The People's Perspective on Medicine

Will Higher Bad LDL Cholesterol Help Older People Live Longer?

Doctors have been taught that so-called bad LDL cholesterol is a killer. When high, statins are almost always prescribed. New data challenge that idea.
Statins, Statin pills and a warning sign,

A new analysis of prior research suggests that higher levels of so-called bad LDL cholesterol is associated with longer life for older people. Not surprisingly, many cardiologists are outraged over the idea that bad LDL cholesterol might be good for senior citizens. After all, they have spent decades convincing people that lowering LDL cholesterol is essential for heart health. That is why statins have been prescribed to tens of millions of people.

The New Study Turns Conventional Wisdom Upside Down:

The investigators reviewed epidemiological studies in which bad LDL cholesterol (LDL-C) had been studied as a risk factor for cardiovascular deaths or mortality for any reason (BMJ Open, June 12, 2016). The subjects were people over the age of 60. In total, 19 studies were analyzed involving over 68,000 participants.

In theory, people with high levels of bad LDL cholesterol should have been at increased risk for deaths from heart attacks and strokes. So-called all-cause mortality should also have been higher when LDL-C was elevated.

What the Researchers Actually Found:

Contrary to expectations, no link was found between bad cholesterol and premature deaths. In this older population (people over 60) there was a surprising discovery. The higher the subjects’ LDL cholesterol, the longer they lived and the less heart disease they seemed to experience. This is exactly the opposite of what conventional cardiology would have predicted. Here are the conclusions in the words of the investigators:

“High LDL-C is inversely associated with mortality in most people over 60 years. This finding is inconsistent with the cholesterol hypothesis (ie, that cholesterol, particularly LDL-C, is inherently atherogenic). Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis. Moreover, our study provides the rationale for a re-evaluation of guidelines recommending pharmacological reduction of LDL-C in the elderly as a component of cardiovascular disease prevention strategies.”

That’s doctorspeak for saying older people didn’t benefit by having low LDL cholesterol and may in fact live longer if their LDL-C is higher. They go on to challenge the foundation of cholesterol-lowering treatments by questioning the idea that LDL cholesterol causes clogged coronary arteries. This flies in the face of conventional medical wisdom and makes the billion-dollar statin industry flinch.

The Backlash About Bad LDL Cholesterol was Fast and Furious:

Cardiologists and other health professionals were quick to condemn the new study published in BMJ Open. They characterized the research as:

“Deeply flawed”

“Unwarranted conclusions”

“Disappointingly unbalanced”

“Serious weaknesses and completely wrong conclusions”

Not a Totally New Story:

Although many people think of cholesterol as the enemy, it is actually essential for health. Not only does cholesterol serve as a building block for vitamin D, estrogen and testosterone, it is crucial for neurons in the brain. Without cholesterol our nerve cells would not function.

Results from the Honolulu Heart Program 2001:

One of the most interesting studies that has been forgotten over time is the Honolulu Heart Program. Scientists at the University of Hawaii studied 3,500 Japanese-American men born between 1900 and 1919. The volunteers’ total cholesterol levels were measured when they were middle-aged and again in the early 1990s, when they were elderly. Then the scientists kept tabs on who survived and who died.

To their surprise, the men with the lowest cholesterol levels had the highest risk of dying over the next several years. Those with cholesterol levels between 188 and 209 fared the best. Even men with elevated cholesterol, over 209, were less likely to die from any cause than those with the lowest cholesterol readings. The investigators confessed their confusion:

“We have been unable to explain our results. These data cast doubt on the scientific justification for lowering cholesterol to very low concentrations (<4.65 mmol/L) [less than 180 mg/dL] in elderly people…”

“Our data accord with previous findings of increased mortality in elderly people with low serum cholesterol, and show that long-term persistence of low cholesterol concentration actually increases the risk of death. Thus, the earlier that patients start to have lower cholesterol concentrations, the greater the risk of death.”

[Reference: Schatz, I. J., et al. “Cholesterol and All-Cause Mortality in Elderly People from the Honolulu Heart Program: A Cohort Study.” Lancet 2001;358:351-355]

Other Contrary Research:

No doubt most physicians prescribing statins to people over 60 are not familiar with the Honolulu Heart Program data, or if they are, they have conveniently ignored the conclusions. There are other studies, including a report to the American Heart Association in 1999 that suggested people with total cholesterol under 180 were twice as likely to suffer a bleeding stroke as those with cholesterol of more than 230.

The Japanese Experience:

Researchers in Japan have long noted that people with low cholesterol are more susceptible to bleeding strokes than people with higher cholesterol levels. A study of 12,334 healthy adults between the ages of 40 and 69 was conducted in 12 rural areas of Japan (Journal of Epidemiology, online, Jan. 5, 2011). The subjects were followed for nearly 12 years. The conclusions:

“Low cholesterol was related to high mortality even after excluding deaths due to liver disease from the analysis. High cholesterol was not a risk factor for mortality.”

The Bottom Line from The People’s Pharmacy:

The idea that low total cholesterol, or especially low LDL cholesterol could be associated with premature death comes as a shock to most health professionals. When such research is published it disappears almost without a trace or is forgotten or ignored because the data do not conform to the predominant paradigm. This cholesterol contrariness is not the only big shock to the cardiology community.

Saturated Fat:

Over the last several months the basic foundations of American cardiovascular medicine have been challenged. Next to bad LDL cholesterol, saturated fat was the other villain behind heart disease. But a study published in BMJ (April 13, 2016) found that people who lowered cholesterol levels by consuming foods high in vegetable oil actually died faster than people eating a standard saturated fat-containing diet. This was data resurrected from the Minnesota Coronary Experiment. More details can be found at this link.

Salt:

As if the cholesterol and saturated fat problem were not trouble enough, along came a large salt study published in the journal The Lancet (online May 20, 2016). The authors reported that a low salt diet like the one recommended by the American Heart Association (less than 1,500 mg of sodium per day) was associated with an increased risk for heart attacks, strokes, heart failure and death. You can listen to the lead author provide the details of the research at this link.

Not surprisingly the cardiology community was quick to respond that the study was flawed. The criticism was not unlike the remarks we are reading today about the new study suggesting that older people may actually live longer if their LDL cholesterol levels are higher.

We hope that no one would ever stop taking medicine without first discussing the research with health providers. At the same time, we would hope that physicians would keep their minds open. Medicine constantly changes as new data are revealed. Perhaps some of the old beliefs will change as research reveals alternate hypotheses and understandings.

Share your own thoughts about medical reversals (flip-flops) in the comment section below. Are you frustrated that the foundations of conventional wisdom about heart health are being shaken?

If you would like to read our chapter on heart disease and a contrarian cholesterol perspective you may find our book, Best Choices from The People’s Pharmacy of interest.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I believe food should be eaten in moderation. If we would abide by that principle, our health would be better. Keeping calories in check is best way to diet, not eliminating this and that.

One can only be thankful that a service like People’s Pharmacy has been active for many years.

Our overall health has, by all accounts, declined over the past 25 years. Have we seen reductions in heart disease, cancers, and oh my, diabetes and dementia? Physicians don’t get a lot of information about nutrition in medical school. They do, however, get a lot of information about pharmaceuticals. On average, medications are prescribed like candy. My father became a diabetic and was immediately put on low pressure meds and statins. His memory rapidly declined, and he began falling a lot. He did not have high cholesterol nor did he have blood pressure issues. Over time, it took its toll. I wonder what his health and mental state would be like now if he hadn’t taken all those meds. After researching I took him off of them. I might have been too late. Brains need fat, and we are starving them under current dietary guidelines. Sugar and refined carbohydrates are the problem.

Hi, I am a family practice M.D. (did my residency in Asheville!) On the first day of medical school in 1977, the head of the school came out to “meet the class”. Scowling at 400 terrified students from under the bushiest eyebrows I have ever seen (!), and leaning on the podium with his knuckles, he glared at us, and finally spoke. I will never forget his words–booming at us! “Fifty percent of what we are about to teach you is INCORRECT! UNFORTUNATELY, I cannot tell you WHICH 50% that is!!!” That is the best advice I got the entire 4 years!

I only want to read comments.

Much of this contrary information is not new. (If you listen to the People’s Pharmacy radio show, you already know this!) Dr. Stephen Sinatra has been on several shows talking about his book, “The Great Cholesterol Myth”, published in 2012.

A study was published in the Lancet in 1971 titled, “Incidence of Cancer in Men on a Diet High in Polyunsaturated Fat.” This was based on the LA Veterans Administration Study involving dietary intervention for 846 elderly veterans in a VA facility for an 8-year period in the 1960s. The control group ate what was a normal American diet at the time that contained a lot of saturated fat. The experimental group was given a diet low in saturated fat and high in polyunsaturated fats. The experimental group reduced heart disease mortality, which was published in Circulation in 1969. All-cause mortality remained about the same between the two groups. This was due to increased cancer mortality in the experimental group. This study was described in the book, “Death By Food Pyramid” by Denise Minger, 2013, which is a fascinating review of the political and scientific battles about healthy diets since Ansel Keyes in the 1940s. The sub-title is, “How Shoddy Science, Sketchy Politics and Shady Special Interests Ruined Your Health … and How to Reclaim It!”

Personalty I had bad side effects while taking statins, sore muscles and dead leg feelings. My doctor changed brand every time I complained about the side effects. I tried three different statins over approximately 10 years before stopping statins and my problems cleared up in about one month after stopping over 9 years ago. I am a “supersenior.”

My mother lived to the ripe old age (lacking 3 months) of 98. She developed
high pressure at a much younger age and started medicine for it. Later on
she stopped taking medicine and had very little wrong with her. When she
died, it was not from high blood pressure.

I’d like to thank People’s Pharmacy for giving us the link to the Government’s web site showing the amount of lunch money given to doctor’s by the pharmaceutical companies. When I questioned my doctor re taking a statin, she said that it was necessary. When I looked her name up on the government list, I found she received close to $400 in 2014 from the drug companies. And we are supposed to believe their advice is valid?

Well they court marshaled Dr. Hammond (Surgeon General of the Federal US Army Medical Corp) back in the days of the Am. Civil War for wanting to ban Calomel (Mercury based drug) from the list of medication civil war doctors were prescribing. Of course he won out in the end, but it took years for the “system” to realize he was right. Dr. Hammond went on to be considered the father of modern medical neurology.

I can understand why the Cardiologists and health professionals condemned this study. It is a great example of how the wrong statistical methodology used on a bad data set can yield any result you want. Statements like “were less likely to die from any cause” should make people think. Does a statistically higher life expectancy with high LDL levels make much sense if the deaths are resulting from car accidents? Bad data in, bad conclusions out.

Two books everyone concerned about cholesterol and heart disease should read: “The Big Fat Surprise” and “The Big Fat Lie”. Very well researched by non- medical writers which in my opinion makes them more credible. We’ve been lied to for the past 50 years, largely because Ancel Keys and Jerry Stampler (among others) refused to allow any challenges to their hypotheses. The truth is starting to come now, but slowly.

I have more questions than comments…. What about the LDL: HDL ratio? Isn’t this more important to know than the individual numbers? It makes sense to keep track of inflammation since that drives disease. Sugars drive inflammation, and also triglycerides, where do they fit in to the new recommendations for reducing illness? Do we have new recommendations??

Why is it not major informative news rather that some of the junk we see?
I believe my mother’s heart issues and especially diabetes were brought on by medicines rather than her body as she was a very hard working farm girl who had always gotten lots of exercise and sunshine and raised 9 children until bp started creeping up and she began meds..down hill after that..more issues, more meds, more issues, more meds.
Just my opinion but, I think doctors look for reasons to put us on meds.

I have showed this article to 3 doctors. Their reaction: Nonsense. New analysis will prove they were wrong.
(P.S.-the doctors,friend of mine,are invited every year to 5 star hotels vacations,sponsored by big Pharma….)

Gatorade was created to correct athletic salt depletion. Too little salinity can kill. Too much just causes bloating. Which is safer? I have developed a list of five essential nutrients: salt, sugar (we need some calories), fat, alcohol, and (recently added) chocolate. Such a list is partly tongue-in-cheek, but it is needed to counter the drug industry propaganda.

As long as 40 years ago I recall reading articles about cholesterol, fat, and salt NOT being the bad guys. Inflammation was listed as the real bad guy and exercise touted as the single best thing a person could do to increase health and longevity. Seems like ongoing research is supporting that to a greater degree right along. Of COURSE it will take decades to change the paradigms. Fresh air, good natural food and exercise are quite inexpensive and make no money for the coffers of big medicine or big pharma. Interestingly, when I was studying to become a certified vet tech, I learned that mammals will seek out fat, salt and water. Seems they wouldn’t if they were the toxins modern western medicine makes them out to be. Thanks Jane

An animal will also overconsume sugar if allowed.

What a silly conclusion.

I have always believed that doctors will never change their thoughts in accordance with how they were trained. Their minds have been ingrained to those curriculum and theories which prevailed during their time spent in classroom study.

How many years ago were people told that women had to take harmone pills or they would get cancer? Now, when the word harmones are used or implied, we are told, “No, harmones will give you cancer.”

How many years have we been told that herbs are dangerous. Now, my Neurologist openly describes Butterbar and Riboflavine for migraine headaches. And guess what? It works!

How many years have doctors tried to force statin drugs on me stating that if I did not take them, I would die? Well, after taking the bull by the horns and having several tests made which resulted in showing that I had a mitochondrial myopathy, I can only say that yes, I WOULD HAVE BEEN DEAD A VERY LONG TIME AGO IF I HAD CONTINUED TO TAKE STATIN DRUGS.

How many years have we been told that Omega 3 didn’t do anyone any good as far as cholesterol was concerned? Yet, today, mostly all heart doctors agree that Omega 3 oils plays an important role in heart health.

My conclusion is that many of us are taught that doctors are God. While I certainly respect doctors, and that we cannot do without them, a great deal of responsibility lies within ourselves and what our gut tells us, as far as taking care of ourselves. We don’t ask anyone else to pay our bills or make our Money Orders or checks out. So why should we expect or assume that doctors should control our every thought, reaction and decision after having done our very own much needed research? It is extremely important that we use our very own minds and good common sense when handling health matters as well as any other matter.

My mother lived to be almost 97 and her cholesterol levels were over 300. She played bridge, worked crossword puzzles, baked bread, cooked and had a great sense of humor. She also drove her car until she no longer felt secure behind the wheel at 91, and put the keys away voluntarily. She took thyroid medication and refused all others including statin drugs, which she said didn’t agree with her. My cholesterol is in the high 200’s and at age 75, I take no meds. Thanks for the info in these studies!

Wouldn’t this directly relate to the massive pharma/US Government connection involving billions of dollars earned for promoting statins? I refused them. We’ll see if I’m right. So far, very high cholesterol, 63 years old, smoker, no heart disease.

I’m 56 years old and my cholesterol has been over 300 for the past 20 years, that’s when I first had blood work done. During those 20 years I was told that if I didn’t lower my cholesterol to under 200, I’d have a heart attack real soon.

Statins were recommended by my doctor at every visit. He still recommends them and I still refuse. My ldl’s are high usually around 200. My hdl is running between 40 and 55. The doctor wrote ticking time bomb on my chart 15 years ago. Still no heart attacks. Don’t buy into the cholesterol hype. Take some antioxidant vitamins daily and you’ll be fine.

Good to see all this getting attention. I’ve been a huge hater of statins for a long time, and to this day, I’m convinced they hastened my dad’s huge decline, if not his actual eventual death.

Nothing on earth would make me take them, and back about 10 years ago or so, I was “fired” by a doctor for refusing to take statins! These days, my solution is to avoid going to doctors as much as possible. But of course I know that at some time it will be inevitable. My current doctor is as anti-statin as I am, but no guarantees of that forever.

My mother lived to 103, always had high cholesterol levels, never took statins, though they were, naturally, recommended by doctors. Although there are many life saving treatments and medications out there, I think many of us blindly take medications without questioning the necessity of same.

I think, too, medical professionals don’t like knowing their recommendations are sometimes proven very wrong, so they refuse
to accept findings such as those reported about cholesterol numbers.

LDL “it is crucial for neurons in the brain. Without cholesterol our nerve cells would not function” — perhaps a reason why Alzheimer’s is much more of a problem now than it was years ago? Has anyone linked low LDL with Alzheimer’s?

What I am seeing is that the links you provide are to publishers outside of the US. What am I to make of that? Is there a bias of the US medical establishment against publishing these studies? Are foreign publications biased in favor of publishing these studies? Is this good research or inferior research? Why is this open to debate? Aren’t experimental methods standardized? Could it be that we are stuck with observational studies, which will never provide the kind of certainty of double blind controlled studies, and these arguments will go on for many more years?

Thank you, John, for your astute questions. Now let’s hope for some equally astute answers.

I have had high cholesterol since my 20’s. I am now 60. I do not plan on taking statins. I have no symptoms of heart disease and my heart is very strong.

I have longevity in my family on both sides. My grandparents lived until their 90’s, and my parents are still going strong with high cholesterol

I read your Health Headlines regularly and want to commend People’s Pharmacy for highlighting recent studies that seem to disprove the medical consensus on saturated fat, cholesterol and sodium in our diets. I find the summaries (and links to the original) very enlightening and you have convinced me that we should be concerned about how the scientific community seems to ignore credible results that do not conform to accepted practice. I have seen you repeat references to these studies in the highlights from time to time. This keeps the key studies fresh in my mind so please keep reminding us!

For some years now, my doctor has wanted both me and my husband to take a statin. I have refused for both of us, and see, this article proves why. I sure wish they would find something on hbp. I am on 2 different meds twice a day and a water pill when needed, and usually my bp still runs between 130 and 160. I have stopped worrying about it.

I’m not frustrated that the foundations of conventional advice are being overturned, but I’m frustrated that this information didn’t come out sooner. Also, how did medicine get everything essentially opposite of how it should be? That is the real question. The history of the lipid hypothesis is fraudulent, starting with Ancel Key’s famous 7, ahem, 22 country study.

It’s interesting to note that all of these ‘disruptive’ publications (LDL, saturated fat and salt) were in British journals. Is it possible US journals are rejecting this type of publication?

After nearly 30 years of statin therapy, I resolved to go off the drug because of the side effects. At age 76, feeling good is a very valuable part of living joyfully. For about a year and a half, I have been statin free. Walking 15+ miles per week and sprinting three days a week has added to my overall feeling of wellbeing. My total cholesterol remains consistently at 230. My internist is happy but my cardiologist is not. I simply have to remain obdurate and polite during the annual checkup for circulatory issues. So far, the amount of buildup in arteries is between 20-30 percent. I take fish oil 1000 mg per day but have gotten off aspirin therapy due to acidity issues.

I think primary care doctors, like all of us, are driven partly by ideology – beliefs they take for granted – and partly by limits on their time for reading new information. My “good” cholesterol is literally off the end of the high range; one of the local doctors I’ve gone to immediately prescribed statins, because my total cholesterol is high. I ignored that and was interested to find that when I went back to a nurse practitioner, also a “PCP” – primary care provider – it was obvious to her that I’m doing fine without meds. On the other hand, a local holistic n.p., whose broader perspective in this mainstream medical environment is almost as secret as if she were a witch in the Middle Ages, suggested I get my CRP (C-reactive protein) checked, as a much better indication of health status for older people (I’m 71). It was very high – a sign of inflammation, not good – and she recommended much more exercise, lessening stress, and a Mediterranean diet. This is the advice I’m trying to follow. Is she smarter? Not necessarily. Does she read more? Not necessarily. She has different values and reads different information than the more conventional practitioners.

Where are the data supporting low cholesterol? I would like to look at all the studies to see how they were structured, what factors were controlled for, how were the subjects selected?

I’m 85 excellent lab numbers according to the VA lab standard. Just some problems with worn out joins. I think more important than anything is your genes, and I have good genes from father. At 85 I’ll go with my mother and grandmother’s advice listen to your body it will always tell you before you have a serious problem.

Mama always said, “If you don’t like what your doctor tells you, wait 10 years. Medical advice will be reversed by then.”

I am a physician, and I agree with your mama, Jo from Raleigh!

First off, I cannot take statins because they cause muscle pain. Secondly my mother lived to age 94 never taking statins or mostly any other medication. A lot of older people in the early 1900’s didn’t believe in running to doctors all the time unless absolutely necessary.

This is a mind blowing series of new research . Its almost too much to take in as literal truth.
I sure hope this LDL story is picked up by other media outlets as I’m looked at funny when I try to discuss this stuff without it appearing anywhere else.

Makes you wonder about those media outlets, doesn’t it?

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