What Is Cholesterol

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Cholesterol is an issue that frequently comes up in medical practice. We have all heard about the association of increased risk of heart attack and stroke with high cholesterol, and the frequent use of statin medication to lower cholesterol. The medical literature is strong about the benefits of lowering cholesterol for what we call secondary prevention, i.e., if you have already had a heart attack or stroke.  However, the issue becomes murkier particularly in women if the only problem, if indeed it is a problem at all, is elevated cholesterol.  Many factors need to be taken into account such as how high it is, which cholesterol fractions are elevated, if there is associated vascular inflammation, your family and personal history, age, sex (yes, men are worse off), the presence of diabetes and various other risk factors.

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What is often not recognized is that there are also potential risks of lowering cholesterol too much, undoubtedly related at least in part to cholesterol's function in building cell walls, and as the template for all your sex hormones (progesterone, estrogen, and testosterone), as well as cortisol, which is essential for life.  Evidence has shown that having a total cholesterol under 130 can actually increase one's risk of death, particularly from cancer. A study in the journal Neurology, looking at data from nearly 28,000 women, found that LDL cholesterol levels below 70 actually doubled the risk of hemorrhagic stroke compared to readings of 100-129.  Similarly, women with triglyceride readings below 75 had double the risk of stroke compared to women with triglyceride levels over 156, surprising since such high triglyceride levels generally are considered to be a potential risk factor themselves.

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Robert W. Bruley, MD