Tuesday, September 22, 2009

Mortality & Cholesterol - not what most Americans think

From Hyperlipid: link here
"Lowest mortality observed when total cholesterol (t-C) is 200-240 mg/dl, low t-C linked to more infectious and parasitic diseases and also low t-C maybe associated with higher CHD (could atherosclerosis be an infectious disease?)"

Interesting stuff. Tip o'the hat to my buddies Zim and Ron for their links to Hyperlipid.


  1. i'm always wary of looking only at total cholesterol. i have to think that the benefit comes from high HDL and low tri's, and not just any "configuration" adding up to that total.

  2. Zim, congratulations, you have a more sophisticated understanding of cholesterol than 95% of all primary-care physicians. Basically almost anyone with TC over 200 in the US these days will walk out of their doctor's office, confused and scared, with a prescription for the statins.

  3. Another nice graph, showing cholesterol & mortality by age: http://4.bp.blogspot.com/_zULJExxrW54/SmaBHOF3S5I/AAAAAAAAAh4/Q72JhytoYaE/s1600-h/Oku+Framingham+chol+mortality.jpg

    As Stephan says, "If you're 80 or older, and you have low cholesterol, it's time to get your affairs in order."

  4. if that 95% is accurate, that's depressing. if they're behind the curve on TC vs HDL/LDL/tri's, how long until they understand that total calculated LDL is also useless?

    perhaps once the statin patents wear out?

  5. I'm not ready to give up my statin just yet: http://www.ncbi.nlm.nih.gov/pubmed/18448847

    While high TC may not be associated with early mortality
    There is an association between high MIDLIFE TC and later dementia. There is some evidence that this is also associated with APOE4 status.

  6. uht oh... let the comment retorts begin to fly... 4... 3... 2... 1... (hunkering down in a bunker, closing the blast doors, knowing what will likely be incoming from Chicago, London, and elsewhere... zoiks!)

  7. Wow, you're on statins? That is shocking. Seriously. Not a single controlled study has EVER shown a mortality benefit to women of any age. There is no good evidence that statins help women at all.

  8. Despite the language in the writeup, the hazard ratios in the study you cite are fairly mild (HR or RR of less than 2 generally doesn't get my attention). This seems a little more worrying: http://www.neurology.org/cgi/content/abstract/01.wnl.0000306313.89165.efv1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=whitmer&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT. So dementia is associated with obesity, diabetes, big ol' gut, and insulin resistance. I'd say lay off the sugar and starch!

    The sad thing is, as zim points out, TC is pretty much a useless measure. Would have been wonderful if we could see midlife LDL-P, trigs, HDL, associations with later dementia. If you eat a ton of fructose and not much in the way of good fats, you'll have sky-high trigs and low HDL (and you'll set yourself up nicely for round middle and insulin resistance). Someone with a similar TC but low trigs and high HDL correlates with much happier outcomes.

  9. I'm on statins at the advice of my physician after a 10 year long upward trend in LDL and triglycerides. (even though my HDL is very good). Family history for CVD is not on my side. I think there are enough studies to show an association with cholesterol and dementia to show there is something going on. But maybe that something is insulin resistance with high cholesterol--I agree that laying off the sugar and simple starch is health, and therefore, neuroprotective. (i'm very protective of my brain) But still the biggest risk factor for AD is age.

  10. i was just reading some positive press on cholesterol.


    statins scare the hell out of me. This piece on oxLDL especially.

  11. Your physician is not acting on hard science, but rather on the guidance of drug company reps (even ostensibly impartial "public" orgs have massive conflicts of interest).

    Of the guys I like to read, one of the more moderate is a practicing cardiologist who is much more skeptical of red meat and saturated fat than I am, and does prescribe statins, but only sparingly for specific reasons. Rather than bombard you with statin-haters, here are a couple of reasonable posts:

  12. Cool -- the midlife cholesterol & dementia study is available for free. The hazard ratios still make me yawn, but it's interesting to note that higher TC levels are associated with higher AD incidence but lower VaD incidence. I also appreciated the discussion, especially "No relationship between midlife serum total cholesterol
    and the risk of AD was found in the HAAS study"
    and, even better, "As the CAIDE and HAAS studies
    have shown, the pattern of change in cholesterol levels
    after midlife is also important; a decline in serum total
    cholesterol after midlife may be associated with early
    stages in the development of dementia"
    [emphasis mine]

    In general my points are: observational studies are useful for generating hypotheses but do not show causation. Nor do risk factors show causation. If you base treatment solely on reduction of risk associations from observational studies, you could very well be treating a symptom and not a cause.


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