The Cholesterol Paradox

Dr. Weeks’ Comment:  For far too long, doctors have targeted cholesterol as the culprit in heart disease. High cholesterol was called “bad” and low cholesterol was the goal.  Too simplistic?  Yes!  Now we see that low cholesterol is DANGEROUS.

 

Here is the 2007 paradigm shifting article Lipids in Aging and Chronic Illness: Impact on Survival

“Hypercholesterolemia has been implicated as a risk factor for atherosclerosis by numerous observational studies in the general population. Observational studies in patients suffering from various chronic illnesses and in individuals with advanced age have indicated an inverse association between cholesterol level and mortality, suggesting that the classical Framingham paradigm may not apply to these groups. It is yet unclear what the reasons for these paradoxically inverse associations are. We present a summary of the descriptive studies that have examined the association between cholesterol levels and outcomes in a variety of patient groups. The various possible mechanisms behind the observed “lipid paradox” and the potential implications of reverse epidemiology of hypercholesterolemia in clinical medicine and public health are discussed…..

Chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) affects approximately 16 million Americans and is the fourth leading cause of death worldwide [42]. Cardiovascular mortality accounts for roughly 50% of deaths in COPD patients, [42] but the relationship between cholesterol and mortality is reversed in these patients too. While studies examining cholesterol and outcomes in COPD are sparse, one large study found a trend towards lower risks of hospitalizations and death in men with COPD who had higher cholesterol levels [43].

Reverse causation

“It is possible that lower cholesterol is not the cause but merely a consequence of conditions that lead to poor outcomes in patients with chronic disease states who exhibit a paradoxical risk factor profile. Reverse causation is a known possible source of bias in epidemiologic studies that examine associations without a clear distinction for the direction of the causal pathway. While it is plausible to attribute the association between low cholesterol and higher mortality to reverse causation, this fails to explain why high cholesterol is associated with better outcomes in the populations discussed above.”

“Changing our current practice pattern could take 40 or more years, but we may one day prescribe cholesterol-raising medications to certain patients. After all, paradigm shifts can lead to scientific revolutions.”

 

 

AND

and watch this video about a patient refusing a statin drug!

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Dr. Weeks’ Comment:  For far too long, doctors have targeted cholesterol as the culprit in heart disease. High cholesterol was called “bad” and low cholesterol was the goal.  Too simplistic?  Yes!  Now we see that low cholesterol is DANGEROUS.   Here is the 2007 paradigm shifting article Lipids in Aging and Chronic Illness: Impact on…
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