Dr. Weeks’ Comment: For the past 20 years, we have taught patients that high cholesterol is not dangerous – but high OXIDIZED cholesterol can be a problem (as is the case with any oxidized -think “rusty” – compound). These articles HERE and HERE and HERE clarify the mis-direction as regards the demonization of cholesterol. Read on and find a doctor to get you and your loved ones off statin drugs. – especially the elderly~ for them, high cholesterol is protective.
“…In people older than 85 years, high total cholesterol concentrations are associated with longevity owing to lower mortality from cancer and infection. The effects of cholesterol-lowering therapy have yet to be assessed…”
The impact of total serum cholesterol as a risk factor for cardiovascular disease decreases with age, which casts doubt on the necessity for cholesterol-lowering therapy in the elderly. We assessed the influence of total cholesterol concentrations on specific and all-cause mortality in people aged 85 years and over.
In 724 participants (median age 89 years), total cholesterol concentrations were measured and mortality risks calculated over 10 years of follow-up. Three categories of total cholesterol concentrations were defined: < 5.0 mmol/L, 5.0-6.4 mmol/L, and > or = 6.5 mmol/L. In a subgroup of 137 participants, total cholesterol was measured again after 5 years of follow-up. Mortality risks for the three categories of total cholesterol concentrations were estimated with a Cox proportional-hazards model, adjusted for age, sex, and cardiovascular risk factors. The primary causes of death were coded according to the International Classification of Diseases (ICD-9).
During 10 years of follow-up from Dec 1, 1986, to Oct 1, 1996, a total of 642 participants died. Each 1 mmol/L increase in total cholesterol corresponded to a 15% decrease in mortality (risk ratio 0.85 [95% CI 0.79-0.91]). This risk estimate was similar in the subgroup of participants who had stable cholesterol concentrations over a 5-year period. The main cause of death was cardiovascular disease with a similar mortality risk in the three total cholesterol categories. Mortality from cancer and infection was significantly lower among the participants in the highest total cholesterol category than in the other categories, which largely explained the lower all-cause mortality in this category.
In people older than 85 years, high total cholesterol concentrations are associated with longevity owing to lower mortality from cancer and infection. The effects of cholesterol-lowering therapy have yet to be assessed.
Drug combinations and all cause mortality in heart disease
Editor—The key problem with the article by Hippisley-Cox and Coupland, who reported benefit from having been prescribed a statin, is outlined by a line in the discussion, according to which confounding by indication could have occurred if patients with a better prognosis were more likely to be prescribed different combinations of treatments.1
High, rather than low, cholesterol concentrations are linked with greater statin use, and this selects the high cholesterol group, in which early death from heart failure is less2 and general mortality in elderly patients is lower.3,4
It is therefore unfortunate that Hippisley-Cox and Coupland say that treatment including statins improves survival rather than emphasising the simple point of selection bias—that is, of not being in the “low cholesterol” group of elderly people, where increased mortality may well be concentrated and cholesterol lowering treatment was not indicated.
This cohort study could lead to “could have” medicine, whereas in a high risk population of virtually identical age, the placebo controlled PROSPER study (surprisingly omitted as reference) found absolutely no mortality benefit but increased cancer in a statin group with fewer smokers.5
Competing interests: None declared.