What do you think when you hear the words ‘raised cholesterol’? For many people, these words are synonymous with ‘heart disease’ and an early demise. It is this reaction that underpins the idea that putting downward pressure on blood cholesterol levels is inherently good for us.
There are many potential flaws in this thinking, though. One major issue concerns the fact that while raised cholesterol is associated with an increased risk of heart disease, it is associated with a reduced risk of other conditions including cancer. None of this evidence proves that raised cholesterol protects against cancer, but then again, this sort of evidence does not prove that raised cholesterol causes heart disease, either.
However, if we are to judge the relationship between cholesterol and health, it makes sense to take as wide a view as possible, and this generally means focusing on overall risk of death (which captures all conditions).
Elderly individuals are generally at a greater risk of death than younger ones, so what is the relationship between cholesterol levels and overall risk of death in this population? A study just out looked at the relationship between cholesterol levels and overall risk of death in Swedish adults aged 70-90 [1]. The results showed no association here (in other words, ‘raised’ cholesterol levels were not found to be associated with an increased risk of death).
However, this study also assessed the relationship between the taking of statin drugs and overall risk of death. Individuals taking statins at age 85 were at a significantly reduced risk of death between the ages of 85 and 90.
Again, this sort of evidence does not tell us if statins actually reduced the risk of death (only that these two things are associated with each other). In fact, if lower cholesterol was not found to be associated with reduced risk of death, but taking cholesterol-reducing statins was, then this supports the idea that any benefit statins may have is not due to their cholesterol-reducing properties.
However, in reality, it may be that statins have no benefits in terms of reducing the risk of death at all. It might be that the association between statin taking and reduced risk of death is due to the fact that statin-takers are more health-conscious than those who do not, or perhaps they tolerate statins better and are inherently healthier individuals.
We can be much better informed about the impact of statins on overall risk of death by looking at the results of ‘randomised controlled trials’. A relevant review of the evidence was published earlier this year in the Journal of the American College of Cardiology [2]. Here, the results of several similar studies were pooled together in the form of what is known as a ‘meta-analysis’. The study focused on elderly individuals who had no history of established cardiovascular disease.
This study found that while statins reduced the risk of heart attack and stroke, death from these conditions was not reduced, and neither was risk of overall risk of death.
So, while the first study showed an association between statin use and reduced risk of death, evidence from clinical trials shows no benefit in reality. This last study asks further questions about the widespread use of statins in healthy individuals, including the elderly. Even in a group at relatively high risk of succumbing to cardiovascular disease and death by virtue of their age, the evidence shows that statins do not save lives.
References:
1. Jacobs JM, et al. Cholesterol, Statins, and Longevity From Age 70 to 90 Years. J Am Med Dir Assoc. 2013 Oct 3 [Epub ahead of print]
2. Savarese G, et al. Benefits Of Statins In Elderly Subjects Without Established Cardiovascular Disease. A Meta-Analysis. J Am Coll Cardiol. 2013 Aug 14 [Epub ahead of print] [hr]
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