Cholesterol Guidelines for Older Adults

In a previous page titled The Great Cholesterol Scam I reported the lack of any benefit from cholesterol lowering medications in older adults unless heart disease is present.

So, a senior citizen found to have a high blood cholesterol level, if otherwise healthy, is probably not a candidate for statin therapy regardless of what the coercive drug company ads suggest.

But, if a senior has evidence of serious atherosclerotic disease, their risk status becomes that of a much younger person and statins may well be justified along with other anti-inflammatory medications to minimize heart attack and stroke risk. Statins are used in these cases, in my opinion, because of their inherent anti-inflammatory action, not for any effect on cholesterol.

The more we study cholesterol the more we learn about how vital this substance is to our body. With the exception of familial hypercholesterolemia, a serious genetic illness, the cholesterol value each of us has should be considered as natural, the optimum value for each of us. My value would not be right for you, nor would yours fit me. There is no such thing as a natural value. In most cases they are all natural whether 150 or 350. Earlier in my writings I have said that we have far more to fear from low cholesterol than high. The following two papers illustrate this fact.

In 2003, Onder and others correlated serum cholesterol levels with in-hospital mortality and reported their findings in the American Journal of Medicine. Onder reached the conclusion that among older hospitalized adults, low serum cholesterol was an independent predictor of short-term mortality. In other words, for this group, the lower the cholesterol the greater was the risk of dying soon, fitting quite well with my statement.

In 2006, this same group led by Onder reported on the correlation between serum cholesterol and recovery from disability among hospitalized older adults, finding that the lower the serum cholesterol the more prolonged the recovery and return to the activities of daily living. Both of these studies were simple statistical analyses of hospital records but they make the point - low cholesterol correlates with ill health and increased risk of dying.

And the cholesterol values Onder was reporting as low were far in excess of today's desirable target cholesterol levels of 100 (or 70 for those people at particularly high risk). To these reports should be added studies revealing poor cognitive ability associated with low serum cholesterol and several recent articles on low serum cholesterol appearing to contribute to aggressive behavior.

You have to remember that today's physicians are still trying to recover from four decades of anti-cholesterol brainwashing, I know because I was one of them. Only recently have we learned that cholesterol is probably not the cause of atherosclerosis, inflammation is. Now it appears, the reason statins work their magic has nothing to do with cholesterol manipulation. Statins are powerful anti-inflammatory agents, a fact learned only in the past few years and completely unexpected.

The ears of today's MDs are still deafened to the reality of cholesterol's innocence but soon they will understand. Several years ago it was only a few website publications presenting this to MDs. Now it is their journals. That is a big step.

Duane Graveline MD MPH
Former USAF Flight Surgeon
Former NASA Astronaut
Retired Family Doctor

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