Higher LDL for better health and longevity?

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If eating fat is bad, why does science keep showing that it’s so healthy?

A new paper was just published that looked at the effects of LDL on mortality. Now, this was a correlational study, so it can only indicate coincidence. Nevertheless, the results of this study are compelling, or at least a little amusing. The study is amusing because it’s correlational evidence that has told us over the years that saturated fat is the devil and it will kill you from heart disease because of a rise in LDL cholesterol.

The paper of interest looked at about 20,000 subjects, and it was from a big U.S. database called the National Health and Nutrition Examination Survey (NHANES). It was just published in the journal Nature [1]. Again, it’s an association, as the authors disclose. And what they found is kind of surprising because they did three different types of controlling for the data. In other words, they have one general method of just looking at all the subjects equally. Then, in the next two figures, they start controlling for things like sex (male or female), body weight, smoking status, drinking status, etc. It didn’t really make any difference, as you’ll see.

Each of the graphs is based off of one “control” point—people with an LDL range of 100 to 129. In each analysis, they use the same control group of LDL cholesterol levels in the range of 120 to 129. From this group they set a risk of heart disease at 1. The graph shows that the lower the LDL cholesterol gets, below 70 or 70 up to 100, the higher the overall mortality is getting. In contrast, the higher the LDL is getting, even up to and above 160, it’s no different. There is no difference in mortality in any of these ways of analyzing the data set differently even though the LDL cholesterol gets much higher. It didn’t matter.

Just to emphasize this: in the control group, they just arbitrarily said people with an LDL in the “normal” range, 100 to 129 have a normal risk of heart disease (set at a risk of 1). Remarkably, the lower the LDL got, the higher the mortality; they literally were dying more. It was a statistically significant trend. Again, this is correlation, but it’s correlational evidence that has been used against LDL, weaponizing LDL, and invoking some kind of fear. So, we’re fighting fire with fire, even if it is weak fire in this case. But again, this seems to indicate that the lower the LDL cholesterol, the higher the mortality. They literally had a higher risk of dying. In contrast, the higher the LDL was getting, it didn’t move at all. They stayed right there in that control range. No significant statistical difference whatsoever. 

So, the takeaway: It is much better to have a higher LDL than it is to have a low LDL. LDL is important with regards to protecting against some really awful health issues [2, 3, 4], and this might be part of the higher mortality. Regardless of the mechanism, this association indicates or hints at a pretty powerful coincidence that if you want to live long, you at least do not want your LDL to go too low.

References

1. https://www.nature.com/articles/s41598-021-01738-w
2. https://pubmed.ncbi.nlm.nih.gov/18000291/
3. https://pubmed.ncbi.nlm.nih.gov/18000291/
4. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1348-0421.2009.00203.x