Keeping Our Wits With (and About) Our Cholesterol

 In LinkedIn

We have long known, and right we have been, that elevated blood cholesterol levels, notably LDL levels, are bad for hearts and arteries, and the bodies and minds those suffuse and serve. What then accounts for headlines like “High Cholesterol Linked to Better Brain Health in People Over 85” issuing from a study just published in Alzheimer’s & Dementia?

The answer, in a word, is: age. The slightly more elaborated 5-word answer is: age as an effect modifier. And, if we can tolerate a few more words still, then the answer is: not everything can be dumbed down to suit the tastes of a culture that prefers all of its ‘facts’ about health to be incontrovertibly good or indisputably bad, for many reasons. Among those reasons is that age, like many other variables, can act as an effect modifier, making “it depends” the often right answer.

An effect modifier (as distinct from a confounder, which is epidemiology’s “red herring”) is a factor that, as it changes, alters the relationship between two other factors. One example is the relationship among weight, illness, and mortality. We have talked ourselves into the mistaken belief that there is an “obesity paradox,” meaning there is a survival advantage to being overweight rather than lean.


Dr. David L. Katz
DAVID L. KATZ MD, MPH, FACPM, FACP, FACLM, is the founding director (1998) of Yale University's Yale-Griffin Prevention Research Center, and current President of the American College of Lifestyle Medicine. He earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates. Dr. Katz has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both Preventive Medicine, and nutrition. Recognized globally for expertise in nutrition, weight management and the prevention of chronic disease, he has a social media following of well over half a million. In 2015, Dr. Katz established the True Health Initiative to help convert what we know about lifestyle as medicine into what we do about it, in the service of adding years to lives and life to years around the globe.
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