High LDL-cholesterol is beneficial

December 2020

As I told you in one of my newsletters from 2016, we have identified 19 studies, where the authors had followed more than 68,000 elderly people for several years after having measured their “bad” LDL-cholesterol. In most of them, those with the highest LDL-cholesterol lived the longest; none of the studies found the opposite. Since then, 19 more studies have been published and with similar results, which we have documented in a recent paper. In fact, several of the studies found that those with the lowest LDL-cholesterol had the highest mortality. Only two of the studies found a higher mortality among those with the highest LDL-cholesterol. Both of them included young and middle-aged people, and as we have pointed out, young and middle-aged people are more stressed than elderly citizens and stress may raise cholesterol substantially, but may cause heart disease in another way. 

In the largest of these two studies, which included more than five million people, the number who died among those with high LDL-C included less than 0.1 per cent of the participant. Most likely, some of them may have had inherited high cholesterol (familial hypercholesterolemia). 

But doesn´t familial hypercholesterolemia prove that high cholesterol is bad? Ask any professor or doctor and he or she will tell you, that most people with this abnormality may die early from a heart attack if we do not lower their cholesterol. But it is not true.

Several studies have found that on average, people with familial hypercholesterolemia live just as long as other people. It is only very few who die early and the cause is, that they have not only inherited high cholesterol, but also a high level of various coagulation factors. Many observations are in support of this explanation. For instance, cholesterol of those who die early is not higher than that of those who live as long as other people, and in the eighteenth century, where the commonest cause of death was infectious diseases, those with familial hypercholesterolemia lived longer than other people, probably because LDL-cholesterol is an important participant in our immune system. You can read more about that in a paper we published two years ago.

Recently, a Danish study of the general population in Copenhagen was published. The authors´ conclusion was that high levels of LDL-cholesterol were associated with an increased risk of all-cause mortality. They also claimed that “no previous study has examined the concentration of LDL-C associated with the lowest risk of all-cause mortality in a general population cohort.” But in 11 of the 19 population studies included in our study mentioned above, the highest mortality was found among those with the lowest LDL-cholesterol; none of the studies found the opposite. 

A relevant question is, how come that the authors have ignored more than 35 studies with the opposite result? Are they paid by the drug industry?

No, no. In their paper you can read that the authors have ”no financial relationships with any organisations that might have an interest in the submitted work in the previous three years.° However, in the section Conflicts of interest in a paper published this year in European Heart Journal, you can read the following about Professor Børge G. Nordestgaard, the corre-sponding author of the Danish paper: “B.G.N. reports consultancies and honoraria for lectures from AstraZeneca, Sanofi, Regeneron, Amgen, Akcea, Kowa, Novartis, Novo Nordisk”.

In the introduction of the paper, you can also read that “Low density lipoprotein cholesterol (LDL-C) is a well established causal risk factor for the development of atherosclerosis and cardiovascular disease.” Obviously, the authors haven´t read our paper, where we have documented that the cholesterol hypothesis is unable to satisfy any of the Bradford Hill criteria for causality.

Uffe Ravnskov