medicine, 1996; 26:66-74

8. Weijenberg MP, et al. Total and high density lipoprotein cholesterol as risk factors for coronary heart disease in elderly men during 5 years of follow-up. The Zutphen Elderly Study. American Journal of Epidemiology, 1996; 143: 151-158

9. Simons LA, et al. Cholesterol and other lipids predict coronary heart disease and ischaemic stroke in the elderly, but only in those below 70 years. Atherosclerosis, 2001; 159: 201-208

10. Abbott RD, et al. Age-related changes in risk factor effects on the incidence of coronary heart disease. Annals of Epidemiology, 2002; 12: 173-181

11. Zimetbaum P, et al. Plasma lipids and lipoproteins and the incidence of cardiovascular disease in the very elderly. The Bronx aging study. Arteriosclerosis Thrombosis and Vascular Biology, 1992; 12: 416-423

12. Fried LP, et al. Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study. Journal of the American Medical Association, 1998; 279: 585-592

13. Chyou PH, et al. Serum cholesterol concentrations and all-cause mortality in older people. Age and Ageing, 2000; 29: 69-74

14. Menotti A, et al. Cardiovascular risk factors and 10-year all-cause mortality in elderly European male populations; the FINE study. European Heart Journal, 2001; 22: 573-579

15. Räihä I, et al. Effect of serum lipids, lipoproteins, and apolipoproteins on vascular and nonvascular mortality in the elderly. Arteriosclerosis Thrombosis and Vascular Biology, 1997; 17:1224-1232

16. Brescianini S, et al. Low total cholesterol and increased risk of dying: are low levels clinical warning signs in the elderly? Results from the Italian Longitudinal Study on Aging. Journal of the American Geriatrics Society 2003; 51(7):991-996

17. Forette B, et al. Cholesterol as risk factor for mortality in elderly women. Lancet, 1989; 1:868-870

18. Jonsson A, et al. Total cholesterol and mortality after age 80 years. Lancet, 1997;350:1778-1779

19. Weverling-Rijnsburger AW, et al. Total cholesterol and risk of mortality in the oldest old. Lancet, 1997;350:1119-1123

20. Studer M, et al. Effect of different antilipidemic agents and diets on mortality. Archives of Internal Medicine. 2005;165:725-730

21. Hayward RA, et al. Narrative review: lack of evidence for recommended low-density lipoprotein treatment targets: a solvable problem. Ann Int Med 2006;145:520-530

14 Responses to The great cholesterol con?

  1. Tiggy 26 May 2007 at 1:48 am #

    You don’t mention the strong links between use of statins and memory loss, especially with Crestor. I accept my father being on statins because he had a mild stroke recently, but my mother only has vascular problems involving her legs and has never had a heart attack or stroke. Does she need to be on statins when they are causing her major problems in functioning due to memory loss? Both my parents are 80 this year.

    Tiggy.

    • Moy Peralta 26 July 2014 at 10:56 pm #

      Tiggy, I am reading this seven years further down the line & am wondering how both your parents now are.
      If their quality of life has been in any way destroyed by statins, there is now a site – RxISK.org – where adverse events can be logged and reported.

      My interest/concern stems from our own lives being brought into doctor-induced chaos by the prescribing of statins, and my husband’s resultant memory loss – with all that entails.

  2. Neil 26 May 2007 at 11:47 am #

    The cholesterol/heart disease association is even less apparent if you don’t include people with the genetic disorder Familial Hypercholesterolaemia in any analysis of data.

    Statins are a cash cow for the pharmaceutical industry.

  3. ally 26 May 2007 at 3:04 pm #

    the problem with alot of these studies they see things in isolation – surely if your cholesterol is high , you smoke have raised blood pressure etc then cholesterol IS an issue!

  4. ally 27 May 2007 at 8:35 am #

    oh come on neil – no one does anything for nothing and a trawl of the net and you find hundreds of these type of sites – adverts, books etc. Doctors are just the same !Her web site looks to me a showcase for atkins . Funny really that alot of my friends who loved atkins a few years ago are beg to admit it was the most miserable diet they had ever been on! It is another example of the dieting industry making money!

  5. ally 27 May 2007 at 8:43 am #

    oops meant to put that on diabetes thread!

  6. sharpsight 14 June 2007 at 7:26 am #

    As well as “The Great Cholesterol Con” by British medic Malcolm Kendrick (2007), there is also another excellent book on the subject by Australian Anthony Colpo, also called “The Great Cholesterol Con” (2006). While Colpo is not a qualified medic, this is more than compensated for by the inclusion of nearly 1500 references, many of them medical journal articles, studies & research papers.

    And Ally, I’d suggest that if someone smokes they should be worrying about THAT, rather than looking for a red herring to take their mind off taking responsibility for their health by giving up cigarettes. Cholesterol is a repair substance – as has been said elsewhere, you may as well blame ambulance staff for causing road accidents because they are often present at smashes!

  7. Dr John Briffa 14 June 2007 at 2:45 pm #

    I’ve read Anthony Colpo’s book and, I agree sharpsight, it is a very thorough treatment of the area. I do recommend it to anyone wanting to further their knowledge regarding the cholesterol concept.

  8. Razwell 16 September 2007 at 12:06 am #

    “Autopsy and angiography/EBT studies have shown NO CONNECTION between total or LDL cholesterol levels and extent of atherosclerosis”

    - Anthony Colpo

  9. Fleur Brown 3 November 2010 at 9:00 pm #

    Dear Dr Briffa, you say in the Blog above that the science shows that cholesterol is not a risk factor in C.V. disease and may indeed even be beneficial, why have you then written an article in the Daily Mail on 29th October about reducing levels of cholesterol and elevating HDL levels ?

  10. John Briffa 4 November 2010 at 12:18 am #

    Fleur

    you say in the Blog above that the science shows that cholesterol is not a risk factor in C.V. disease

    That’s not what I wrote, Fleur.

    I have not written for the Daily Mail since 2001.

  11. Fleur 5 November 2010 at 12:34 pm #

    Apologies John for misinterpreting this. what the Blog says is “After that time (over age 50 or so), plenty of evidence shows “raised” cholesterol levels in later life are not associated with adverse effects on health. Indeed, there is even some evidence that higher cholesterol is actually associated with enhanced longevity and survival”.

    Re the Daily Mail – I saw an article on their website that you had written about how to lower cholesterol, a couple of days ago. So it looks like it must be from their archives – it is not dated but the date on the link said October 2010. I thus (incorrectly I see) assumed that you had written it recently !

    There seems to be a big debate whether raised cholesterol and LDL are causative factors in c.v. disease and really what I am trying to find out is whether a cholesterol level of 9.8 nmol/L with an LDL of 7.7 nmol/L and HDL of 1.4 nmol/L in a woman aged 58 should be considered a high risk factor in c.v. disease. In January this year I attended a seminar by Dr David Brownstein at the Royal Society of Medicine – he thinks that elevated cholesterol/LDL’s are not the “villians” that we have been told they are…..

    I have ordered the book by Dr Michael Kendrick to help me find out more on the cholesterol debate.
    Fleur

  12. robert 28 February 2011 at 9:21 am #

    The trick to achieving a normal cholesterol range is simply to change one’s lifestyle. You should eat healthy and exercise more.

    Through better nutrition, LDL cholesterol levels can be greatly lowered in no time. Failure to do this will result in a huge risk for coronary heart disease, atherosclerosis, and stroke.
    Reference:
    http://www.hdlcholesterollevels.org/ldl-cholesterol-how-to-reduce-them/

  13. Alice Reid 20 December 2012 at 10:16 pm #

    I believe that we should all get ourselves off of sugar and all the foods that turn to sugar such as foods made with white flour. I believe that these food are raising our cholesterol and causing way too much inflammation in our bodies which is leading to heart attacks and stroke

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