Lower Is Not Automatically Better—Especially in Older People

The relationship between cholesterol and overall mortality differs across populations and ages. Observational studies have reported very low cholesterol alongside higher mortality in some older populations, U-shaped total-cholesterol associations, and different relationships among people aged 85 and older.

Nutritional status, frailty and illness can lower cholesterol. This creates an important question of direction: is low cholesterol causing illness, or is illness lowering cholesterol? Observational associations alone cannot resolve that question.

LOWER IS NOT AUTOMATICALLY BETTER—ESPECIALLY IN OLDER PEOPLE.

AGE AND CONTEXT MATTER.

This is not evidence that unlimited cholesterol elevation is beneficial, nor a reason to stop indicated lipid-lowering treatment. Cardiovascular history, inherited risk, functional status, treatment benefits and personal goals need individual consideration.