Cholesterol lowering... does it make you live longer?

[bulkbiker]

https://jcbmr.com/index.php/jcbmr/article/view/35/75

Seems not.

Oops

 

[Oldvatr]

Interesting approach here. Significant changes in HDL and / or LDL in patients already on statin therapy and still resulting in no significant change in outcome. Based on RCT trials already performed by others, so evidence based. This reinforces the meta study published last year on statins that showed no real benefit from statin therapy for women and all patients except a slight benefit to those recovering from an existing CVE. As was pointed out in that meta study, someone on max dosage of the trial statin for 40 years solidly migh possibly increase their lifespan by a day or so. That is what the HR evaluated to in effect.

This paper described in the following link explains how statistics can be used to re interpret study results. It is from a source that I have not validated so nay be equally biassed in the opposite sense, but I agree with the general tenet made regarding the use of relative risk (RR ) to portray results in a new light.
https://www.sciencedaily.com/releases/2015/02/150220110850.htm

 

[Oldvatr]

Here is another paper on similar subject by one of the authors of the OP article.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513492/

 

[NicoleC1971]

I walk with a bunch of type 2s and as far as the general public and their gp goes the narrative and the treatment targets that follows remains something like this:
Your arteries are injured because you are diabetic and your body will stick a sticking plaster onto the wound. If too many sticking plasters are patched in, one will eventually break away and cause a stroke or heart attack' A statin will reduce this process. If you are diabetic you must take a statin (and I will get a brownie point if you do).
I usually advise that some good questions to ask are Will I live any longer if I take this drug? How many people would need to take this drug before a CVD event was prevented ? (Number needed to treat)?
Thanks for the papers though as I think I will be asked to take statins at my next diabetology appointment and it is always good to keep an open mind given that some doctors think statins should be in the water supply and others feel they are solving the wrong problem....

 

[Resurgam]

I saved this just to print off and hand to HCPs with a hopeful smile and a prescription for statins.
cholesterol

Abstract from bmjopen.bmj.com

Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review


Objective It is well known that total cholesterol becomes less of a risk factor or not at all for all-cause and cardiovascular (CV) mortality with increasing age, but as little is known as to whether low-density lipoprotein cholesterol (LDL-C), one component of total cholesterol, is associated with mortality in the elderly, we decided to investigate this issue.

Setting, participants and outcome measures We sought PubMed for cohort studies, where LDL-C had been investigated as a risk factor for all-cause and/or CV mortality in individuals ≥60 years from the general population.

Results We identified 19 cohort studies including 30 cohorts with a total of 68 094 elderly people, where all-cause mortality was recorded in 28 cohorts and CV mortality in 9 cohorts. Inverse association between all-cause mortality and LDL-C was seen in 16 cohorts (in 14 with statistical significance) representing 92% of the number of participants, where this association was recorded. In the rest, no association was found. In two cohorts, CV mortality was highest in the lowest LDL-C quartile and with statistical significance; in seven cohorts, no association was found.

Conclusions High LDL-C is inversely associated with mortality in most people over 60 years. This finding is inconsistent with the cholesterol hypothesis (ie, that cholesterol, particularly LDL-C, is inherently atherogenic). Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis. Moreover, our study provides the rationale for a re-evaluation of guidelines recommending pharmacological reduction of LDL-C in the elderly as a component of cardiovascular disease prevention strategies.

 

[mariefrance]

Thanks bulkbiker and Oldvatr for these articles. I've downloaded them and will read later.

Edited:
Resurgam - thanks for this too. I think I've got it (found it when you've previously mentioned it, maybe?) but will doublecheck. I find it really helpful to keep on top of the research as I'm regularly asked about going on to statins.

 

[Oldvatr]

I saved this just to print off and hand to HCPs with a hopeful smile and a prescription for statins.
cholesterol

Abstract from bmjopen.bmj.com

Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review


Objective It is well known that total cholesterol becomes less of a risk factor or not at all for all-cause and cardiovascular (CV) mortality with increasing age, but as little is known as to whether low-density lipoprotein cholesterol (LDL-C), one component of total cholesterol, is associated with mortality in the elderly, we decided to investigate this issue.

Setting, participants and outcome measures We sought PubMed for cohort studies, where LDL-C had been investigated as a risk factor for all-cause and/or CV mortality in individuals ≥60 years from the general population.

Results We identified 19 cohort studies including 30 cohorts with a total of 68 094 elderly people, where all-cause mortality was recorded in 28 cohorts and CV mortality in 9 cohorts. Inverse association between all-cause mortality and LDL-C was seen in 16 cohorts (in 14 with statistical significance) representing 92% of the number of participants, where this association was recorded. In the rest, no association was found. In two cohorts, CV mortality was highest in the lowest LDL-C quartile and with statistical significance; in seven cohorts, no association was found.

Conclusions High LDL-C is inversely associated with mortality in most people over 60 years. This finding is inconsistent with the cholesterol hypothesis (ie, that cholesterol, particularly LDL-C, is inherently atherogenic). Since elderly people with high LDL-C live as long or longer than those with low LDL-C, our analysis provides reason to question the validity of the cholesterol hypothesis. Moreover, our study provides the rationale for a re-evaluation of guidelines recommending pharmacological reduction of LDL-C in the elderly as a component of cardiovascular disease prevention strategies.

Sorry, but this study was apparently withdrawn by the BMJ as being biassed and of inadequate quality. It is still showing in the Lancet
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31942-1/fulltext
Check with BMJ before using it for onward referral. I was unable to find any reference to it on bmjopen

There has been a revisited analysis done to replace it
https://www.medscape.org/viewarticle/910162

 

[Resurgam]

I'll look at the revisited analysis when I can do the logging in - first thought though is that they are not going to get far on reevaluating one aspect of the original study - age at death seems pretty fixed in stone.....

 

[Bogie]

"Lower Cholesterol - Does it make you live longer?". A small but very broad question.

Research results and opinions on Cholesterol has varied over time - especially in the last couple of years. Personally, I revert back to my stand that everybody has a different "combination lock" to their physiological makeup.

Is there a history of high or low Cholesterol in your family (immediate or previous generations)?

Is there a history of Cardiac problems, Cancer, or serious illnesses/inflictions in your family line?

What has the lifespan of your family line been? Keeping in mind that we seem to be living longer, on average, with each generation. Quality of medical care has dramatically improved.

Average lifespan now seems to be around 85 yrs old (male or female). Note: AVERAGE lifespan. My mother is 94 with T2D on insulin and has a mild dementia. My wife's parents both died in their late 60s and 3 of her 4 siblings died years ago. My family siblings are fine, except for myself and one sister with T2D (thanks Mom!). My father was the anomaly and died at 60 from cancer (brain tumour). None of my family have Cholesterol issues to speak of. My youngest sibling (of 5) is 60.

What is your lifestyle, diet, exercise routine (if any), weight (and this can be hereditary), and medications you are on for "whatever"?

I think you can see why "Does Low Cholesterol Make You Live Longer" is a very hard question to answer.

That said, my Cholesterol was on the "high side of good" as my doctor used to tell me. After diagnosis of T2D my Endo wanted me on Statins to lower it a bit ... and it did (quite a bit) - as shown in my signature. No history of Cholesterol problems in my family but why tempt it I am 71 and feel 20 years younger than my actual age and still work 8-12 hrs per day (another factor in a healthy makeup as I stay active).

 

[PatsyB]

I was given simvastatin when i was about 62.... ended up with Diabetes when I was 66 so i believe these tablets caused it but the Nurse told me if i didn't take the tablets i most probably be dead by now needless to say i do nto see that Nurse anymore laughs

 

[aard]

I think genes have a lot to play, all my family on both sides had diabetes (going back multiple generations), all had poor lifestyle, drank to excess, no exercise etc. all ate cakes etc despite diabetes.

Nearly every one lived into their eighties/nineties. All were independent and relatively healthy before they died. Only the few smokers died early.

 

[Oldvatr]

Just an observational thought. but diabetes is associated with raised LDL-C levels. I think there is a sensible and logical explanation. for that. When diabetes reduces the utilisation of glucose for energy, the body switches to using lipids instead. So the liver creates more LDL to transport them in the blood. This is an automatic reaction, and it has been found that the alpha cells detect the [high glucose + high insulin] status, and starts releasing other enzymes and co-trsnsporters to kick start an emergency response. This response has been shown to open up another pathway into the beta cells to increase insulin output, and there may be other psthways opened up to trigger fat burning which also needs insulin. So it is no surpride to me that our bodies would react like this. What I cannot explain is the reaction from the medical profession.

 

[Deleted member 543160]

AFAIK , my body decides how much cholesterol I need.

I was on long term statins before I ended up with T2, and believe they may have been a partial trigger. I eventually refused to take them any longer, had slight improvement in my glucose levels, very little change to actual cholesterol, and will be 80 this year and am still alive and kicking. My mum who tended to avoid doctors where possible, ended lived to be in her mid 90s, and her sister and my father both died in their 80s. And for what it's worth as a family we always ate normal (full) fat, moderate carbs, 3 meals a day. It was only when I ended up eating high carbs as well (thanks to husband's choice of shopping & cooking) that I ended up firstly with dreadful brain fog and later with diabetes. Cutting the carbs back down again and relying on burning fats/ketones definitely improved matters. and I'm still relying on that fat to keep me going.

And my GP (who originally suggested I tried the Atkins diet) looks at my long term pre-diabetic figures and has actually agreed "no more statins".

 

[Resurgam]

There seems to be a growing amount of actual analysis of data from population studies which shows that elderly people with higher TC, LDL and HDL show lower all cause mortality compared with those with lower lipoprotein levels. There are also reports that over half the people attending cardiology clinics have lower than average cholesterol.
Having medical people urging me to try to achieve something which could actually reduce my lifespan whilst making me feel absolutely dreadful (from previous experience) is quite concerning.

 

[Oldvatr]

There seems to be a growing amount of actual analysis of data from population studies which shows that elderly people with higher TC, LDL and HDL show lower all cause mortality compared with those with lower lipoprotein levels. There are also reports that over half the people attending cardiology clinics have lower than average cholesterol.
Having medical people urging me to try to achieve something which could actually reduce my lifespan whilst making me feel absolutely dreadful (from previous experience) is quite concerning.

I have seen such reports, and agree with both the points you make here

 

[Oldvatr]

I can remember reading a study from an Australian Hospital where they found that post mortems on many indivuals who had passed due to cardiac events had low LDL readings., and that there seemed to be no evidence that high LDL was connected to heart disease. However this study has been withdrawn because it is known that LDL decays naturally after death, and that this was the effect that was observed, making the study unsound.

Now I remember that this team went back to the pre death medical history and manged to re-associate with their findings, but this action was halted by legal means. They were unable to complete their follow up.

So I am delighted to find that somone else has picked up the challenge and indeed has gone back deeper into history too to update the findings
https://academic.oup.com/qjmed/article/95/6/397/1559536

These studies were instrumental in me coming to my conclusion to not take statins, but up till now the evidence had been suppressed.

I also found this study report in the Lancet:
https://www.thelancet.com/journals/lancet/article/PIIS0140673601055532/fulltext

 

[Outlier]

The latter study seems only to have been made only on men. Sigh. Half the population that other studies show respond differently to cholesterol just don't count.

 

[Oldvatr]

The latter study seems only to have been made only on men. Sigh. Half the population that other studies show respond differently to cholesterol just don't count.

Many studies in the US use the VA (Veteran Affairs Dept) hospitals and care homes for their studies. It is a fairly static, sedentary, and captive cohort that is already catered for by the institution. They are good sources of elderly participants, and a goodly supply of cardio patients.