The Sardinian Cholesterol Paradox

Broadly speaking, low-density lipoprotein (LDL), or “bad” cholesterol, is generally considered to be… Well… Bad. Specifically because of how it can functionally narrow arteries, causing bits of floating detritus to get stuck in it, narrow it further, and eventually harden into atherosclerotic plaque, at which point it becomes even harder for the body to clear out.

We wrote about the process here: Demystifying Cholesterol

When it comes to cholesterol, the most common lay understanding (especially under a certain age) is “it’s bad”.

A more informed view (and more common after a certain age) is “LDL cholesterol is bad; HDL cholesterol is good”.

A more nuanced view is “LDL cholesterol is established as significantly associated with (and almost certainly a causal factor of) atherosclerotic cardiovascular disease and related mortality in men; in women it is less strongly associated and may or may not be a causal factor”

We wrote more about that, here: Statins: His & Hers? ← despite most research being on men, statins have very different effects (and side effects) for women, often being relatively less useful, and more dangerous. There are exceptions (for some women’s specific profiles they can still be worthwhile), but the trend is certainly troubling.

What, then, of Sardinia?

Sardinia is well-known for being one of the “Supercentenarian Blue Zones”, a place whose inhabitants enjoy (on average, statistically) unusually healthy longevity. These places have been looked to for clues as to how to live the healthiest life.

For example: From Blue To Green: News From The Centenarian Blue Zones

However, researchers recently were investigating life in a region of Sardinia where a lot of people are aged 90+, and followed the health of 168 of them for up to 6 years (because in the case of those who died during that time, obviously the time was less than 6 years).

Note: because this was specifically a Blue Zones study, they only included participants of whom all four grandparents were born within the Blue Zone—so not, for example, looking at the health of someone who just moved there from New York, say.

They collected a lot of interesting data (of course), but what we’re talking about today is that they found that participants with LDL levels above 130 mg/dL had a significantly longer average survival than those with LDL levels below this threshold. Specifically, a 40% lower mortality risk.

This is interesting, because LDL levels ≥130 mg/dL are considered moderate hypercholesterolemia (i.e., the LDL levels are a bit too high).

However, if the same participants had total cholesterol levels over 250mg/dL, they got no extra survival benefits, and very high cholesterol was still linked with shorter survival.

You can read the paper here: The Cholesterol Paradox in Long-Livers from a Sardinia Longevity Hot Spot (Blue Zone)

But before you reach for the butter…

The researchers have several hypotheses about why these results could be so, including:

• The longevity has less to do with LDL itself, and more to do with the diet, with the ratio of grain to olive oil.
• Most of the participants with higher LDL cholesterol were on antihypertensive drugs, which a) will obviously have a cardioprotective effect, and b) means that their heart health is probably enjoying greater scrutiny, and medical scrutiny can also have a protective effect (indeed, that’s the point of it).
• It was also speculated that the locals of that region may have a genetic defense against the harm of moderate hypercholesterolemia, due to historical exposure to malaria meaning that naturally slightly higher cholesterol levels without increased cardiovascular risk may have been naturally selected-for (i.e. those without it were more likely to die of malaria and not pass on their genes).

Thus, it may be that it’s not so applicable more generally. However, it is still reason to at least re-examine how bad LDL cholesterol actually is, and whether for some demographics it could have a protective factor (much like “overweight” BMI is a protective factor for people over 65).

Still, if you’d like to keep on top of your cholesterol levels, check out:

How To Lower Cholesterol Naturally, Without Statins

Enjoy!