“Cholesterol? At my age, it's normal, everyone ends up having it”; “I have cholesterol, but everyone has it!”; “I don't eat fats, I don't understand, it must be a lab error”; “But didn't they say that a little cholesterol is good?”... These phrases, so common in everyday conversations, reflect an attitude of unconcern or minimization towards a diagnosis of high cholesterol. It is so common in our society that many have normalized it and relegated it to that category of unavoidable ailments of aging.
However, this misconception can be very costly, as high cholesterol not only increases the risk of cardiovascular diseases but, as recent research suggests, can also affect brain health. This is supported, for example, by a study presented at the Scientific Sessions of the American Heart Association, linking significant variations in LDL or total cholesterol with a 60% higher risk of developing dementia compared to those with stable levels. This finding reinforces the idea that cholesterol is more than just a marker of heart health; it is also a warning sign for brain health. Detecting and controlling levels and fluctuations can make the difference between preventing serious complications or facing them too late.
The Good, the Bad, and the Ugly
The American Heart Association defines cholesterol as a waxy substance found in the blood, mainly produced by the liver but also coming from foods such as meat, eggs, or dairy. It is an essential component for the body's functioning, but its excess can become a dangerous element. To better understand its role in health, it is worth knowing the main characters of this plot: the good, the bad, and the ugly. The 'good', represented by HDL cholesterol (high-density lipoprotein), is responsible for picking up unused cholesterol and returning it to the liver for storage or elimination outside through bile, reducing the risk of heart disease and stroke. The 'bad', starring low-density lipoproteins known by the initials LDL, is a villain that has the ability to bind to fats and other substances, accumulating in the walls of arteries, causing their narrowing and obstruction, thereby reducing blood flow. Finally, 'the ugly' would be embodied by triglycerides: another type of fat that contributes to the accumulation of unhealthy cholesterol when levels are high. An imbalance in any of these actors can compromise health. That's why managing cholesterol properly is key to preventing the 'bad' and the 'ugly' from dominating the stage of our old age.
What is believed and what is
Certain myths still persist in the collective imagination that distort the perception of cholesterol and its impact on health. A common mistake is thinking that “it is always harmful.” Although high levels of LDL cholesterol are harmful, cholesterol itself is vital for the body. “Our body needs cholesterol to function properly, as it is the precursor of molecules of great biological importance, such as the production of steroid hormones, vitamin D, and bile acids. The problem does not lie in its existence, but in its excess or imbalance,” explains Dr. Patricia Andrada Álvarez, a specialist in endocrinology and nutrition at the University of Navarra Clinic.
Another common myth is thinking that cholesterol and fats are not necessary, a belief that Dr. Tomás Fernández Jaén, chief of sports medicine at Clínica Cemtro, categorically refutes: “In nature, everything that exists, exists for a functional reason, everything has a purpose. The same applies to fats; the issue is the accumulation or excess of them.” Similarly, he rejects the belief that when losing weight through a diet, only fat is lost. In reality, argues this expert, everything is lost, not just fat, but also muscle and bone. “We are a whole structure, and for this reason, weight loss should be appropriate, balanced, and accompanied by specific exercises tailored to each individual.”
Our body needs cholesterol to function properly, as it is the precursor to molecules of great biological importance”
Also, many people believe that it is not necessary to evaluate cholesterol levels until adulthood. However, the American Academy of Pediatrics recommends conducting check-ups from the age of 9 in children with family history, and then every 4-6 years after the age of 20 in adults at low risk. Furthermore, the lack of evident symptoms (cholesterol doesn't hurt or bother) contributes to the neglect and underestimation of its seriousness.
The cholesterol paradox: is it always the enemy?
Research is advancing, leading to a better understanding of cholesterol. One topic that has sparked interest in recent years is the so-called 'cholesterol paradox.' Several studies suggest that in older individuals, high levels of LDL cholesterol may be linked to increased longevity, possibly due to a protective effect on the immune system in this population. However, in young and middle-aged adults, it remains a significant risk factor.
In 2016, a meta-analysis, which included 19 cohort studies and over 68,000 people over 60 years old, found that those with high levels of LDL cholesterol tended to live just as long or even longer than those with low levels. These results contradicted the hypothesis that 'bad' cholesterol is inherently harmful, questioning the general recommendation to aggressively reduce LDL cholesterol in older adults.
But let no one be deceived, this does not mean that the issue should be downplayed or that it opens a free bar for the consumption of high-fat foods. What this paradox highlights is the need to adopt an individualized approach, and in the case of older people, to weigh the benefits and risks of treatments.
As Patricia Andrada points out, the figures must be interpreted based on each patient's circumstances and risk factors, from age to genetics, including lifestyle, associated risk factors, and the overall health status of each patient. “Cholesterol is a complex marker that, far from being just an enemy, requires a balanced and personalized management,” concludes the doctor.
Figures dance
Cholesterol levels not only depend on individual factors, but also on how their interpretation has evolved over time. From the early normal values established in 1963 or the first guidelines published in 1988, the optimal values have been constantly reviewed, adapting to new scientific findings.
Andrada insists that ignoring cholesterol levels can have serious consequences, and keeping it within the established ranges based on age, sex, or associated pathologies is key to reducing vascular risk. She also points out that increased longevity “provides more time for risk factors to produce disease, complicate preexisting conditions, and consequently reduce the essential marker of good health in older people, which is functional capacity.” Likewise, she warns about how lipid metabolism disorders and chronic inflammation contribute to the development of atherosclerosis, cardiovascular disease, cerebrovascular disease, and dementia.
Having high cholesterol is not good, but what about having it too low? According to the specialist, abnormally low levels, whether due to genetic causes or rare disorders, can affect the absorption of fats, fat-soluble vitamins, growth delays, or nervous system problems. “In the case of acquired hypolipidemia secondary to other diseases, it does not have clinical consequences on its own, but it does have those of the underlying disease that causes it.”
Just taking a pill is not enough to 'fix' cholesterol
Do you always have to take medication?
Medications to reduce cholesterol, such as statins, have been shown to be effective, but they are not a universal solution. “A pill is not enough to 'fix' cholesterol,” warns the doctor. This idea can foster the false perception that high LDL is a minor problem that can be easily resolved, diverting attention from other more effective measures to treat it, such as lifestyle changes. In fact, for people at low cardiovascular risk, guidelines recommend keeping bad cholesterol below 116 mg/dL through diet and exercise modifications before turning to medication. Only when these measures are not sufficient is it advisable to resort to drugs.
In the case of older adults, the European Geriatric Medicine Society states that statins should only be considered for individuals without a history of cardiovascular disease but with abnormal lipid profiles, and only if their life expectancy, based on their functional capacity, exceeds five years. This reinforces the idea that medication should be tailored to each case.
Taking just one pill isn't enough to 'fix' cholesterol”
Could exercise be enough?
Physical activity has been revealed as a potent therapy and one of the most effective pillars for maintaining health in advanced ages. However, Dr. Fernández Jaén warns that in many cases, high cholesterol has a familial or genetic component that may require complementary pharmacological treatment. In any case, there is no doubt that exercise is a powerful tool in cholesterol control.
According to this expert, “aerobic exercise is particularly effective in reducing hyperlipidemia, which includes high cholesterol and other fats in the blood.” This benefit becomes even more relevant for older adults, who can find in physical activity an effective method to improve their cardiovascular and metabolic health.
Aerobic exercise is particularly effective in reducing hyperlipidemia, which includes high cholesterol and other fats in the blood”
According to Fernández, an effective routine could be walking, swimming, or cycling, between five and seven days a week, for 30 to 60 minutes, with an intensity reaching between 40% and 70% of the maximum heart rate, calculated by subtracting the age from 220. However, he adds, “it is essential to adapt it to each person's abilities and conditions, always prioritizing safety”, as exercise is like a medication, “it can have side effects, adverse effects, and even specific contraindications”. That is why it is important to have the guidance of a specialist who can design a suitable and safe program.
On the other hand, Tomás Fernández argues that the impact of exercise on cholesterol levels varies according to age. In young people, lipid metabolism responds more quickly due to higher hormonal and biological activity. In contrast, in older individuals, metabolism tends to be slower, making consistency in exercise key to obtaining visible results.
Ultimately, cholesterol is much more than just a number on a blood test. Understanding its role in cardiovascular and brain health, debunking myths, and adopting personalized strategies —such as a proper diet, regular exercise, and, if necessary, medication— is essential to prevent complications and improve the quality of life at all stages. Taking it seriously is crucial to protect longevity and quality of life.