Should your grandma be worried about cholesterol?

Posted on November 8, 2011 by graeme

Cholesterol and heart disease is becoming somewhat of an obsession for me. With a big talk coming up in the next week at major investment bank I know questions on the topic will be popular, particularly given the evidence and opinions I present. I can often hear the intakes of breath and see eyebrows raising when I suggest why you shouldn’t be so worried about saturated fat or indeed your cholesterol being ‘slightly elevated’ and why you should be concerned if your doctor suggests a statin as a solution.

So, I was interested to hear that my grandmother was concerned after her GP had recently expressed concern to see her cholesterol elevated. While I don’t have time for a diatribe on the whole diet/heart hypothesis and the complexity of the evidence surrounding heart disease, it is worth just exploring why the doctor would be worried.

I can understand why the public at large still believes cholesterol to be nothing more than an indicator of impending death, it is drummed into us both directly and indirectly by products that line the shelves claiming to lower it (despite a stunning lack of evidence to show that consuming these products will actually have any impact on your life expectancy). Ironically these products are often aimed at women, who seem more concerned about this issue despite the fact that there is very little reason for most women to worried about their cholesterol level (heart disease is after all only one cause of death and doesn’t become the leading cause of death in women until after 85 years old).

Very few people realise that far from being a dangerous risk to health, such as cigarette smoke or air pollution that have both been shown to increase a woman’s risk of death, cholesterol is an essential for a healthy life. Without it we couldn’t manufacture vitamin D or bile acids, and it is critical for a range of functions from nerve transmission to cell structure and formation. It is so important that if we don’t eat enough of it our body manufactures it to compensate. It’s worth mentioning that it is also an essential component of breast milk, which would seem strange if it were such a noxious disease-forming substance. Nature is rarely so errant.

Unfortunately, or indeed perhaps fortunately, it really isn’t as simple as a raised cholesterol level indicating impending doom. Firstly, we have to realise that heart disease (which is after all what all the fuss is about when it comes to cholesterol) should not be considered in the same context for men and women. Death rates are wildly skewed with women in the UK suffering a third of the amount of deaths from heart disease as men. It gets even more confusing when you consider that in study after study results have actually shown higher cholesterol to be linked to living longer in women and that a higher level may actually be healthier than a lower one. So, hold back on the Benecol and the Flora Pro-Active ladies, you may just find that eating butter isn’t so bad after all.

A study from the Lancet is one of many to conclude that older women with a lower cholesterol level may be at a greater risk of death. They found that those with a level of 4.0mmol had a death rate five times that of those with the highest levels of 7.0mmol. This study although on a relatively small population group is not the only one that has failed to show that there is any real evidence for older women to worry about their cholesterol levels. The Framingham Heart study, which is the longest running study to look at heart disease, concluded that low cholesterol significantly increased risk of death in people over the age of 50 from all causes, while studies from Italy and Austria both concurred finding that high cholesterol was actually associated with greater longevity and less cardiac events in older women. Disturbingly the Austrian study found lower cholesterol to be linked with increased death rates from cancer, liver disease, depression, and mental illness.

In fact, there is a surprising amount of evidence that runs contrary to what most of us believe, which is that even the most modest of increases in cholesterol levels is harmful and that we should all seek to obtain lower levels in order to improve our health. Despite this fact, cholesterol still remains the arch villain of heart health perhaps due in no small part to the ability of the pharmaceutical companies to produce drugs that are able to modify this apparent ‘risk factor’ so effectively (again with little efficacy in older women with out existing heart disease).

So, at the tender age of 87, what does my grandmother have to fear about having an elevated cholesterol level? From the evidence it would seem not much and more to the point, how much harm can you do by telling someone that they should be worried about their health when in fact they may have no need to be at all? While we would all do well to reduce our risk of ill health, we cannot afford to look at these issues in such simplistic fashion. Risk factors are many and varied and the data is complex and often confusing. So, many people trust their doctors to be guided on what is and what isn’t ‘healthy’. With cholesterol-lowering statin sales in the tens of billions of pounds per year worldwide and doctors bombarded by the PR from drug companies, it is perhaps no wonder that so much of this evidence goes unnoticed by the general population. Lets hope our health professionals speak from the evidence in the literature and not just from the propaganda that the statin manufacturers circulate.

If you are interested to know more about this topic you can find the links of the aforementioned studies below and an entertaining and thorough dissection of this topic in the books The Great Cholesterol Con By Dr Malcolm Kendrick and Trick and Treat by Barry Groves.

Tikhonoff V et al, “Low-density lipoprotein cholesterol and mortality in older people,” Journal of the American Geriatrics Society 2005; 53:2159-2164.

Forette et al Cholesterol as a Risk Factor for Mortality in Elderly Women. The Lancet Volume 333, Issue 8643, 22 April 1989, Pages 868-870

Ulmer H, Kelleher C, Diem G et al. Why Eve is not Adam: Prospective follow-up in 149,650 women and men of cholesterol and other risk factors related to cardiovascular and all-cause mortality. Journal of Women’s Health. 2004; 13(1):41-53.

Albert CM, Chae CU, Grodstein F et al. Prospective study of sudden cardiac death among women in the United States. Circulation. 2003; 107:2096-2101.

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  • Tommo

    Good article  Graeme, the study that influenced most Doctors was the Jupiter study which was flawed http://balancedbodymind.wordpress.com/2010/08/27/statinscholesterol-medication-jupiter-study-was-flawed/
    What alot of medics tend to forget is that statins also block the production of HMG co reductase which is a powerful antioxidant especially for cardiac tissue. 

    Lowering circulating cholesterol levels with a higher cholesterol and an anti inflammatory diet with good fats such as coconut fat works wonders, but leaves many medics gasping for air because of the saturated  fat tag.

    hope all is well in London? Tommo

  • http://www.facebook.com/gmarshpt Graeme Marsh

    Hey Tommo, glad you like it! Yup, it is amusing that medics are still advising (in some cases) the kinds of diet for people that are likely to have an entirely opposite effect. It is also interesting how narrow minded the view on cholesterol is, despite the evidence that LOW cholesterol has strong links to everything from depression to cancer. 

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