I would like to make a short compilation that should evoke in those regarding high cholesterol as inherently a problem a measure of suspicion. This is the first follow up on the sentiment displayed in the first sentence of The Carnivore Diet by Shawn Baker. The observations go well beyond notions such as “high cholesterol is bad” or “HDL is the good cholesterol whereas LDL is the bad one.”

Ravnskov et al. (2016) Systematic Review

This is a review looking at 68 thousand people aged 60+ across 30 cohorts. Inverse association between LDL cholesterol and all-cause mortality was seen in 16 cohorts; the remaining cohorts showed no association. Also, in 2 cohorts, cardiovascular mortality was highest in those with the lowest LDL cholesterol; in 7 cohorts no association was found.

Lee et al. (2022) Korean Nationwide Study

This study of about 1.4 million 65+ year old Koreans presents many tables and graphs, but there is one I wish to highlight. The hazard ratios are for all-cause mortality. Note how low LDL cholesterol was associated with higher hazard ratios. LDL-j-curve

Wang et al. (2023) Chinese Elderly Cohort Study

This study of about 4500 Chinese elders found that higher HDL, LDL, and total cholesterol levels were associated with lower cardiovascular disease mortality. Also, higher HDL cholesterol levels were associated with lower all-cause mortality.

Budoff et al. (2024) KETO Trial

Carbohydrate restricted diets result in elevation of LDL cholesterol levels. This study of 80 metabolically healthy ~55-year olds showed that high LDL cholesterol levels (190+), induced as a result of carbohydrate restriction, were not associated with arterial plaque burden.

Schroevers et al. (2024) Dementia Prevention Trial

This study of ~3400 elders aged 70-78 shows high total cholesterol is associated with lower dementia risk.

So?

Don’t jump to the conclusion that you need to lift your carbohydrate restriction or take cholesterol drugs just because your lipid profile shows high LDL or total cholesterol numbers. Investigate further. Maybe, no action is needed.

References

  1. Ravnskov U, Diamond DM, Hama R, et al. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review BMJ Open 2016;6:e010401. doi: 10.1136/bmjopen-2015-010401
  2. Lee YB, Koo M, Noh E, Hwang SY, Kim JA, Roh E, Hong SH, Choi KM, Baik SH, Cho GJ, Yoo HJ. Myocardial Infarction, Stroke, and All-Cause Mortality according to Low-Density Lipoprotein Cholesterol Level in the Elderly, a Nationwide Study. Diabetes Metab J. 2022 Sep;46(5):722-732. doi: 10.4093/dmj.2021.0225. Epub 2022 Mar 8. PMID: 35255552; PMCID: PMC9532170.
  3. Wang SS, Yang SS, Pan CJ, Wang JH, Li HW, Chen SM, Hao JK, Li XH, Li RR, Li BY, Yang JH, Shi YT, Li HH, Bao YH, Wang WC, DU SY, He Y, Li CL, Liu M. Cholesterol paradox in the community-living old adults: is higher better? J Geriatr Cardiol. 2023 Dec 28;20(12):837-844. doi: 10.26599/1671-5411.2023.12.003. PMID: 38161338; PMCID: PMC10755211.
  4. Budoff M, Manubolu VS, Kinninger A, Norwitz NG, Feldman D, Wood TR, Fialkow J, Cury R, Feldman T, Nasir K. Carbohydrate Restriction-Induced Elevations in LDL-Cholesterol and Atherosclerosis: The KETO Trial. JACC Adv. 2024 Aug 28;3(8):101109. doi: 10.1016/j.jacadv.2024.101109. PMID: 39372369; PMCID: PMC11450898.
  5. Schroevers JL, Richard E, Hoevenaar-Blom MP, van den Born BH, van Gool WA, Moll van Charante EP, van Dalen JW. Adverse Lipid Profiles Are Associated with Lower Dementia Risk in Older People. J Am Med Dir Assoc. 2024 Sep;25(9):105132. doi: 10.1016/j.jamda.2024.105132. Epub 2024 Jul 6. PMID: 38977201.