It’s a good theory and the priors for it being true are high, but the one study that should have been able to test it directly got the opposite results as the theory would have predicted; patients with consistently low cholesterol over twenty years had higher mortality rate than patients with sudden drops in cholesterol.
One study isn’t enough to draw any conclusions, but it does prevent me from considering the issue completely solved despite the elegance of this explanation.
Fascinating. But note that these are still very old people with declining cholesterol as they age. The study is more relevant to physicians deciding whether to prescribe statins to their elderly patients, and less relevant to young people deciding whether to keep cholesterol low throughout life with diet.
I’d need to read the whole study, but what I see so far doesn’t even contradict the hypothesis I outlined. The abstract says that people who had low cholesterol at the last two examinations did worse than people who had low cholesterol at only the last examination. But most of these old people had declining cholesterol. So maybe this just means that the earlier your cholesterol starts to decline from aging, the sooner you die.
Anyway, I put more stock in the cross-cultural epidemiology and intervention trials, than in these observational studies trying to parse small differences within relatively homogeneous, free-living populations. We know that the longest-lived, healthiest populations in the world ate a low saturated-fat diet that induces low cholesterol. And we know that Dean Ornish was able to reverse heart disease with a lifestyle intervention including a cholesterol-lowering diet. Show me a population as healthy as the Okinawans with high cholesterol, or an intervention as effective as Ornish’s without lowering cholesterol, and I’ll reconsider. Otherwise, I do consider the issue settled from a pragmatic perspective, even if some of the academic questions remain to be answered. That is, it may be possible to have a healthy lifestyle that raises cholesterol, but we don’t have any proven examples of such a lifestyle to emulate, do we? Mike Darwin gave a good explanation of this idea in “Interventive Gerontology”.
It’s a good theory and the priors for it being true are high, but the one study that should have been able to test it directly got the opposite results as the theory would have predicted; patients with consistently low cholesterol over twenty years had higher mortality rate than patients with sudden drops in cholesterol.
One study isn’t enough to draw any conclusions, but it does prevent me from considering the issue completely solved despite the elegance of this explanation.
Fascinating. But note that these are still very old people with declining cholesterol as they age. The study is more relevant to physicians deciding whether to prescribe statins to their elderly patients, and less relevant to young people deciding whether to keep cholesterol low throughout life with diet.
I’d need to read the whole study, but what I see so far doesn’t even contradict the hypothesis I outlined. The abstract says that people who had low cholesterol at the last two examinations did worse than people who had low cholesterol at only the last examination. But most of these old people had declining cholesterol. So maybe this just means that the earlier your cholesterol starts to decline from aging, the sooner you die.
Anyway, I put more stock in the cross-cultural epidemiology and intervention trials, than in these observational studies trying to parse small differences within relatively homogeneous, free-living populations. We know that the longest-lived, healthiest populations in the world ate a low saturated-fat diet that induces low cholesterol. And we know that Dean Ornish was able to reverse heart disease with a lifestyle intervention including a cholesterol-lowering diet. Show me a population as healthy as the Okinawans with high cholesterol, or an intervention as effective as Ornish’s without lowering cholesterol, and I’ll reconsider. Otherwise, I do consider the issue settled from a pragmatic perspective, even if some of the academic questions remain to be answered. That is, it may be possible to have a healthy lifestyle that raises cholesterol, but we don’t have any proven examples of such a lifestyle to emulate, do we? Mike Darwin gave a good explanation of this idea in “Interventive Gerontology”.