I hate to say I told you so. But I did. Like a million times. Yet, the fear of cholesterol continues. What is it? Is it the Lipitor ads? Is it your cholesterol-phobic doctor, determined to get your cholesterol under 200 mg/dl at all cost? Whatever it is, it's about time we stopped worrying so damn much about high cholesterol. This new study, entitled "Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study.", shows us why. Did anybody hear anything about this one in the media?? I didn't think so, not with a catchy title like that. At least now the 3 people that read my blog will be aware of it. The researchers followed 52,087 Norwegians aged 20-74 who were free of cardiovascular disease (CVD) for 10 years, then assessed the relationship of total cholesterol with total mortality, CVD mortality, and ischemic heart disease mortality (IHD). (Just to be clear, CVD mortality signifies deaths from any disease of the cardiovascular system, while ischemic heart disease refers only to diseases involving restricted blood flow to the heart.) Let's jump straight into the data then, shall we? And another note: since this study comes from Europe, the units for blood cholesterol are shown in mmol/L, rather than the mg/dL that we are used to. The researchers classified the participants into four groups, based on their blood cholesterol. Here are the converted unit values in mg/dL for the four groups... <193, 193-229, 230-269, and >270
First, the least shocking data. This graph compares the association between cholesterol levels and death from ischemic heart disease. For the men, it looks like there's not much variation. Deaths from heart disease rose slightly along with cholesterol levels, but nothing dramatic. Women, on the other hand, yielded a much more interesting result. Clearly, by a LARGE margin, cholesterol below 193 mg/dL was most predictive of death from heart disease. All other groups, including the group with cholesterol over 270 mg/dL, showed significantly lower risk. Yes, seriously. On to the next graph!
This one here shows the association between cholesterol and cardiovascular disease, or CVD, which includes heart disease with stroke and any other disease of the cardiovascular system. Again, let's begin with the men. The lowest risk appears to lie in those with total cholesterol between 193 and 229 mg/dL, but a close second is the next range up, from 230 to 269. If you know your reference ranges, you know that anything over 200 is considered dangerous. Does anybody ever bother to check why this is considered dangerous, or do we just accept it without question?? Clearly, the data from this study suggests that a cholesterol level in men between 193 and 269 is optimal for CVD prevention. As for women... oops, looks like they screwed up the data there! They must have it backwards! Except they don't... yes, the data shows that if you're a woman, the higher your cholesterol is, the lower your risk of death from CVD. I'd repeat it, but I'll be doing that again shortly. Read on to all-cause mortality!
Here we are, all-cause mortality... the only statistics that really matter. Deaths from IHD or CVD are cool, but not nearly as cool as all-cause mortality. This one cuts through the bullshit. It's not your risk of dying from one disease that really matters, it's your risk of dying overall. So, for men... the group with the HIGHEST risk of dying overall had the LOWEST cholesterol (below 193 mg/dL). Even those with a cholesterol level over 270 fared better. The sweet-spot, protective level here was shown to be 193-229, a level that, based on the current reference ranges, will likely get you prescribed a statin drug for being too high! It's just not right I tell ya. And for the women, we see another complete inverse relationship between blood cholesterol and all-cause mortality. High cholesterol appears to be protective for the ladies! Maybe I could incorporate that into a pickup line somehow... but I digress.
So, does this prove anything? No. Not really. Although it happens to be in accordance with what I believe, it's all just observation. But this isn't the only study to show this kind of trend, just the most recent; there are at least 20 others like it if you just follow that link. And it certainly makes a strong case for women... having low cholesterol, in the healthy reference range, mind you, just appears to be straight up deadly! Despite the study's inability to conclusively prove anything, that didn't stop the researchers from letting loose a little on the drug industry. And I quote from the conclusion of the paper... "Many individuals who could otherwise call themselves healthy struggle conscientiously to push their cholesterol under the presumed 'danger' limit, coached by health personnel, personal trainers, and caring family members. Massive commercial interests are linked to drugs and other remedies marketed for this purpose." That may not seem so harsh, but for a group of researchers to say this and imply that massive commercial interests are wrongly influencing the clinical guidelines... that's a pretty strong statement. And I agree wholeheartedly. The guidelines need to be reassessed.
What does this mean, though, if having high cholesterol isn't a bad thing? What are the implications? Well, for one, maybe it will get people off these ridiculous statin drugs. But even more significant, to me, are the implications for saturated fat consumption. These days, everyone just "knows" saturated fat is bad. But if I asked you, could you tell me why? The standard answer is, because saturated fat raises your blood cholesterol. Well... um... so what? If you step outside of this cholesterol=bad paradigm for a while, things start to look a bit different. What else is known about saturated fat? Well, if you eat more of it, it makes up more of your cell membranes, and it's highly resistant to oxidative damage. So that's good, it protects your cells. And... short-chain saturated fats like butyric acid, found in butter, are burned preferentially as fuel and promote proper immune function. And... saturated fats enhance calcium absorption, along with all the fat-soluble vitamins (A, D, E, K). And don't forget, if you're a woman, having high cholesterol appears to be beneficial. Wait a minute... could saturated fat be... healthy!? So much for a French paradox...