As We Age, Cholesterol Level Loses Its Value as a Risk Factor

Because both a high total cholesterol level and a high LDL-cholesterol level are risk factors for heart disease, statin drugs, which lower both levels, are widely prescribed. In the U.S., more prescriptions are written for Lipitor, the most popular statin, than for any other drug. Estimates for the number of people who take statins range between 11 million and 30 million. But should so many people be taking statins? A recent analysis, in which scientists reviewed 14 studies that included data from over 34,000 patients, showed little evidence that statins prevent heart trouble in patients with no history of cardiovascular disease. And because there is some evidence linking low cholesterol levels with increased risk of death from other causes, the study authors feel that doctors should be more cautious about prescribing statins.

An important factor to consider when deciding whether or not to prescribe statins is the patient’s age. A study by Kronmal et al., entitled, “Total Serum Cholesterol levels and mortality risk as a function of age” in the Archives of Internal Medicine (vol. 153, pp. 1065-1073, 1993) examined how age affected the ability of cholesterol level to predict the risk of dying, and it showed that the predictive value declined with age.
The most important consideration when judging mortality risk is the overall likelihood of dying from any cause. In that regard, at age 40, those people with higher total serum cholesterol levels had a significantly higher all-cause mortality risk. However, the relationship declined with age, and by age 60, the relationship between total cholesterol level and all-cause mortality had vanished. By age 80, the relationship actually reversed, so that those with higher cholesterol levels were at significantly lower risk of dying.

Looking specifically at the risk of death from coronary heart disease, the death risk at ages 40, 50, and 60 years was greater for those with higher cholesterol levels, although the effect got smaller with age. By age 70, the relationship was still positive but weak, but by age 80 the relationship reversed, and those with higher cholesterol levels actually had less chance of dying.

Looking at death due to causes other than heart disease, (e.g. cancer), from age 50 on, there was a lower risk of dying as cholesterol levels rose. This apparent protective effect of cholesterol against non-heart-disease death increased with age. Seventy-three percent of 80 year-old men with cholesterol levels above 240 survived for 5 years, while only 49% of those with levels below 240 did. The effect was in the same direction but weaker for women, with a 74% and 70% 5-year survival rates for women with cholesterol levels respectively above and below 240 mg/dl. In regard to cancer alone, higher cholesterol level was associated with lower death risk.

Bottom Line
The current practice of the medical establishment of prescribing statins to anyone with a total cholesterol level above 200 appears to be unjustified. For patients with elevated cholesterol levels and a history of heart disease, statins provide a proven reduction in risk. However, for patients with mildly elevated levels and no history or heart disease, the evidence in favor of prescribing statins is weak or nonexistent. And for men above age 70, even those with cholesterol levels above 240, statins could very well increase the risk of death.

Heart Attack Deaths in the U.S. Have Dropped Sharply

In the Harvard Health Letter, vol 35, no. 10, August 2010, and article appeared entitled, "Is the heart attack going out of style?". It stated that, based on Medicare data, the U.S. heart-attack hospitalization rate declined by 23% from 2002 to 2007. Also, a study based on 3 million members of a northern California health plan showed a 24% drop in heart attack hospitalizations between 1999 and 2008. While an increasing number of people are diagnosed with heart disease, fewer are dying from it - heart attack deaths have been declining in the U.S. for the past 40 years.

The article conjectures that, "Maybe decades of efforts to eat right and exercise more, stop smoking, lower LDL cholesterol levels, and control blood pressure are working." This appears only partially true. Yes, fewer Americans smoke, and Lipitor, a medication for reducing LDL and total cholesterol, is the most prescribed drug in the U.S. Many people are also taking blood pressure medication. Yet, there is little evidence that people are "eating right" as fast-food consumption and obesity continue to increase. Also, various national campaigns, such as the American College of Sports Medicine's Healthy People 2000, have failed dismally to get people to exercise more. Thus, it appears that the reduction in heart attacks is less due to anything that requires will power than to modern medicine. Another possible factor is reduced stress, as the economy was doing well over the study period. It remains to be seen what the recession and high unemployment rate will do to the heart attack rate. Hopefully, and emphasis on family and personal fulfillment and relationships will help keep stress to a minimum, even in the face of economic difficulties.

The reduction in heart attacks is encouraging, yet it would be even better if people became healthier through lifestyle changes such as exercise and good nutrition.

FDA Warns That Statin Drugs Can Cause Muscle Damage

Statins, the most widely prescribed medications in the world, have been widely recognized to cause muscle pain and weakness in a small percentage of users. Now, the U.S. Food and Drug Administration has issued a warning that Zocor, a popular version of simvastatin, can cause muscle damage, particularly when used in its highest approved dosage (80 mg). What makes this even more dangerous is that muscle damage results in the release into the blood stream of large proteins that are not easily flushed through the kidneys. This can result in kidney failure and death. Admittedly, fatal problems due to statins are highly unlikely. Nevertheless, the problem is very serious for susceptible individuals. The 80 mg dose should be avoided, if possible, and patients must be encouraged to lower their total and LDL cholesterol by more natural means (e.g. weight control, exercise, reduced consumption of saturated fat and cholesterol). It is unfortunate that so many people see statins as the easy way out. Who wants to control one's eating and activity level when a pill will do? Mens-fitness-and-health.com believes that MOST people can keep their total and LDL cholesterol levels within recommended ranges if they follow a healthy lifestyle. Drugs should only be used as a last resort. See our natural methods for reducing total and LDL cholesterol levels.