Low cholesterol increases total mortality in the middle-aged
Children and the elderly have both been shown to have higher death rate with low cholesterol levels. That leaves the middle aged.
Amongst men in their forties there does seem to be a correlation between high cholesterol and greater coronary death rates. But here again we find that total mortality is highest in men whose blood cholesterol is lowest — less than 4.8 mmol/l (185 mg/dL). These deaths are largely due to cancers and other non-cardiovascular causes.
In this age group, while the lowest total mortality was seen between 4.8 mmol/l and 5.4 mmol/L (185-208 mg/dL), it rose only slightly as cholesterol concentrations rose above 5.4 (208 mg/dL); it was considerably higher below 4.8 (185).
In 1993 Dr M G Dunnigan, writing that both primary and secondary trials had shown a significant number of excess deaths from non-cardiac causes: cancer, violence and suicide, and pointing out that a meta-analysis of 35 randomised controlled trials (RCTs) had little relevance to the non-symptomatic person under 65, said:
'Without definite data on all-cause mortality and with current unresolved concerns about excess deaths from non-cardiac causes in RCTs, decisions to embark on lifelong lipid lowering drug treatment in most patients with primary hypercholesterolaemia depend on the doctor's interpretation of available evidence. . . this varies from evangelical enthusiasm for lowering lipid concentrations to therapeutic nihilism.'
So low levels of cholesterol in the blood aren't beneficial even for the group most likely to suffer from heart disease!
1. Wannamethee G, Shaper AG, Whincup PH, Walker M. Low serum total cholesterol concentrations and mortality in middle aged British men. BMJ 1995; 311: 409-13
2. Dunnigan M G. The problem with cholesterol: No light at the end of this tunnel? BMJ 1993; 306: 1355-6.
Part 4: Young deaths
Part 5: Middle aged deaths
Part 6: Elderly Death — 1 | Part 7: Elderly Death — 2 | Part 8: Elderly Death — 3