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Is High Cholesterol Actually Bad for You?

by Dr. Sharon Orrange on June 29, 2016 at 10:50 am

High cholesterol may be much ado about nothing, especially in older folks. A recent meta-analysis published in BMJ Open raises a strong argument that lowering LDL cholesterol in older people doesn’t help at all.

Where does this leave us? Are we over-treating millions of folks with cholesterol lowering drugs, “statins” like Lipitor (atorvastatin), Crestor (rosuvastatin), and Zocor (simvastatin)? Let’s take a look.

After reviewing 19 studies with over 68,000 people here are 6 things we know:

  1. Previous research has shown a weak association between total cholesterol and death in folks over the age of 60. Most people in this current study were 65 – 85 years of age.
  2. Many of you take cholesterol lowering drugs because some studies have shown you can lower your risk of death from stroke and heart disease by lowering LDL (“bad”) cholesterol with statin medications. Turns out, that is seen most often in younger people.
  3. This new widespread review showed no association between LDL cholesterol and mortality among people older than 60 years. So even high “bad” cholesterol was not found to increase risk of stroke and heart disease in people older than 60.
  4. Our way of thinking about cholesterol may need to change. Because atherosclerosis (plaque buildup in your arteries) starts mainly in middle-aged people and becomes more pronounced with increasing age, there should be an even greater risk of heart attack over time—if untreated high cholesterol was a factor. Why is high cholesterol a risk factor for heart attack and stroke in the young and middle-aged, but not in elderly people? We don’t really know.
  5. What does this mean for the use of statins in older people? They are likely over prescribed. Most statin trials have shown little effect on cardiovascular disease and mortality, with best results showing a 2% reduction in mortality.
  6. This review will again ignite the debate about the cause of atherosclerosis and heart disease and whether the benefits from statin treatment have been exaggerated.

Confused? Where are we now on the use of statins to lower cholesterol if we aren’t even sure lowering LDL cholesterol in folks over 60 years of age helps? For now, those of you between the age of 40 and 65 should check out a risk calculator to see where you stand.

If your 10 year risk is higher than 7.5% according to the calculator, you should talk to your doctor about the risks and benefits of statins.

What do we know for sure? If you score above the 7.5 percent largely because you smoke or have high blood pressure, the best thing you can do is quit smoking or control your blood pressure. That may be enough to get you below the cutoff, so you don’t need to start on statin therapy. Lifestyle changes also help reduce risk so diet and exercise changes are a no brainer.

Dr O.

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