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Low cholesterol levels prove dangerous
A 20-year study following the medical outcomes of 3572 Japanese/American men aged 71-93 years found that:
  • those with the lowest cholesterol levels were 28-40% more likely to die sooner
  • the longer a low cholesterol level was maintained the higher the risk

The researchers questioned the practice of lowering cholesterol levels in elderly people below 4.65mmol/L.


(8419) Lancet 2001;358:351-55


Let them eat cake, butter, cream ...
According to a loose network of radical researchers called ''The Cholesterol Skeptics':
  • Many studies have shown that only 50% of people who develop heart problems have high cholesterol. Malcolm Kendrick, a GP from Cheshire and the UK's most active Skeptic, reported that the link with cholesterol and heart disease was far more tenuous than is generally supposed, and that in Russia, for instance, heart attack rates are rising dramatically although cholesterol levels are the opposite of those found in the US and the UK: high levels of so-called "good" high-density lipoprotein cholesterol and low levels of "bad" low-density lipoprotein cholesterol. Joel Kauffman, a professor at the University of the Sciences in Philadelphia (US), agreed. His review of statin use in 2003 found that what correlates best with high cholesterol is age, a major factor in heart disease. "When you correct for age," he concluded, "there is almost no correlation between high cholesterol and heart disease."

  • A study in the BMJ in 2001 found no link between changing fat in the diet and heart disease

  • Findings that statins reduced the risk of heart attacks and strokes by a quarter in healthy individuals are less impressive when you discover that the average healthy individual's risk of heart attack or stroke is only 4% anyway. Statins appeared to reduce this to 3%. In Sweden official advice is to reserve statins largely for secondary care (to prevent a second heart attack)

  • If you don't already have heart disease, you probably won't live any longer if you bring your cholesterol level down

  • On average, the millions of people who dutifully take their drugs and endure cholesterol-reducing diets for years do not live longer. Some trials have found that, even though the number of deaths from heart disease falls when cholesterol is reduced in primary care (GP level, before any heart attack has taken place), there is often an increase in the overall death rate from other causes. Some studies have even found that, over the age of 50, reducing cholesterol increases the death rate

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The Skeptics suspect that inflammation is a key factor in developing heart disease (an inflamed point on an artery makes it more likely that plaque will form) and that it is by reducing inflammation rather than cholesterol that statins protect against heart attack. Much of the inflammation which occurs in the body is controlled by a molecular switch called NF kappaB which, according to recent studies, is "dimmed" by statins.

However, this is what aspirin, omega-3 fatty acids, garlic and vitamin E (all effective, safer and cheaper treatments) also seem to do. Other ways of reducing your risk of heart disease include stopping smoking, losing weight and exercising.

The value of statins to women is less clear because, although they tend to have higher levels of cholesterol throughout life, they also tend to develop heart disease 15-20 years later. Now that the dangers of HRT are more fully recognised, GPs are prescribing statins to healthy women with the intention of protecting them against heart disease. This is unwise. Having re-analysed the findings of five statin trials with regard specifically to women, the University of British Columbia's James Wright concluded that "the results do not support the use of statins by women without heart disease."
(10540) Jerome Burne. Guardian

Cholesterol coming in from the cold

Countries with diets high in saturated fats tend to suffer from high levels of colon cancer as well. It would therefore appear to be common sense that individuals with high levels of cholesterol in their blood would be more at risk of cancers, but it is not so. A 1974 review of data from the Framingham Study and Key’s Seven Countries Study showed that people with cancer tended to have lower than average levels.

A 1990 study [1] compared the cholesterol rates over ten years of people who developed colon cancer with a control group of people who did not. The cancer group’s rates had fallen an average 13% over the period whilst the control group’s had risen an average 2%. They established beyond doubt that the fall in cholesterol preceded the development of the cancer, rather than the cancer causing the fall. Worryingly, the average blood cholesterol level of those who developed the cancers had declined to an average 5.56 millimoles per litre (mmol/l) yet the UK Government’s Health of the Nation strategy still aims to reduce everyone’s levels to below 5.2 mmol/l.

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Low cholesterol and stroke
Over the past few decades the Japanese have begun to eat more total fat, saturated fatty acids, cholesterol, animal fats and protein, and less rice and vegetables. Investigators were surprised to find that this change to Western and urban eating patterns had been accompanied by a general lowering of blood pressure and a large decline in the incidence of deaths from strokes and cerebral haemorrhage during the period from 1960 to 1989. They attributed these reductions to an increase in blood cholesterol levels over the period. [2] Supporting their findings, but the other way round, a follow-up study of the 350,000 US men screened for the MRFIT study found that middle-aged men ran a sixfold risk of death from cerebral haemorrhage if they had low blood cholesterol levels. [3]

In December 1997, the Framingham researchers stated that, in their view, “blood serum cholesterol levels were not related to incidence of stroke” and showed that for every 3% more food energy derived from fat there could be 15% fewer strokes and significant decreases in all types of heart disease. Another study [4] concluded that each 1mmol/l increase in total blood cholesterol led to a 15% reduction in child deaths. Yet another study, this time of men over 80 years old, found that those with blood cholesterol levels over 6.5mmol/l had been half as likely to die during the period of the study compared to those whose blood cholesterol level was around the 5.2mmol/l mark we are told is healthy. [5]

Low cholesterol and Alzheimer’s disease
Approximately half of the brain is made up of fats. Writing on ways of reducing the symptoms of Alzheimer’s in 1991, Dr Frank Corrigan and colleagues called for “strategies for increasing the delivery of cholesterol to the brain” and recommend increasing fat intake. [6]

Low cholesterol and premature death
Correlations between saturated fat intake and blood cholesterol levels are solid. Although the next step, evidence that raised blood cholesterol leading to increased risk of heart disease, has not been shown conclusively, this saturated fat-cholesterol link has been used extensively to justify dietary advice. A second solid correlation has received less publicity: that between low blood cholesterol levels in young children and premature death:

Country ------------------Blood Cholesterol ------ Under age 5 Mortality
---------------------------- (millimoles per litre) ---------- (per 1,000)

Finland --------------------------- 4.9 ------------------------------- 7
Netherlands -------------------- 4.5 ------------------------------- 9
USA ------------------------------- 4.3 ------------------------------12
Italy -------------------------------- 4.1 ------------------------------12
Philippines ---------------------- 3.8 ----------------------------- 72
Ghana ---------------------------- 3.3 -----------------------------145

Table: Child mortality under age 5 per 1,000. 1992 Britannia Book of the Year. Encyclopaedia Britannica, Chicago.

Low cholesterol and brain function
Decreases in blood cholesterol levels cause decreases in serotonin receptors in the brain, disrupting brain function. Psychiatric patients with low blood cholesterol levels were more prone to depression and suicide. [7]

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[1] Winawer,SJ et al. Journal of the American Medical Association 1990; 263(15):2083
[2] Shimamoto,T et al. Circulation 1989;3:503
[3] Ben-Shlomo Y et al. Journal of Epidemiology and Community Health 1998;52:683-84
[4] Weverling-Rijnsburger,AWE et al. Lancet 1997; 350: 1119-23
[5] Jonsson,A et al. Lancet^I- 1997; 350: 1778-79
[6] Corrigan,FM et al. Journal of Nutritional Medicine 1991;2:265-71
[7] Modai,I et al. Journal of Clinical Psychiatry 1994; 55:6; 252-54

(11041) Second Opinions