Rogue Health and Fitness

Higher Cholesterol Is Associated with Longer Life

Is it possible that mainstream medicine got cholesterol all wrong? That not only does cholesterol have no connection to heart disease, but that high cholesterol is actually a good thing? Yes, it’s more than possible — here I’ll show some evidence that higher cholesterol is associated with longer life.

All-cause mortality vs heart disease

Obviously, people die from many causes, whether natural, such as heart disease, cancer, or infection, or unnatural, such as from homicide, suicide, or accidents.

Should we be concerned about what cause we die from?

Yes, and no. On the one hand, if you’re dead, you’re dead, no matter from what. On the other, dying in your sleep in old age is preferable to a long, lingering illness.

Nevertheless, from a public health standpoint, it seems a mistake to focus on changing something that lowers the risk of death from one cause only to raise that risk from another.

While total cholesterol is a poor if not utterly worthless risk marker for heart disease, doctors have focused on it to the exclusion of how it might affect other causes of death. It does you little good to save yourself from heart disease if it means that you increase your risk of death from cancer.

All-cause mortality — death from anything — is the most appropriate measure to use when looking at risk factors.

Older people with higher cholesterol live longer

Population studies in Japan show that people of all ages with higher cholesterol live longer.1

Overall, an inverse trend is found [in Japan] between all-cause mortality and total (or low density lipoprotein [LDL]) cholesterol levels: mortality is highest in the lowest cholesterol group without exception. If limited to elderly people, this trend is universal. As discussed in Section 2, elderly people with the highest cholesterol levels have the highest survival rates irrespective of where they live in the world.

cholesterol-mortality-japan

Consider the chart above, taken from the paper. It shows all-cause mortality by cholesterol levels, men on the left, women on the right.

Current guidelines call for keeping cholesterol at 200 mg/dl or lower, yet higher levels meant lower death rates.

What about outside Japan? The following chart shows cumulative all-cause mortality of people older than 85 in Leiden, The Netherlands, by cholesterol level.

cholesterol-leiden

The cohort with an average cholesterol of 252 mg/dl, the highest, had the lowest death rates.

The following shows data from Finland.

cholesterol-finland

The data from Japan is for all ages; the data from outside Japan is for the elderly. What about the data for all ages, outside of Japan? The authors believe that the presence of people with familial hypercholesterolemia, which causes a very high cholesterol level and which raises the risk of death, in the highest cholesterol categories, accounts for higher death rates in those categories. They also argue that cholesterol levels in that disorder are not the cause of increased death rates.

A recent review in the BMJ regarding LDL cholesterol, the risk marker considered most significant, found either no association or an inverse association between LDL and death rates.2

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.

Is high cholesterol protective?

Why would people with low cholesterol die at higher rates than those with higher cholesterol?

Several things could be going on.

Cholesterol may protect against infections and atherosclerosis.3

Cholesterol may protect against cancer.4

A strong association was found between low cholesterol and violence. Odds ratio of violence for cholesterol of <180 mg/dl was 15.49. 5

Several studies have found an association between low cholesterol and suicide. For instance, one study found that those in the lowest quartile (fourth) of cholesterol concentration had more than 6 times the risk of suicide as those in the highest quartile.6

Update: A newer (2017) study, Serum total cholesterol and risk of cardiovascular and non-cardiovascular mortality in old age: a population-based study, found a 30% lower rate of all-cause mortality in people over 60 with high cholesterol.

 Compared to normal total cholesterol (<5.18 mmol/l), borderline-high (5.18–6.21 mmol/l) and high (≥6.22 mmol/l) total cholesterol were associated with a decreased risk of all-cause mortality, with the multiple-adjusted hazard ratio (95% confidence interval, CI) of 0.71 (0.61–0.83) and 0.68 (0.57–0.80), respectively (P for trend <0.001).

 

Conclusion

A number of studies have found that, at least in people older than 60, high cholesterol is associated with lower death rates.

This fact casts considerable doubt on the cholesterol hypothesis of heart disease.

Why, with so much evidence against it, does the cholesterol theory still have so much traction. To quote the authors in the first cited study, it’s all about the money:

We believe the answer is very simple: for the side defending this so-called cholesterol theory, the amount of money at stake is too much to lose the fight.

 

Update: I hadn’t seen this before I wrote this article, but Uffe Ravnskov, a co-author of some of the above-cited studies, has a good article with many relevant citations, The Benefits of High Cholesterol.

PS: For more on how to live longer, see my books, Stop the Clock and Muscle Up.

PPS: Check out my Supplements Buying Guide for Men.

 

 

  1.  Ann Nutr Metab 2015;66(suppl 4):1–116 DOI: 10.1159/000381654 ↩
  2.  Ravnskov, Uffe, et al. “Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review.” BMJ open 6.6 (2016): e010401. ↩
  3.  Ravnskov, Uffe. “High cholesterol may protect against infections and atherosclerosis.” Qjm 96.12 (2003): 927-934. ↩
  4.  Ravnskov, U., K. S. McCully, and P. J. Rosch. “The statin-low cholesterol-cancer conundrum.” QJM (2011): hcr243. ↩
  5.  Mufti, Rizwan M., Richard Balon, and Cynthia L. Arfken. “Low cholesterol and violence.” Psychiatric services (2006). ↩
  6.  Ellison, Larry F., and Howard I. Morrison. “Low serum cholesterol concentration and risk of suicide.” Epidemiology 12.2 (2001): 168-172. ↩
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19 comments
Higher Cholesterol Is Associated with Longer Life | Technology and Longevity Feed says September 20, 2016

[…] Original Article: Higher Cholesterol Is Associated with Longer Life […]

Reply
Titus Hauer says September 20, 2016

Great post and as usual the Mainstream Media has told us the exact opposite. Mind blowing how much misinformation there is.

Reply
George Henderson says September 20, 2016

The die-hard defenders of the lipid hypothesis have constructed mathematical genetic models to demonstrate that the inverse link between high LDL and mortality is a matter of reverse causality.
However, this is refuted by a Hawaiian study showing that the increased risk of low LDL was completely reversed if LDL increased in an elderly person

Mean cholesterol fell significantly with increasing age. Age-adjusted mortality rates were 68.3, 48.9, 41.1, and 43.3 for the first to fourth quartiles of cholesterol concentrations, respectively. Relative risks for mortality were 0.72 (95% CI 0.60-0.87), 0.60 (0.49-0.74), and 0.65 (0.53-0.80), in the second, third, and fourth quartiles, respectively, with quartile 1 as reference. A Cox proportional hazard model assessed changes in cholesterol concentrations between examinations three and four. Only the group with low cholesterol concentration at both examinations had a significant association with mortality (risk ratio 1.64, 95% CI 1.13-2.36).
http://www.ncbi.nlm.nih.gov/pubmed/11502313

Further, there’s a Scandinavian study where BOTH statin use and high LDL are independently associated with reduced mortality in the elderly. A good indication that any benefit from statins doesn”t result from LDL lowering. Especially if we remember the reason why most people are prescribed statins in the first place.

Reply
    P. D. Mangan says September 20, 2016

    Thanks, George. Regarding reverse causality, a number of the studies I looked at found that the results persisted even when death in the first several years was excluded.

    Reply
charles grashow says September 20, 2016

Studies 2-4 are by Uffe Ravnskov – a cholesterol denier who will NEVER admit he might be wrong and who cherry picks studies to prove his point.

Study # 5 used a sample size of 40 and defined low cholesterol as < 180 mg/dL

Reply
    P. D. Mangan says September 20, 2016

    “Denier” is a word used by ideologists, as in global warming. As for never admitting he might be wrong, why would he if he’s right? Will lipid hypothesis proponents ever admit that they’re wrong? Uffe Ravnskov has been more correct on cholesterol than anyone in the mainstream.

    As for sample size, the studies that were used in the graphs used hundreds of thousands of people.

    Reply
jer says September 21, 2016

Wow. I wish I had been skeptical of science, or at least medicine/biology, from an earlier age. Taleb said it well when he said Granma’s advice is more rigorous than modern science fads.

You forgot to tell us how to boost our cholesterol!

Reply
B says September 21, 2016

Any ideas how to increase cholesterol? I have low cholesterol (which of course my doc says is great…), with a total ~95 and LDL hovering around ~20. When I was on keto, both LDL and total only increased by about 40.

I eat 6 eggs a day, and really can’t down more — as you’ve said, eggs fill you up like nothing else. What diet/supplement changes would help?

Reply
    P. D. Mangan says September 21, 2016

    B, that a great question, and your cholesterol certainly is low. Unfortunately, most of the information on this topic seems, well, tainted, by the lipid hypothesis. Searching “how to increase cholesterol” gives results for HDL. An article at WebMD on foods to avoid if you have high cholesterol seems to me to be just the usual saturated fat phobia. An article by that great fraud Ancel Keys himself says that beef tallow and coconut oil do not raise serum cholesterol.

    As for eggs, what happens is that when you eat the cholesterol in eggs, your own liver downregulates your internal cholesterol production.

    Uffe Ravnskov says that diet has next to nothing to do with cholesterol level.

    Last I checked, my total cholesterol was ~240 on a low-carb (but not always ketogenic), paleo diet. I eat eggs, meat, cheese, yogurt, vegetables, a bit of fruit, occasional corn tortillas, and drink coffee, tea, and chocolate with cream, and red wine. Rarely I’ll eat something like a hamburger with a bun. (BTW, my triglycerides were 46, HDL 92, giving me a trig/HDL ratio of 0.5, which indicates very low heart disease risk.)

    So, it’s a puzzle. I need to learn more about how to raise cholesterol and why, if diet has little effect, cholesterol levels vary so much between individuals.

    Reply
Laguna Beach Fogey says September 22, 2016

That graphic at the top looks delicious.

Reply
Quinton White says September 29, 2016

There’s a selection issue occurring which negates claims of causality and intuitively explains the result. First, let’s acknowledge that people are potentially different or heterogenous in how their body would react to cholesterol (or anything else). Imagine if some people were less prone to cholesterol’s negative health effects. Then, when looking at a population survival study then you would observe only those people living longer and thus a higher average cholesterol level among elderly patients. Alternatively, you could imagine that people who live an active lifestyle are more likely to consume high-cholesterol proteins. The active lifestyle causes them to live longer and have higher cholesterol levels. None of this is to say that cholesterol couldn’t be beneficial but just that this type of epidemiological study is a weak form of evidence and not useful for assessing causality. In general, we know very little about nutrition and higher quality research that allows for control and treatment groups would be valuable.

Reply
    P. D. Mangan says September 29, 2016

    Some good points there. However, epidemiological studies like these are just like the ones used to establish the damaging effects of high cholesterol. It turns out that if you look at these past associational studies, the case against cholesterol has always been very weak at best. As for your stipulation about active lifestyle and high cholesterol skewing results, in my opinion it’s more likely to be the opposite: intelligent, health-oriented people have been following the advice to keep cholesterol low and therefore would skew the results so it looks like low cholesterol is healthy, when in fact it could be genetic or lifestyle factors. The same problem arises with studies of vegetarians, or fruit and veg intake, or a number of other things.

    Reply
Weekly Roundup #28 - Charles Sledge says September 30, 2016

[…] P.D. Mangan’s “Higher Cholesterol Is Associated With Longer Life” […]

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Processed Food, Supernormal Stimuli, and Obesity - Rogue Health and Fitness says October 4, 2016

[…] told us that cholesterol and saturated fat was bad for us and caused heart disease — which we now know to be utterly false — they also told us that sugar and carbs were benign — we also now know that to be […]

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Do Statins Work? - Rogue Health and Fitness says October 5, 2016

[…] In a previous article, I discussed why statins might cause atherosclerosis and heart failure. The mechanism may be related to how higher cholesterol is associated with longer life. […]

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Weekend Knowledge Dump- October 7, 2016 | Active Response Training says October 7, 2016

[…] Higher Cholesterol Is Associated with Longer Life […]

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Nick says October 19, 2016

A very interesting (for layman me, at least) show just ran on the German & French cooperative public TV channel ARTE last night, and looks to be available online for the coming month:
http://www.arte.tv/guide/en/051063-000-A/cholesterol-the-big-bluff (English subtitles with French audio; no subtitles for the German audio though, if that should be your thing)

Very eye-opening for me, going back to the 50’s and covering up to the present with the statin controversy.

Reply
Cholesterol vs Blood Sugar in Heart Disease - Rogue Health and Fitness says November 18, 2016

[…] older people with higher cholesterol live longer, then it seems unlikely that high cholesterol causes heart […]

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The Truth About Soy - Rogue Health and Fitness says May 23, 2017

[…] Cholesterol itself doesn’t cause heart disease anyway, so the FDA’s reasoning in this case is spurious. […]

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