Penalized for have too low cholesterol?

Factual Questions
1

I recently had some blood work done for a life insurance application. I got the results back yesterday, and I saw a peculiar thing. They create a “smart score” based on various lab results and other physical factors (age, etc.) and use this to rate your risk of croaking earlier than the average person. A negative score is good, anything over 150 is bad. Well, I got an 11, which is pretty good, but then I noticed that they had rated my cholesterol levels as “51,” which I thought was pretty strange, when my total cholesterol was 132 (expected range 130-220), HDL was 61 (expected range 25-75), and LDL was 56 (expected range 80-200). So, they must have penalized me because my LDL was too low, when I always understood that the lower the LDL value, the better!.

What gives?

2

victim of an automated algorithm which flagged you ‘cos your LDL was outside of the “normal” range? I put in my numbers from a recent lipid panel into my company’s “wellness” site’ and it squawked at me because my total was over 200. my Dr. said not to worry about it since my HDL was high (80 something) and my triglycerides were in the basement.

3

Very low LDL cholesterol that occurs not as a result of cholesterol lowering medication seems to be a marker for greater risk of several poor outcomes including greater risk of depression, anxiety, and of developing cancer in the decades to come. I have no idea why.

4

Traditionally, it’s been stated (and believed) that there is a U-shaped relationship between mortality and cholesterol level, with both very high and very low levels of cholesterol associated with increased death rates.

We (presumably) understand why high cholesterol levels are associated with higher rates of death, i.e. high cholesterol levels are associated with atherosclerosis and thus with things such as heart attacks and strokes.

Very low cholesterol levels have for many years also been observed to be associated with higher death rates (as has, for example, very low body weight). The explanation for these observations has generally been attributed to the fact that people with cancer and other serious illnesses are often malnourished and that leads to lowering of the cholesterol levels (and body weight). Obviously, the higher death rates would seem to be a result of the underlying serious illness and not the low cholesterol. As mentioned, the same relationship has been observed for low body weight and mortality. With respect to the explanation of that relationship, the notion of underlying serious illness has been put forth just as it has for low cholesterol and mortality. However, with respect to low body weight and higher death rates, there is probably also a contribution (and confounding) by cigaretter smokers. People who smoke tend to be leaner than those who don’t. And, of course, smoking IS associated with higher death rates and thus likely explains some of the relationship.

More recent studies have indicated that the above U-shaped relationship may not, in fact, be valid, or at least may not be valid in all populations. For one, the use of statins has now placed more healthy people than in the past in the ‘very low cholesterol’ range. Such individuals would not be expected to have high rates of death. In addition, the prevalence of vegetarianism has increased in some populations, as has the adherence to a generally lower cholesterol-inducing diet. The net effect in the population is, again, to shift the average cholesterol level and place some totally healthy people into the “very low cholesterol” group. And, once more, their death rates would not be expected to be higher than those with higher cholesterol levels.

Despite the new data, the older observations are the ones that still inform insurance companies in terms of actuarial survival. If the newer data is valid, the insurance companies WILL catch up but it will take decades.

(I should also point out that the older studies, in particular, often did not distinguish among the various types of cholesterol which, as you know, have opposite effects on mortality. This sort of omission obviously adds to the potential for the older studies to be misleading.)

5

FWIW, cholesterol is a building block is several metabolic pathways for the production of a variety of things such as cortisol, androgens, estrogens, and bile.

Low cholesterol levels can result in low levels of those other things which can, in turn, lead to higher morbidity and mortality.

6

This is far from clear.

For example, you talk about cortisol and other hormones. Tell me, how does cholesterol get into the cells of the adrenal, testes, ovaries, etc? Answer: via the LDL receptor. Okay, then why do people with no functioning (or simply absent) LDL receptors (Familial Hypercholesterolemia) not have hormone deficiencies.

It is far from clear.

7

The problem, Karl, with the explanation that the low cholesterol (LDL in particular) is caused by poor malnutrition secondary to extant chronic illness is that low levels of LDL cholesterol predate cancer cases by nearly two decades. There is a fair amount of confidence that the low cholesterol is not the cause of the cancer - there does not seem to be an increased risk of cancer from low cholesterol caused by statins, for example. It instead suggests that whatever is causing the unusually low cholesterol is also something that increases cancer risk; it is a marker, not a cause.

8

who was the female olympic medalist years ago who died of heart attack and they determined it was because of no body fat and too little cholesterol? I want to say her name was kersay or something like.

my doctor actively gets after me to eat bacon. I’m short and overweight but am at health risk because chronic low cholesterol (both kinds) and severe hypoglycemia, which is chronically low blood sugar, never gets over 80 unless they put stuff in my IV Most of my family is the same way