Read this first. Statins and other cholesterol-lowering medicines are prescribed to prevent heart attacks and strokes, and large randomized trials show they do. Do not stop, reduce or skip a cholesterol medication because of anything on this page. If you have questions about whether yours is still right for you, that is a conversation to have with the clinician who prescribed it.
An earlier version of this article presented one side of a contested question as settled fact, and told readers that statin benefits were “grossly exaggerated.” That was not a fair summary of the evidence, and it has been rewritten.
What the review reported
In 2016 a group led by Uffe Ravnskov published a systematic review in BMJ Open covering 19 cohort studies — about 68,000 older people in total. The authors reported that in most of the cohorts they examined, high LDL cholesterol was not associated with higher all-cause mortality, and in a number of cohorts the association ran the other way: higher LDL, lower mortality.
Why it was criticized
Heavily, and by mainstream bodies. The main objections:
- Method. The Oxford Centre for Evidence-Based Medicine and others argued the review relied on aggregated published summaries rather than individual participant data, an approach prone to bias, and that its selection and analysis were not robust.
- It contradicts trial evidence. Observational associations between cholesterol level and death are not the same thing as testing what happens when you lower it. Randomized trials of cholesterol-lowering therapy consistently show reduced heart attacks and strokes, including in older participants.
- Reverse causation is a known trap here. Serious illness — cancer, frailty, advanced heart failure — lowers cholesterol. In an elderly cohort, low LDL can be a marker of being ill rather than a cause of dying, which can manufacture an apparent inverse association.
What is genuinely unsettled
There is a real and legitimate clinical question underneath the controversy, and it is narrower than the headlines: how much benefit does starting a statin for primary prevention give someone in their late 80s with a limited life expectancy and a long list of other medications? Guidelines are genuinely more cautious there, and deprescribing near the end of life is an accepted part of good geriatric practice.
That is a very different proposition from stopping a statin in someone who has already had a heart attack. “Is this still the right medication for me?” is a good question to bring to a clinician. “I read online that cholesterol does not matter” is not a plan.
What this means for day-to-day care. Personal care attendants do not advise on medication and should not be drawn into it. If the person you care for raises doubts about their prescriptions, the right response is to encourage them to raise it with their clinician or their family — not to agree, disagree, or look it up for them. What is worth reporting is practical: pills going untaken, confusion about doses, or new side effects like muscle pain.
Sources
- BMJ Open — Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review
- Centre for Evidence-Based Medicine, University of Oxford — Post-publication peer review of the above
- Science Media Centre — Expert reaction to the review
- American Heart Association — LDL and HDL cholesterol
This article is general information, not medical advice. It describes published research; it is not a recommendation for you or the person you care for. Never start, stop or change a prescribed medication because of something you read here — talk to the prescribing clinician first. Communicare Elite provides non-medical personal care through Missouri’s Consumer Directed Services program and does not provide medical advice or treatment.