Defending the Cholesterol Hypothesis in the Elderly

MedPage_Today Defending the Cholesterol Hypothesis in the Elderly

by Jeffrey Dach MD

Med Page Today ran an article by cardiologist Larry Husten, defending the cholesterol theory of heart disease entitled “Cholesterol Skeptics Launch Another Attack”. (1)(10)  Left Image Medpage Today Logo courtesy of Medpage Today.

Uffe Ravnskov Cholesterol Heart Disease StatinDr Husten is responding to an article published in British Medical Journal by Dr Uffe Ravnskov (left image) in which a number of previously published studies contradict the cholesterol theory by showing an “Inverse association between low-density-lipoprotein (LDL) cholesterol and mortality in the elderly”.(2) 

In other words,  higher serum cholesterol in the elderly is associated with decreased mortality.   This directly contradicts the cholesterol theory which states that higher cholesterol should increase mortality from heart disease.  In the elderly, it doesn’t work this way.  Old people tend to live longer if they have a higher serum cholesterol.  Low serum cholesterol in the elderly is a marker for increased mortality.

Cholesterol Theory has Been Falsified

Current accepted dogma proposes cholesterol as the cause of  atherosclerotic plaque, and therefore, reduction of serum cholesterol with a statin drug (left image)  should prevent coronary artery disease. Quite to the contrary, the cholesterol theory has been falsified. According to Dr. William R Ware, there is no correlation between serum cholesterol and the amount of atherosclerotic plaque when reviewing either autopsy studies or coronary calcium score studies.(5)

The lack of relationship between serum cholesterol and calcium score was reported by Dr. Hecht who says:

”There were no significant differences in the calcium scores throughout the entire range of all lipid parameters; calcium percentiles were virtually identical within lipid value subgroups.”(6)

More than a dozen studies show low cholesterol in the elderly is a marker for increased mortality, not improved survival.  In women, cholesterol lowering drugs should not be used as they do not improve survival and do not improve health.

cholesterol Drug AdAlso, in selected medical conditions such as congestive heart failure, haemodialysis, chronic obstructive pulmonary disease (COPD), as in the elderly, higher cholesterol is associated with improved survival, and lower cholesterol with increased mortality.(9) Left Image advertising for the cholesterol theory of heart disease, creating irrational fear .  This has been falsified.

Conclusion:  Med Page Today cardiologist Larry Husten’s misplaced enthusiasm defending the cholesterol theory of heart disease is a sad commentary on the state of cardiology today.  By now, the published data is overwhelming that the cholesterol theory of heart disease has been falsified.

Jeffrey Dach MD

Articles with related Interest:

Low Level Endotoxemia Coronary Artery Disease

Getting Off Statin Drug Stories

The Art of the Curbside Cholesterol Consult

Cholesterol Lowering Drugs in the Elderly, Bad Idea

Cholesterol Lowering Drugs For Women, Just Say No.

Links and References:

1) CardioBrief: Cholesterol Skeptics Launch Another Attack
But most experts say new study is highly flawed by Larry Husten Cardiologist

Michael Blaha, MD, MPH, also of Johns Hopkins, said that he agrees with the authors that LDL by itself is a poor marker of risk in the elderly
According to Blaha, the fact that the role of LDL diminishes with age “has been known for a long time — and in fact is baked into equations like the Framingham Risk Score and the Pooled Cohort Equations.” One reason is that “cumulative exposure to high cholesterol is likely what matters most, thus very high LDL matters more in younger patients, while late-life elevation matters very little.”
In addition, Blaha said, “one must also account for survival bias in these studies,” as the older patients with high LDL are a selected group.

2) BMJ Open 2016;6:e010401 doi:10.1136/bmjopen-2015-010401
Cardiovascular medicine
Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
Uffe Ravnskov1, David M Diamond2, Rokura Hama3, Tomohito Hamazaki4, Björn Hammarskjöld5, Niamh Hynes6, Malcolm Kendrick7, Peter H Langsjoen8, Aseem Malhotra9, Luca Mascitelli10, Kilmer S McCully11, Yoichi Ogushi12, Harumi Okuyama13, Paul J Rosch14, Tore Schersten15, Sherif Sultan6, Ralf Sundberg16

Abstract
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.

3) Uffe Ravnskov The Cholesterol Myths by UffeRavnskov, MD, PhD

4) THINCS For decades, enormous human and financial resources have been wasted on the cholesterol campaign, more promising research areas have been neglected, producers and manufacturers of animal food all over the world have suffered economically, and millions of healthy people have been frightened and badgered into eating a tedious and flavorless diet or into taking potentially dangerous drugs for the rest of their lives. As the scientific evidence in support of the cholesterol campaign is non-existent, we consider it important to stop it as soon as possible.
The International Network of Cholesterol Skeptics (THINCS) is a steadily growing group of scientists, physicians, other academicians and science writers from various countries. Members of this group represent different views about the causation of atherosclerosis and cardiovascular disease, some of them are in conflict with others, but this is a normal part of science. What we all oppose is that animal fat and high cholesterol play a role. The aim with this website is to inform our colleagues and the public that this idea is not supported by scientific evidence; in fact, for many years a huge number of scientific studies have directly contradicted it.

5) Ware WR. The mainstream hypothesis that LDL cholesterol drives atherosclerosis may have been falsified by non-invasive imaging of coronary artery plaque burden and progression. Med Hypotheses. 2009;73(4):596-600.  cholesterol atherosclerosis falsified coronary artery plaque Ware Medical Hypotheses 2009

6) Hecht HS, Superko HR, Smith LK, McColgan BP. Relation of coronary artery calcium identified by electron beam tomography to serum lipoprotein levels and implications for treatment. Am J Cardiol. 2001;87(4):406-12.

7) Ravnskov U, McCully KS. Biofilms, lipoprotein aggregates, homocysteine, and arterial plaque rupture. MBio. 2014;5(5):e01717-14.Biofilms Arterial Plaque Rupture Ravnskov Uffe Kilmer McCully 2014

8) Ravnskov U, McCully KS. Infections may be causal in the pathogenesis of atherosclerosis. Am J Med Sci. 2012;344(5):391-4.  Infections May be Causal in the Pathogenesis of Atherosclerosis Ravnskov McCully 2012

9) Sandek A., Utchill S, Rauchhaus M. The endotoxin-lipoprotein hypothesis-an update. Arch Med Sci. 2007;3(4A):S81.   The endotoxin lipoprotein hypothesis Anja Sandek 2007

10)  CEBM response: “Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review” – a post publication peer review
Here we provide a post publication critical appraisal of the methodology and evidence used to support the findings from the Ravnskov et al paper.

Therefore their search strategy and reporting thereof presents a high risk of bias for missing important and relevant studies.

link to this article: http://wp.me/p3gFbV-3JT

Jeffrey Dach MD
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Summary
Defending the Cholesterol Hypothesis in the Elderly
Article Name
Defending the Cholesterol Hypothesis in the Elderly
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Defending the Cholesterol Hypothesis in the Elderly
Author
Jeffrey Dach MD