Cholesterol & Longevity. Is High Cholesterol Protective? The Swedish AMORIS Cohort Results
- Oct 5, 2023
- 7 min read
Updated: Apr 6
A recent long-term study from Sweden, using data from the AMORIS cohort, has provided valuable research on cholesterol, and somewhat surprisingly shows a correlation between higher cholesterol levels and increased longevity.
The longevity study (Murata et al PMID: 37726432) looked at the blood work data of 45,000 people over a 35 year period. Taking regular blood samples and measuring the biomarkers (glucose, cholesterol, iron, creatinine etc) the researchers could identify what factors were associated for those reaching 100 years or more. They found that high cholesterol is associated long life.
The new data appears to contradict what we have learnt, that high cholesterol is bad. Right? Wrong. When one reads past the headlines and the study's abstract, the discussion of the results and actual conclusion show otherwise. Links to this study and others are provided at end of page.
Please note, if you have immediate questions and concerns about your health and cholesterol levels, always consult with your medical practitioner most familiar with your personal medical history and circumstances.
To answer a common question relating to cholesterol, it is an essential part of all cellular function. It forms the membrane of every cell and the backbone of many key hormones. Our bodies make the required amount of cholesterol that we need for cellular function. Ingested dietary cholesterol is not required by the body, nor (for most) a health problem as it once used to be thought.
It is well established that dietary saturated fat (the fat we eat) increases LDL cholesterol. These particles, both small and large, can penetrate the lining of the vascular system and cause atherosclerosis - heart disease. The effect of LDL cholesterol on risk of heart disease is linear: the greater the exposure over lifetime, the greater the risk. There is a also dose dependent risk of LDL cholesterol for heart disease.
So what does this study show? Does it overturn the dietary recommendations?
Firstly, it is worthwhile to understand the study population. 97% were deceased by age 100. So what is happening with the remaining (actually 3%) very elderly surviving with higher levels of LDL cholesterol?
The study does indeed show a correlation between high LDL cholesterol and those reaching 100. However, the study’s authors do not find that cholesterol is protective of health but rather that the results“…indicate that high cholesterol levels are more frequently observed among individuals predisposed to survive longer."
The study concludes "Higher levels of total cholesterol and iron and lower levels of glucose, creatinine, uric acid, ASAT, GGT, ALP, TIBC, and LD were associated with a greater likelihood of becoming a centenarian. While chance likely plays a role for reaching age 100, the differences in biomarker values more than one decade prior death suggest that genetic and/or lifestyle factors, reflected in these biomarker levels may also play a role for exceptional longevity."
The study's conclusion does not state the high cholesterol is protective, as some have stated; in scientific terms: correlation is not equal to causation. For the lucky few that made it to 100, genetics and lifestyle seem to be the deciding factor.
Using data from the same AMORIS cohort, another study (Ding et al, PMID: 34952923) found that high total cholesterol at age 39–59 years was associated with a higher all-cause mortality and cardiovascular but high total cholesterol at age 60–79 and ≥ 80 years was associated with a lower mortality. This finding is in keeping with other studies, that mid-life high cholesterol is a genuine risk factor.
We know that genes play a role in people’s response to cholesterol. Some people have high cholesterol due to genetics, others the opposite. Another related scenario involves the convoluted story of dietary cholesterol. The old thinking was that dietary (ingested) cholesterol raised blood cholesterol, so the advice was to "avoid cholesterol". Based on later findings, this statement was retracted as it was not found to be the case. Confusing.
More recent studies demonstrate that a small number of people, about 25% of the population - are so called hyper absorbers (Simonen et al, 2023). Dietary cholesterol raises their serum cholesterol. This segment of the population needs to be careful with what they eat.
When it comes to reducing cholesterol levels, diet should be a key area of focus. Says Felicia Koh (MA Human Nutrition), The Whole Health Practice's co-founder and nutritionist:
A diet that promotes longevity is high in fibre and low in saturated fat. High in omega-3s, rich in whole foods and antioxidant polyphenols. Focus on flavours that you enjoy. Try the Mediterranean diet or traditional Asian diets, mainly plants and whole foods, a little meat, fish or dairy as you prefer.
What does this mean when it comes to the plate? On a daily basis eat a whole food diet, avoid processed foods. Enjoy small portions of lean meat, oily fish, nuts and seeds, colourful vegetables, dark leafy grains, beans and whole grains, herbs and spices. Be mindful of your total alcohol intake. The PORTFOLIO diet was specifically designed with cholesterol lowering as its goal.
Other proven cholesterol lowering measures include regular physical activity and stress reduction.
Similar to this study, in another article we discussed a 2018 study associating high cholesterol with brain health in the very elderly. The conclusion was similar, not that cholesterol is neuroprotective but rather to look to the role of genetics.
Final Thoughts
When presented with new evidence It is important to ask questions and be open to new findings, that is how science works. But once again it is easy to see how science can be misrepresented by the headlines (and those that quote them) even when the actual conclusions of a study clearly state what factors are involved.
For most people, improving health is about finding motivation and prioritising self-care with an ultimate goal of taking action. If you want to take effective and targeted steps that fit into your unique lifestyle, The Whole Health Practice is here to help.
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Alastair
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AMORIS Studies
Murata S, Ebeling M, Meyer AC, Schmidt-Mende K, Hammar N, Modig K. Blood biomarker profiles and exceptional longevity: comparison of centenarians and non-centenarians in a 35-year follow-up of the Swedish AMORIS cohort. Geroscience. 2024 Apr;46(2):1693-1702. doi: 10.1007/s11357-023-00936-w. Epub 2023 Sep 19. Erratum in: Geroscience. 2023 Nov 4;: PMID: 37726432; PMCID: PMC10828184.
Ding M, Wennberg A, Ek S, Santoni G, Gigante B, Walldius G, Hammar N, Modig K. The association of apolipoproteins with later-life all-cause and cardiovascular mortality: a population-based study stratified by age. Sci Rep. 2021 Dec 24;11(1):24440. doi: 10.1038/s41598-021-03959-5. PMID: 34952923; PMCID: PMC8709841
Related Studies
Simonen P, Öörni K, Sinisalo J, Strandberg TE, Wester I, Gylling H. High cholesterol absorption: A risk factor of atherosclerotic cardiovascular diseases? Atherosclerosis. 2023 Jul;376:53-62. doi: 10.1016/j.atherosclerosis.2023.06.003. Epub 2023 Jun 2. PMID: 37290267.
Nguyen XT, Ho YL, Li Y, Song RJ, Leung KH, Rahman SU, Orkaby AR, Vassy JL, Gagnon DR, Cho K, Gaziano JM, Wilson PWF. Serum Cholesterol and Impact of Age on Coronary Heart Disease Death in More Than 4 Million Veterans. J Am Heart Assoc. 2023 Nov 7;12(21):e030496. doi: 10.1161/JAHA.123.030496. Epub 2023 Oct 27. PMID: 37889207; PMCID: PMC10727410.
Jung E, Kong SY, Ro YS, Ryu HH, Shin SD. Serum Cholesterol Levels and Risk of Cardiovascular Death: A Systematic Review and a Dose-Response Meta-Analysis of Prospective Cohort Studies. Int J Environ Res Public Health. 2022 Jul 6;19(14):8272. doi: 10.3390/ijerph19148272. PMID: 35886124; PMCID: PMC9316578.
Li S, Hou L, Zhu S, Yi Q, Liu W, Zhao Y, Wu F, Li X, Pan A, Song P. Lipid Variability and Risk of Cardiovascular Diseases and All-Cause Mortality: A Systematic Review and Meta-Analysis of Cohort Studies. Nutrients. 2022 Jun 13;14(12):2450. doi: 10.3390/nu14122450. PMID: 35745179; PMCID: PMC9231112.
Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev. 2020 Aug 21;8(8):CD011737. doi: 10.1002/14651858.CD011737.pub3. PMID: 32827219; PMCID: PMC8092457.
Anna Helgadottir, Gudmar Thorleifsson, Kristjan F Alexandersson, Vinicius Tragante, Margret Thorsteinsdottir, Finnur F Eiriksson, Solveig Gretarsdottir, Eythór Björnsson, Olafur Magnusson, Gardar Sveinbjornsson, Ingileif Jonsdottir, Valgerdur Steinthorsdottir, Egil Ferkingstad, Brynjar Ö Jensson, Hreinn Stefansson, Isleifur Olafsson, Alex H Christensen, Christian Torp-Pedersen, Lars Køber, Ole B Pedersen, Christian Erikstrup, Erik Sørensen, Søren Brunak, Karina Banasik, Thomas F Hansen, Mette Nyegaard, Gudmundur I Eyjolfssson, Olof Sigurdardottir, Bjorn L Thorarinsson, Stefan E Matthiasson, Thora Steingrimsdottir, Einar S Bjornsson, Ragnar Danielsen, Folkert W Asselbergs, David O Arnar, Henrik Ullum, Henning Bundgaard, Patrick Sulem, Unnur Thorsteinsdottir, Gudmundur Thorgeirsson, Hilma Holm, Daniel F Gudbjartsson, Kari Stefansson, Genetic variability in the absorption of dietary sterols affects the risk of coronary artery disease, European Heart Journal, Volume 41, Issue 28, 21 July 2020, Pages 2618–2628, https://doi.org/10.1093/eurheartj/ehaa531
Ference BA, Ginsberg HN, Graham I, Ray KK, Packard CJ, Bruckert E, Hegele RA, Krauss RM, Raal FJ, Schunkert H, Watts GF, Borén J, Fazio S, Horton JD, Masana L, Nicholls SJ, Nordestgaard BG, van de Sluis B, Taskinen MR, Tokgözoglu L, Landmesser U, Laufs U, Wiklund O, Stock JK, Chapman MJ, Catapano AL. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017 Aug 21;38(32):2459-2472. doi: 10.1093/eurheartj/ehx144. PMID: 28444290; PMCID: PMC5837225.
Ference BA, Yoo W, Alesh I, Mahajan N, Mirowska KK, Mewada A, Kahn J, Afonso L, Williams KA Sr, Flack JM. Effect of long-term exposure to lower low-density lipoprotein cholesterol beginning early in life on the risk of coronary heart disease: a Mendelian randomization analysis. J Am Coll Cardiol. 2012 Dec 25;60(25):2631-9. doi: 10.1016/j.jacc.2012.09.017. Epub 2012 Oct 17. PMID: 23083789.
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