High cholesterol among older people is associated with longer life. In Japan, high cholesterol is associated with longer life at all ages. More recent evidence indicates that the relation of high cholesterol to longevity is as robust as ever, and that older people with high cholesterol live longer.
Consider the following an “out of sample” study in which results are verified, associations confirmed, and the risk of data mining undercut.
Cholesterol and mortality
A newly published study looked at 3090 adults aged 60 and up in the Swedish National study on Aging and Care. Baseline date was 2001-04. The study followed the subjects until the end of 2011.
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)… reduced all-cause mortality associated with high total cholesterol (≥6.22 mmol/l)) was mainly due to the reduced risk of non-cardiovascular mortality (hazard ratio = 0.67, 95% CI = 0.51–0.88). These associations were statistically evident only among individuals without use of cholesterol-lowering medications.
The inverse association between high total cholesterol and reduced all-cause mortality in older adults is primarily due to non-cardiovascular mortality, especially among those who are not treated with cholesterol-lowering medications.
Graphs showing survival curves shown below. Those with the highest cholesterol, >240 mg/dl, lived the longest, those at 200-240 mg/dl were in the middle, and those with cholesterol <200 had the highest death rate. (To convert cholesterol from mmol/L to mg/dl, multiply by 38.67.)
Noteworthy, those who had high cholesterol but took cholesterol-lowering drugs such as statins had no survival advantage.
The reduced risk of death seen in those with high cholesterol was mainly due to lower risk of non-cardiovascular death. High cholesterol was associated with a ~30% lower mortality rate.
The authors speculate that higher cholesterol may modulate inflammation, or that low cholesterol is a sign of frailty and poor health. Proponents of the harmfulness of cholesterol argue the latter case, but even if true, why would you want your cholesterol in the range of unhealthy, frail people?
In men aged 85 or more, who are described as “very elderly”,
… total mortality in the low-TC [total cholesterol] group was 1.7-fold higher than that in the high-TC group. Mortality, adjusted for the same factors, decreased 0.9% with each 1 mg/dL increase in the serum TC concentration and decreased 0.8% with each 1 mg/dL increase in the serum (low-density lipoprotein) LDL-cholesterol (LDL-C) concentration. Our results indicate an association between lower serum TC concentrations and increased all-cause mortality in a community-dwelling, very elderly population. Mortality decreased with the increases in both TC and LDL-C concentrations, after adjustment for various confounding factors. These findings suggest that low TC and low LDL-C may be independent predictors of high mortality in the very elderly.
When I’m 85 years old or more, I don’t plan on being described as “very elderly”. I’ll still be doing deadlifts and won’t be trying to lower my cholesterol.
Should the elderly take statins?
In a review of studies on cholesterol and statins in the elderly – greater than 80 years old – found two basic conclusions:
- total mortality was highest at the lowest cholesterol levels: “Low TC (<5.5 mmol/l) [total cholesterol <212 mg/dL] is associated with the highest mortality rate in 80+-year olds.”
- no benefit of lipid-lowering in this age group: “There is not sufficient data to recommend anything regarding initiation or continuation of lipid-lowering treatment for the population aged 80+, with known CVD, and it is even possible that statins may increase all-cause mortality in this group of elderly individuals without CVD.” [Emphasis added.]
In hemodialysis patients, who are quite ill indeed, higher levels of LDL were associated with reduced risk of infections, and no increase in cardiovascular risk.
When will the cholesterol-lowering, statin-prescribing insanity end? Probably not any time soon, since Big Pharma has a large influence on medical practices. There’s huge money in prescription drugs including statins.
Cholesterol is a natural molecule synthesized by the human body, and is critical for the function of cell membranes and hormones.
If higher cholesterol is associated with longer life in the elderly, and in all ages in Japan, then that casts considerable doubt on cholesterol as a cause of cardiovascular disease. Since age is a risk factor for CVD, if high cholesterol caused it, we would expect to see higher death rates in the elderly with high cholesterol. But we do not.