Does High Cholesterol Really Play A Role In Heart Disease?

An extensive new review suggests high cholesterol is not linked to cardiovascular disease in the elderly, and may actually help them live longer

As if the good/bad fat debate wasn't confusing enough already, an extensive review of data from 70,000 people has determined that high cholesterol has no link to cardiovascular disease mortality in the elderly. It may even have a protective effect. 

The controversial new review has been published in the BMJ open journal and reveals that after analysis of 70,000 people, 92% of people with high cholesterol actually lived longer in comparison. The authors call for a rethink of our approach to cardiovascular disease and atherosclerosis, claiming that cholesterol lowering treatments like statins are largely ineffective, and their benefits have been overstated.

“What we found in our detailed systematic review was that older people with high LDL (low-density lipoprotein) levels, the so-called “bad” cholesterol, lived longer and had less heart disease. Lowering cholesterol with medications for primary cardiovascular prevention in those aged over 60 is a total waste of time and resources, whereas altering your lifestyle is the single most important way to achieve a good quality of life”

A cholesterol embolus in a medium sized artery of the kidney Credit: J Am Soc Nephrol 12 (8): 1781-7

Debate ensues

Not everyone is convinced by the study however and it has received criticism, with claims of serious methodological weaknesses. Other voices claim that a randomised trial involving a placebo group and a cholesterol lowering group would better answer the question. 

“There have been several studies that tested whether higher cholesterol increases the risk of heart disease by lowering cholesterol in elderly patients and observing whether this reduces their risk of heart disease. These have shown that lowering cholesterol using a drug does reduce the risk of heart disease in the elderly, and I find this more compelling than the data in the current study”

The biggest risk factor is aging

The British Heart Foundation questioned the papers, explaining that LDL cholesterol levels in the elderly are hard to detect, and many factors determine health as we get older. It may also be that treatments like statins have shown some beneficial effect through other mechanisms, independent of their cholesterol lowering effect. Regardless of whether cholesterol is, or is not a key risk factor of cardiovascular disease, it's abundantly clear many other factors are at play here. Aging creates a multi-factorial decline that raises disease risk across the board, and until we admit that age-related disease is linked by a common denominator (aging), we're unlikely to make significant therapeutic progress tackling each disease separately. 

Read more at The Telegraph