“When my doctor told me I had high cholesterol, I was scared. I’ve always heard that it’s a risk factor for heart disease,” says 56-year-old Huang. “However, my health indicators were excellent. Even my doctor told me this some people with high cholesterol live longer. I don’t get it, shouldn’t that be bad?”
Juan’s story is not so exceptional. For many years, cholesterol was considered the worst enemy of health, and reducing its levels was a medical priority. However, recent research suggests that in some groups, especially older people, having this high rate may be associated with longer life expectancy. This phenomenon is called “cholesterol paradox“
Ubiquitous fat
Cholesterol is a fat that is found in all cells of the body and is necessary to maintain their structure. It performs important functions such as cell repair and the production of hormones, vitamin D and substances that aid digestion.
Since fats do not dissolve in the blood, they travel through the bloodstream, attaching to proteins, forming so-called lipoproteins.
There are two main types of cholesterol: “bad” (low-density lipoprotein, or LDL) and “good” (high-density lipoprotein, or HDL). In Spain, for example, the recommended ideal total cholesterol level is less than 200 milligrams per deciliter (mg/dL). LDL limits vary: less than 115 mg/dL for low cardiovascular risk, less than 100 mg/dL for moderate risk, less than 70 mg/dL for high risk, and less than 55 mg/dL for very high risk. HDL levels should be above 40 mg/dL in men and 50 mg/dL in women.
For many years, it was thought that high levels of LDL cholesterol increase the likelihood of heart disease because it can build up on artery walls and block blood flow. However, the link between this fatty substance and mortality is more complex than originally thought.
Controversial restrictions
The evolution of cut-off values in clinical guidelines has generated controversy, particularly regarding the influence of the pharmaceutical industry. With the reduction in recommended LDL cholesterol levels, the number of people treated statinswhich some see as beneficial for the industry. Moreover, the participation of pharmaceutical company-funded experts on the committees developing these guidelines has raised questions about possible conflicts of interest.
Additionally, some studies have questioned the extreme reduction in LDL levels, especially in people without a heart history. In 2016, Danish physician Uffe Ravnskov and his team found that there was no link between high levels of this parameter and an increased risk of death. In fact, many people with higher levels of bad cholesterol lived longer than people with lower levels. Other studies confirm these results.
It’s important to clarify that this does not mean that high cholesterol is good. in people young or middle agedhigh LDL levels actually increase your risk heart disease and mortality.
The cholesterol paradox
There are several theories that try to explain the cholesterol paradox. The most generally accepted view is that LDL may play a role protective in the immune system. Some research suggests that this lipoprotein may help fight infections by binding to and neutralizing bacteria and viruses. This is especially important for older people, whose defense system is usually weaker.
Another theory suggests that other risk factorssuch as high blood pressure, diabetes or smoking have a greater impact on heart disease than cholesterol. A high level of this parameter will not be the main cause, but rather will act in conjunction with other factors.
Does overtreatment occur?
The “Cholesterol Paradox” highlights the fundamental difference between secondary and primary prevention in treatments aimed at controlling cholesterol levels. In high school (for people with history of heart disease), the benefits of using statins are widely supported by scientific evidence: these drugs significantly reduce the risk of future cardiac events.
However, in primary prevention (people without a history of cardiovascular disease), the relationship between lowering LDL cholesterol and reducing cardiovascular risk is less clear and pronounced. In these cases, the side effects of the medication (eg. muscle pain, diabetes and liver problems) may be disproportionate to their potential benefits.
In addition, the expansion of the limits of cholesterol considered “normal” has led to an increase in the number of people without heart symptoms receiving drug therapy. This preventive approach has sparked debate about risk of overtreatment
and the associated cost of prescribing medications to people at low cardiovascular risk. For these patients, the benefit of statins may be minimal, while the side effects and costs of long-term treatment will be disproportionate to the clinical benefit.In conclusion, high cholesterol is associated with cardiovascular disease, but the situation is more complex in older adults. This suggests that treatment should be personalized and balanced as people age.
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