Cholesterol is a word that strikes fear into the heart. But does it also strike disease? Because here’s the curious thing: having a high cholesterol level is associated with living a longer life, especially if you have heart disease. Confused? Of course you are! Welcome to the cholesterol paradox.
The term “cholesterol paradox” was coined as early as 2006 (if not before), when a study of data collected from 24 countries, involving nearly 11,000 patients with heart disease, found that “Low cholesterol levels were associated with worse prognosis in patients with acute heart failure.”
That was just the start of it. Since then, many studies have been published that discuss this baffling observation, one that has been replicated many times.
Indeed, raised total cholesterol has been shown to be a predictor of survival — in a study of 114 patients with chronic heart failure, the chances of survival increased by 25% for each mmol/l increment in total cholesterol. Similarly, it has been found that most — nearly 75% — of people who are admitted to hospital with heart attack have normal cholesterol levels.
How is it possible to make sense of all this? Easy. Just call it a paradox and ignore the cognitive dissonance.
Nobody argues that cholesterol is essential to life. This fat-like substance, made in the liver, is present in every cell of the body. It is needed to make hormones and to make vitamin D. It is a component of the cell membrane and plays a key role in the immune system. The brain has the highest concentration of cholesterol in the body, where it is involved in nerve transmission and memory recall. So vital is it that the brain makes its own supply.
Drugs designed to reduce cholesterol in the body — statins — are among the most prescribed in the world. In 2019, Atorvastatin was the most widely prescribed drug in both the UK and US.
“The recently presented ACCELERATE trial dumbfounded many experts by failing to demonstrate any cardiovascular benefit of evacetrapib (cholesterol-lowering…