Low Cholesterol to “Die For”

I was having an email exchange with my aunt the other day who was lamenting how her husband's doctor told him that his total cholesterol of 117 (!) is one that most people would "die for." Maybe he's right, as we'll see in a minute; but first, I should point out that George is in his late 80's. So, always be careful about assigning causes to correlations. Correlations are great things, but the best way to regard them is as falsification (disproof) of hypothesized causation.

Reader and commenter on this blog, Ricardo, and blogger in his own right at Canibais e Reis has done something truly amazing (and has surely put Ancel Keys in short pants). Lots of this is going to go over the heads of most people, including myself, but I'm quite confident a number of math and health whizzes will be on this project in short order.

Ricardo has essentially combined data from the following sources into a single database anyone can access:

  • UN Food and Agriculture Organization Statistical Yearbook
  • FAOSTAT food consumption database
  • British Heart Foundation Health Statistics database
  • World Health Organization Global Health Atlas

In the end, he had data on 170 countries, which he eventually narrowed to 86 countries in order to get a complete data set for all available parameters. You can read about the whole thing right here. This just scratches the surface of what can be done, but here's a couple of examples. How about death in men from heart disease against total cholesterol? (click here for full size).

Picture 1

While the correlation isn't great, it is interesting to note that the lowest heart disease mortality is associated with total cholesterol of 200-220 for quite a group of countries. And do note the saturated fat junkie French right down there at the bottom, edged out only slightly by the Japanese.

Now let's look at life expectancy for women from birth against total cholesterol (click here for full size).

Picture 2

Here, the correlation is much stronger and shows unmistakably an association between higher total cholesterol levels and longevity for women. Interestingly, it looks again like total cholesterol of 200-220 seems to be the sweet spot.

So, guys & gals, how much do you want to "die for" low cholesterol?

Let me stress and reiterate, however. This does not prove or suggest that higher cholesterol causes longevity or reduced mortality from heart disease. Nor does it prove that low cholesterol causes decreased longevity or increased mortality from heart disease. What it does do is prove that "high cholesterol" does not cause more death from heart attack or decreased longevity and it proves that "low cholesterol" does not cause less death from heart attack or increased longevity.

Finally, it proves that every single person, worldwide, out there touting "low cholesterol" is an abject ignoramus. That means we're probably talking about more than 95% of physicians, including your own.

Here's a good primer on the cholesterol con from Dr. Malcolm Kendrick, which I blogged a bit over a year ago.

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  1. Cory McKenna on April 11, 2009 at 20:19

    Besides the fact that I already knew that the body produces cholesterol, I recall reading a biology textbook (my daughter-in-law) had from high-school, that stated
    that cholesterol was essential in the
    digestive process. Go figure.

  2. Brandon Thomson on January 25, 2010 at 20:12

    mortality rate seems like a silly thing to graph against… that’s going to confound a country’s average quality of emergency medical care with the variable we are actually interested in, which is incidence of cardiovascular problems. but i’m sure incidence data is harder to come by.

    • Richard Nikoley on January 25, 2010 at 20:41

      Nope, and there’s a lot of talk on this recently. Here’s the deal: even if you just study heart disease deaths, epidemiologically, lower cholesterol always has higher mortality, especially amongst women and the elderly.

      Remember, observational studies are BS anyway, and I never take any stock in them except to falsify. And that’s why you need to look at total mortality. If you want to single out variables, the only valid way to do so is with intervention.

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