When we hear the word ‘cholesterol’ it’s easy to imagine this fat-like substance whooshing around in the bloodstream and perhaps contributing to the build-up of ‘atherosclerotic plaque’ on the inside of artery walls. However, we should perhaps not forget that cholesterol is an essential body constituent and, for example, is a basic building block within the membranes of the body’s cells including those in the brain. It is perhaps interesting to note that in the elderly, low levels of cholesterol are associated with worse health outcomes, including an enhanced risk of death. This sort of evidence does not mean that low cholesterol can kill people, but perhaps serves as a reminder of cholesterol’s vital role within the body.
Cholesterol – how low do you go?
I was interested to read the summary of a recent article which appeared in the journal Neurologia  which reminds us of cholesterol’s essential function. The article outlined treatments that the authors believe are inappropriate in individuals suffering from ‘cognitive decline’ – essentially compromised brain functioning that is not bad enough to be labelled ‘dementia’. They, for example, make the case that blood pressure in these individuals should be maintained at a reasonable level, recommending that the systolic blood pressure (the higher of the two blood pressure readings) should be above 130 mmHg. This makes sense, of course, when one considers that it is blood pressure that ‘forces’ blood into organs such as the brain to provide oxygen and nutrients, and lower blood pressures may do this less effectively. Of course we don’t want blood pressure to be too high, but we don’t want it too low either.
The authors of this article also point out the fact that low blood levels of cholesterol are associated with worse health outcomes, and specifically an increased risk of aggressiveness and suicide. In their view, total cholesterol levels should be kept above 160 mg/dl (4.1 mmol/l).
Some researchers and commentators in the scientific community have attempted to popularise the ‘lower is better’ mantra in reference to blood pressure and cholesterol. However, my own view is that this stance is nonsense. For example, when blood pressure is low enough it kills people, and between that extreme and ‘normal’ blood pressure there are low blood pressure that can obviously compromise health and vitality. So, clearly, lower is not always better at all. And the same, it appears, is true of cholesterol. I think the authors of this review should be applauded for taking a more balanced (and common-sense) approach to the management of blood pressure and cholesterol issues.
They also raise the issue that medications, and particularly multiple medications, may actually be at the root of cognitive impairment in some individuals. It’s nice to see some doctors recognising that lower is not always better, and that when it comes to medical management, less can be more.
Here’s to a healthy heart
Dr John Briffa
for The Cholesterol Truth
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1. Robles Bayon A, et al. Inappropriate treatments for patients with cognitive decline. Neurologia 2012 Oct 9. [Epub ahead of print]