The prescribing of statins for elderly patients with high cholesterol had always caused me some hesitation. Statins block a key enzyme in the synthesis of cholesterol to lower both total cholesterol and ‘the bad guy’ LDL. I knew the dogma that high cholesterol is dangerous increasing the risk for heart disease. The catch being that cholesterol is such an important component to so many life processes from bile to sex hormones to the myelin sheaths that line axons running through our brains. In fact, the brain is the most cholesterol rich organ in the body using 20% of the body’s entire production1. Hm… given conditions like Alzheimer’s that afflict the elderly, I would think they would need brain nutrition like cholesterol.
So I decided to search the medical literature and it turns out higher cholesterol may not only be okay in the elderly but may in fact be protective. The real danger is low cholesterol. Studies show that there is not an increased death rate (mortality) for those with higher cholesterol, but there may a moderate protective effect for all-cause mortality for those with higher cholesterol2. This means higher cholesterol protects against non-heart disease causes of death, but that effect reduces when the population is treated with statins2. The group with the highest death rate by far have low cholesterol3.
I am not basing this on one study but multiple ones that followed thousands of people over decades. The Swedish study I cited above followed 3000 individuals over a decade, The Lancet study followed 8404. Finally, a systematic review in the BMJ complied data from over 68,000 elderly patients5. **
So why are we told high cholesterol is bad? Well, high cholesterol is bad in middle age people ages 35-57. Population studies involving 100,000s of patient such as Framingham and The Multiple Risk Factor Intervention Trial were skewed towards middle age men3.
In conclusion, once you hit 60 years of age the cholesterol you should most worry about is LOW cholesterol.
** Keep in mind that these studies are following an otherwise healthy population. Those with pre-existing heart conditions may need to follow different guidelines.**
Work Cited
1. Zhang J, Liu Q. Cholesterol metabolism and homeostasis in the brain. Protein Cell. 2015;6(4):254-264. doi:10.1007/s13238-014-0131-3
2. Liang Y, Vetrano DL, Qiu C. Serum total cholesterol and risk of cardiovascular and non-cardiovascular mortality in old age: A population-based study. BMC Geriatr. 2017;17(1):1-7. doi:10.1186/s12877-017-0685-z
3. Tikhonoff V, Casiglia E, Mazza A, et al. Low-density lipoprotein cholesterol and mortality in older people. J Am Geriatr Soc. 2005;53(12):2159-2164. doi:10.1111/j.1532-5415.2005.00492.x
4. Amery A, Birkenhäger W, Brixko P, et al. Mortality and morbidity results from the European Working Party on High Blood Pressure in the Elderly trial. Lancet (London, England). 1985;1(8442):1349-1354. doi:10.1016/s0140-6736(85)91783-0
5. Ravnskov U, Diamond DM, Hama R, 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. 2016;6(6):1-8. doi:10.1136/bmjopen-2015-010401