Millions of people around the world take statins to reduce their risk of heart attack and stroke. But new research suggests they may be wasting their time: an international team of scientists has found no link between high levels of low-density lipoprotein (LDL) cholesterol and heart disease in a study of people aged 60 and over.
A team of academics and cardiologists from Scandinavia, the United States, Italy, Japan and Great Britain analysed 19 studies involving a total of 68,094 elderly people. They found that in 92% of cases, older people who had high levels of this LDL (or so-called "bad") cholesterol lived as long or longer, and were in fact less likely to die prematurely from other diseases, including cancer.
For years doctors have been prescribing statins to prevent cardiovascular disease and atherosclerosis, a hardening and narrowing of the arteries, because they were thought to be linked to high levels of cholesterol.
Now the authors are calling for a rethink of guidelines for statin prescriptions. They wrote: “Our review calls for a re-evaluation of the guidelines for cardiovascular prevention, in particular because the benefits from statin treatment have been exaggerated.”
But their findings, published in the BMJ Open Journal, have sparked a backlash from other academics, who say there is a wealth of research showing that cholesterol is indeed linked to cardiovascular disease.
To add to the confusion, another recent study claimed that decades of health advice urging people in England to adopt low-fat, low-cholesterol diets had been disastrous for the fight against obesity.
What do the experts say?
One of the authors of the new study on statins, Dr Malcolm Kendrick, defended the controversial findings as “robust” and “thoroughly reviewed”.
“What we found in our detailed systematic review was that older people with high LDL (low-density lipoprotein) levels, the so-called ‘bad’ cholesterol, lived longer and had less heart disease,” he said.
His co-author, Sherif Sultan, professor of vascular and endovascular surgery at the University of Ireland, said: “Lowering cholesterol with medications for primary cardiovascular prevention in those aged over 60 is a total waste of time and resources, whereas altering your lifestyle is the single most important way to achieve a good quality of life.
“Cholesterol is one of the most vital molecules in the body and, in the elderly, prevents infection, intra-cerebral bleeds, cancer, premature cataracts, muscle pain and fatigue, and thus must be protected and nourished.”
But Professor Colin Baigent, an epidemiologist at Oxford University, said the new study had “serious weaknesses and, as a consequence, has reached completely the wrong conclusion”.
Randomized trials of statin therapy, involving substantial numbers of older people, show “very clearly that people benefit just as much from reducing their cholesterol when they are in their 70s as when they are younger,” he said.
The British Heart Foundation also raised concerns about the new study, arguing that the link between high LDL cholesterol levels and death in the elderly is harder to pin down because, as people get older, more factors determine their overall health.
“There is nothing in the current paper to support the authors’ suggestions that the studies they reviewed cast doubt on the idea that LDL cholesterol is a major cause of heart disease or that guidelines on LDL reduction in the elderly need revaluating,” the charity said.
Consultant cardiologist Dr Tim Chico, from Sheffield University, said he would be more convinced by a randomized study where some patients have their cholesterol lowered using a drug, such as a statin, and others receive a placebo.
He said: “There have been several studies that tested whether higher cholesterol increases the risk of heart disease, by lowering cholesterol in elderly patients and observing whether this reduces their risk of heart disease.
“These have shown that lowering cholesterol using a drug does reduce the risk of heart disease in the elderly, and I find this more compelling than the data in the current study.”