Cholesterol in the bloodstream is carried within protein-rich packages known as ‘lipoproteins’. These come in two main types, so-called ‘low-density lipoprotein-cholesterol’ (LDL-C) and ‘high-density lipoprotein-cholesterol’ (HDL-C). Conventional wisdom has it that LDL-C is responsible for dumping cholesterol on the inside of arteries, and is dubbed ‘bad cholesterol’ as a result. On the other hand, HDL-cholesterol is said to be a sign of cholesterol being cleared from the inside of arteries, as is generally thought of as ‘good cholesterol’.
I was interested to read a recent study in which the associations between LDL- and HDL-C levels and degree of arterial disease were assessed in a group of individuals age 80 and over [1]. Arterial disease was assessed via calcium scoring. This test is believed to provide an accurate measure of the degree of build up of ‘atherosclerotic plaque’ on the inside of the arteries around the heart.
In this study, low levels of HDL-C were associated with higher calcium scores (and therefore the degree of arterial disease). This finding is consistent with conventional wisdom. However, this study also found that there was no association at all found between LDL-C levels and calcium scores in this population. This result does ask questions about the general assumption that higher levels of LDL-C are a ‘bad sign’ in older individuals.
In fact, there is evidence to the contrary. For instance, in a study published earlier this year, higher levels of both total cholesterol and LDL-C were found to be associated with a reduced risk of death in individuals aged 85 followed for 10 years [2].
In another study published last year, researchers assessed the levels of cholesterol and risk of death in almost 120,000 adults living in Denmark [3]. The researchers found that having higher than recommended levels of total cholesterol was associated with a reduced risk of death.
For instance, in men aged 60-70, compared with those of total cholesterol levels of less than 5.0 mmol/l, those with total cholesterol levels of 5.00-5.99 had a 32 per cent reduced risk of death. For those with levels 6.0-7.99 mmol/l, risk of death was 33 per cent lower. Even in individuals with levels with 8.00 mmol/l and above, risk of death was no higher than it was for those with levels less than 5.0 mmol/l.
The results were similar for women too. In women aged 60-70, levels of 5.0-5.99 and 6.0-7.99 were associated with a 43 and 41 per cent reduced risk of death respectively.
In individuals aged 70 and over, the results were similar, except here, levels of total cholesterol of 8.00 mmol/l or more were associated with a reduced risk of death too (in both men and women).
In short, we are misguided if we assumed that higher levels of cholesterol are a sign of increased death risk. In older individuals, there is evidence that the reverse is true.
References:
1. Freitas WM, et al. Low HDL cholesterol but not high LDL cholesterol is independently associated with subclinical coronary atherosclerosis in healthy octogenarians. Aging Clin Exp Res. 2014 Jun 7. [Epub ahead of print]
2. Takata Y, et al. Serum total cholesterol concentration and 10-year mortality in an 85-year-old population. Clin Interv Aging. 2014;9:293-300
3. Association of lipoprotein levels with mortality in subjects aged 50 + without previous diabetes or cardiovascular disease: A population-based register study. Scandinavian Journal of Primary Health Care 2013;31(3):172-180
Sorry to nitpick (enjoy reading your blog very much), the description of cholesterol was imprecise. The cholesterol doesn’t come in two main types, it’s the lipoprotein that comes in two types. The cholesterol contained in all types of lipoproteins is all the same. The substance of your review is very useful, as usual.
Friday nights in Florida are reserved for wine drinking in the neighborhood. It is a pleasant gathering, typically. As the grape flows, one neighbor has two topics that he typically brings up. The first being that wine is good for his heart, and good for his diabetes. He will say that once he began drinking wine years ago his cholesterol lowered nearly by half or something like that. I’ve noticed the numbers reported seem to change from gathering to gathering. He enjoys pointing this out to me in particular. We’ve discussed how I’m not the biggest believer in the cholesterol theory so I believe he enjoys needling me. Then as the night goes on, he typically discusses another neighbor who is from the UK, (who isn’t part of the wine drinking group), going on about how he believes he is the king of England.
I’ll have to print this article out and present it to him next time I’m Florida attending the Friday gathering. I doubt it will substantially chance the talks. I suppose excuses are needed for why wine is drunk. Possibly I might hear from the one neighbor a minor reversal on the health effects of wine. Instead maybe he’ll mention how wine raised his cholesterol levels. Doubtful the talk about royalty residing in the neighborhood will change though.
For over 40 years in my working life, I have seen the criteria for abnormal lipids change every 5-10 years…and it is still changing. I am becoming convinced that lipid levels as we measure them is merely a symptom and the underlying cause is usually undertermined. Not that it can’t be determined, we just aren’t on that wavelength yet. An abnormal lipid profile is the body’s sign that the lipid system is responding to something. What is that something? Like a kid with fever, do you give the kid aspirin to lower the fever and go back to bed? Of course not, you have to find the cause of the fever, UTI? Pneumonia? The same with an abnormal lipid profile. Don’t give a statin to lower it like giving asperin for fever, find out what the hell is causing it. Could be carbs, could be inflammation, or things we haven’t even thought of yet. Oh, well, I am just a skeptical old man.
Not skeptical, you’re absolutely right in your thinking. If only more people would dare to think like you, we would stop interfering with our body’s systems while the primary problem is not in our bodies. Our bodies REACT to problems, for instance long term (mental / emotional) stress, wrong thought patterns that causes us to feel constant frustration / stress, etc. You might like Dr. Caroline Leaf’s books & seminars.
Is there anyway I could get the research papers for these studies emailed to me? I would love to show them to m biochemistry professor.
The best I can do. 2 and 3 provide a full pdf file
1. http://www.ncbi.nlm.nih.gov/pubmed/?term=Freitas+Aging+Clin+Exp+Res.+2014+Jun+7
2. http://www.ncbi.nlm.nih.gov/pubmed/?term=Clin+Interv+Aging.+2014%3B9%3A293-300
3. http://www.ncbi.nlm.nih.gov/pubmed/?term=Scandinavian+Journal+of+Primary+Health+Care+2013%3B31%283%29%3A172-180
“LDL not dangerous” makes a lot of sense especially after reading the books “Wheat Belly” and “Grain Brain”.
Next I am looking forward to see how cholesterol levels associate with Alzheimers! Ethically sound intervention trials are feasible by putting slightly dement and other volunteers on low carb high (natural) fat and use age adjusted population averages or/and dementia progress as control.
Once the variable “glycemic control” is incorporated it would be really interesting as it seems clearer and clearer that high blood sugar is one culprit, if not the major culprit. Research shows that high blood sugar makes ordinary LDL, which has never been proven to cause heart disease, bad by glycating it. I think “glycation” = “sugar coating” . High blood sugar baths three times per day, or after every high carb meal! Then the real culprit could be exposed, if it really is the culprit and big media allows it. Our bigger media has to look after readers, news and advertisers, and that last leg it stands on is also feeding it and therefore has a much better traction than everything else, causing substantial editorial caution when news happens to go opposite to just those big advertisers interest. The ones are of course mainly BIG food and drink, the biggest business there is, today.
At least Dr Briffa and most bloggers can still afford to write without constraints and
I believe it will last!
That glycated LDL sticks anywhere makes good sense to me. But how much of it do we have ? It may be reasonable to think that hemoglobin glycates at same rate as most other functional proteins in the blood stream, given it is a maillard (=caramelization ) reaction, so that standard HbA1c may be a clear indicator of danger around and ahead. And that diabetes-2 with HbA1C levels at 7 and over are heading towards heart disease several times faster than the rest of us is well known, and fits the picture. But that is DB-2 patients that stick to standard food and standard medical treatment. Once on LCHF also their HbA1C drops, and saturated fats or LDL have never been proven to do any harm with sugar controlled for.
Alzheimer’s
Dement Geriatr Cogn Disord 2009;28:75–80
DOI: 10.1159/000231980 Can be downloaded in full.
Midlife Serum Cholesterol and Increased Risk of Alzheimer’s and Vascular Dementia (VD) Three Decades Later
Alina Solomon et al. Can be downloaded in full.
This paper attempts to link high, mid-life cholesterol to Alzheimer’s. Problem is that the treatment details are NOT AVAILABLE. Patient records without treatment details – tell that to the marines! More hidden data to protect Big Pharma perhaps?
In tables 2-4 replace the row titles (cholesterol levels) with the US guideline treatments for those levels. This assumes that the medical insurance company follows official guidelines.
This does not change numbers or statistics but does provide an alternative interpretation given the cholesterol paranoia in the US and the introduction of statins in the late 1980s; 2-3 decades later with the majority of patients (>80%) being tolerant, the alternative interpretation being that the incidence of AD and VD are associated with statin treatment. This is supported by the FDA admission that statins cause polyneuropathy and memory loss.
I’ll be sending this to my 81 year old mother whose doctor just put her on cholesterol lowering medication! It really burns me up. My mom is in very good health. She doesn’t feel good on the on the medication but is afraid to stand up to her doctor. She won’t listen to me but maybe she’ll listen to you.
Cholesterol is necessary for the proper function of the immune system. It might be that higher cholesterol in older people boosts their immune systems and keeps them alive longer.
“Cholesterol is the key factor in this process, as it is present in higher concentrations in a memory cell. This higher concentration of cholesterol leads to the aggregation of receptors, because the cholesterol joins them together like glue.
http://www.sciencedaily.com/releases/2012/12/121221081619.htm
http://high-fat-nutrition.blogspot.com/2008/12/cholesterol-and-innate-immunity.html
Please Doc, I don’t understand lab levels due to the fact I am in USA. Could you post the levels so those of us could understand or a chart could help.
Sincerely,
Lynn RN
Hello Lynn – just Google “convert cholesterol levels from UK to American readings” and you’ll get a chart or a simple formula to use. Same applies to Blood glucose levels.
Alzheimer’s
Dement Geriatr Cogn Disord 2009;28:75–80
DOI: 10.1159/000231980 Can be downloaded in full.
Midlife Serum Cholesterol and Increased Risk of Alzheimer’s and Vascular Dementia (VD) Three Decades Later
Alina Solomon et al. Can be downloaded in full.
This paper attempts to link high, mid-life cholesterol to Alzheimer’s. Problem is that the treatment details are NOT AVAILABLE. Patient records without treatment details – tell that to the marines! More hidden data to protect Big Pharma perhaps?
In tables 2-4 replace the row titles (cholesterol levels) with the US guideline treatments for those levels. This assumes that the medical insurance company follows official guidelines.
This does not change numbers or statistics but does provide an alternative interpretation given the cholesterol paranoia in the US and the introduction of statins in the late 1980s; 2-3 decades later with the majority of patients (>80%) being tolerant, the alternative interpretation being that the incidence of AD and VD are associated with statin treatment. This is supported by the FDA admission that statins cause polyneuropathy and memory loss.
fits in nicely with the dvd, “Cereal Killers”….excellent, no sugar and no wheat
Spot on again and it’s a face book share. Getting there slowly,… can you tackle the so called healthy plate next, I have to try and keep my cool when talking about it to health professionals.
This is all very good news – I’m 67, and since I was first alerted to the possibility of having high cholesterol about 25 years ago (my doctor noticed the ‘cholesterol ring’ round my irises) tests have shown it has fluctuated between 7.5 and 12 (whatevers), and at the latest count was around 10. Since then (when it was first published) we’ve followed the Waist Disposal diet . . . but as I refuse to take statins the doctor won’t sanction another test, on the grounds I wouldn’t act on it anyway. My mother is now 97, very very badly afflicted with Alzheimer’s disease, totally bedridden and dependent. She was a very early follower of Nature Cure, low sugar and wholemeal bread, home-grown vegetables – I’d love to know what her cholesterol levels were, or are, but alas, it’s too late. Of course the whole cholesterol furore blew up way after she would have considered testing – but wouldn’t it have been interesting to know. My father was killed when I was a tiny baby, so no track-back there either. Needless to say, grains are very infrequent visitors in our lives these days, we buy barely a kilo of sugar a year – but spend a fortune on fish and nuts! And feel pretty alert and healthy, I’m sure as a result.
Very interesting. Keep these blogs coming,
Thanks
Ian
Dr Briffa,
In “The Great Cholesterol Myth:…………” by S. Sinatra and Bowden, J, Chap 5, they cite Simopoulos AP, De Meester F (eds): A Balanced Omega-6/ Omega-3 Fatty Acid Ratio, Cholesterol and Coronary Heart Disease. World Rev Nutr Diet. Basel, Karger, 2009, vol 100, pp 1–21 , (DOI:10.1159/000235706) to the effect that, contrary to the cholesterol hypothesis, that those with the highest cholesterol (>240 mg/dL- aka >6.0 mmol/L) lived longest.
The actual sequence in increasing life was:
[<160 mg/dL (< 4.0 mmol/L)] < [160 to 199 mg/dL [ 4.0 – 5.0 mmol/L)] < [200 – 230mg/dL (< 5.0-6.0 mmol/L)] 240 mg/dL ( 6.0 mmol/L)]
In short expectation of live was longest for high cholesterol and shortest for low cholesterol.
No wonder this work in 2009 did not get the publicity it deserved.
Hypothyroidism is one cause of high cholesterol. In fact, before the advent of thyroid blood tests, doctors used to use high cholesterol levels as a diagnostic sign of hypothyroidism. Ray Peat says “By the mid-1930s, it was generally known that hypothyroidism causes the cholesterol level in the blood to increase … Administering a thyroid supplement, blood cholesterol came down to normal exactly as the basal metabolic rate came up to the normal rate.”
There are thought to be many thousands of people with undiagnosed hypothyroidism today; how many of those are getting treated with statins when they should be on thyroid meds instead?
This makes a 100%, absolute sense ! I LOVE it when common sense and proper thinking collaborates with science to make life makes sense !
Malcolm Kendrick’s The Great Cholesterol Con alerted me to this. I have since noticed that the fittest (mentally and physically) old people I come across in my work with them are those with ‘high cholesterol’ from 7 to as high as 10. It is good that studies that show this are beginning to get publicity.
As indicated by posts, wouldn’t it be sensible to look at whether ageing naturally means cholesterol levels rise as part of Nature’s process of protection?