The relationship between cholesterol and heart disease is more complex than commonly believed.
Being told that you have high cholesterol can feel like a verdict: Start taking a statin or risk a heart attack or stroke.
However, recent studies suggest that high cholesterol is not as uniformly harmful as once thought. Still, the message has swung hard in the other direction on social media, where claims range from “high cholesterol might save your life” to “high cholesterol is the secret to living to 100-plus.”
So, is high cholesterol really “good” or “bad”?
The reality is more nuanced than either extreme suggests. The more useful question may not be whether high cholesterol is harmful, but when—and in whom—it becomes risky.
The ‘Lipid Paradox’
Some health influencers on social media have turned the tables on cholesterol, promoting it as a key to longevity instead of something that needs to be lowered with aggressive treatment.
Much of this internet discussion traces back to real research. A 2023 Swedish study followed older participants for 35 years and found that those with higher total cholesterol were more likely to live to 100. In a separate 2025 study, researchers found that adults aged 90 or older with low-density lipoprotein cholesterol (LDL-C)—or so-called “bad” cholesterol—levels above 130 milligrams per deciliter (mg/dL) lived longer than those with levels below that threshold. This is notable, given that the American Heart Association considers an optimal LDL-C level to be at or below 100 mg/dL.
However, a 2023 study, which analyzed data from more than 4 million veterans aged 18 or older, offered a key caution. The higher rates of coronary heart disease deaths among older participants with low cholesterol levels appeared to reflect what researchers called “reverse causality,” a phenomenon in which the data seem to show that A causes B, when in reality it is B that causes A. In other words, a serious underlying illness may drive cholesterol down, not the other way around.
The researchers called this the cholesterol or “lipid paradox”—the counterintuitive observation that low LDL-C and total cholesterol levels are unexpectedly associated with poorer health outcomes in studies.
“My concern with the current ‘lipid paradox’ hypothesis is that, it is also known that very low cholesterol levels in the elderly (especially over 80 years old) is most often a marker of … underlying chronic disease like cancer,” Dr. Marschall Runge, a cardiologist and former executive vice president for medical affairs at the University of Michigan, told The Epoch Times.
“The reported studies supporting the ‘lipid paradox’ did not account for these variables.”
Dr. Eddie Hackler, a cardiologist in Atlanta, told The Epoch Times, “Simply put, low cholesterol often reflects underlying illness, frailty, malnutrition, or chronic disease that independently increases mortality risk.” In other words, higher cholesterol in older adults may mean that they are disease-free or well-nourished, factors that independently lower the risk of death. That could explain the association between high cholesterol and longevity reported among older participants in studies.
However, there is no evidence to discount the proof that high cholesterol increases the risk of heart disease in the general population, Runge noted.
“For the vast majority of adults (young and middle-aged), high LDL cholesterol remains a primary driver of atherosclerotic cardiovascular disease and reduction of LDL cholesterol saves lives,” he said.
