Does a Nonagenarian Need to Worry About Cholesterol?

Doctors interested in preventive medicine often quote Benjamin Franklin approvingly. However, he wasn’t thinking of medicine when he noted that an ounce of prevention is worth a pound of cure. (Actually, he was thinking of fire safety.) While prevention is sensible in midlife, there may come a time when a person no longer needs to worry about cholesterol and blood pressure numbers or make strenuous efforts to keep them at “normal” levels.

Nonagenarians in Sardinia Don’t Worry About Cholesterol:

Despite decades of public health initiatives to lower cholesterol, heart disease remains the number one killer in the US. High cholesterol is seen as the most important risk factor for heart disease. A recent study in the journal Nutrients assessed cholesterol levels of Sardinians in their 90s (Nutrients, Feb. 21, 2025).

Sardinia is considered a blue zone for longevity, one of the special places in the world where people live exceptionally long, healthy lives. Researchers recruited the nonagenarian volunteers in 2018 and followed them through December, 2024 or until they died. Median total cholesterol was right around 200, with slight differences by sex.

Perhaps surprisingly, people with LDL cholesterol above 130 survived significantly longer (nearly 4 years) than those with LDL cholesterol below 130 (less than 3 years). In fact, elderly Sardinians with elevated LDL cholesterol were 40 percent less likely to die over the next few years than those with normal cholesterol. This runs counter to everything that American cardiologists espouse.

The authors observe that

“moderate hypercholesterolemia does not preclude the oldest adults from obtaining advanced ages, contrary to common belief.”

Keep in mind that there may be significant lifestyle differences between Sardinia and other parts of the world. Moreover, people who have already survived into their 90s might be people who don’t need to worry about cholesterol as much as the rest of us. But with American medical guidelines urging doctors to consider statins even for elderly individuals, we might all keep these data in mind (Circulation, Nov. 10, 2018).

How Long Does a Person Need to Worry About Cholesterol Levels?

Q. My 93-year-old mother is still on a statin. Her doctor won’t take her off this medication because her cholesterol is considered “too high.”

She has experienced side effects, starting with debilitating muscle pain. Then she had balance problems, severe muscle weakness and dementia. Now she has developed diabetes. Does the statin really make sense at her age?

Who Needs to Take a Statin to Lower Cholesterol?

A. The American Heart Association recommends that virtually all men over 64 and women over 70 should be on statins even if their blood pressure, cholesterol and blood sugar are normal. However, a study in JAMA Internal Medicine (July 2017) showed no benefit in giving a statin to older people without heart disease.

There might be a justification for a 93-year-old person taking a statin if she had heart disease. Ask your mother’s doctor if her life expectancy justifies this preventive medication, especially given the side effects you describe.

Will Higher LDL Cholesterol Help Older People Live Longer?

OK, we admit that headline is heretical. It is what we call a classic man-bites-dog-story. That’s because we have all been told that the lower your LDL cholesterol the better your heart health will be.

But what if new data contradict that old perspective? An article in BMJ Open (June 12, 2016) found precisely that. Of course the results disappeared almost without a trace. When people have a long-cherished belief it is hard for them to give it up. If anything, they are likely to double down on the old way of thinking.

If you would like to read more about LDL cholesterol levels and longevity here is a link to the article we wrote about those results. You will discover that this is not the first study to reveal a relationship between higher cholesterol levels and longevity in older people.

What Do Readers Say?

Some of the most valuable insights we receive come from visitors to this website. Here is what one physician had to say about the article above:

K. Price, MD, from Florida wrote:

“Hi, I am a family practice physician. On the first day of medical school in 1977, the head of the school came out to ‘meet the class.’ Scowling at 400 terrified students from under the bushiest eyebrows I have ever seen and leaning on the podium with his knuckles, he glared at us, and finally spoke. I will never forget his words-booming at us!

“Fifty percent of what we are about to teach you is INCORRECT! UNFORTUNATELY, I cannot tell you WHICH 50% that is!!!”

“That is the best advice I got the entire 4 years!”

Dov in Haifa, Israel had this to say:

“I have showed this article to 3 doctors. Their reaction:

“Nonsense. New analysis will prove they were wrong.”

(P.S.-the doctors, friends of mine, are invited every year to 5 star hotel vacations sponsored by big Pharma…)

Maimee in Florida offered this:

“My mother lived to the ripe old age (lacking 3 months) of 98. She developed high blood pressure at a much younger age and started medicine for it. Later on she stopped taking medicine and had very little wrong with her. When she died, it was not from high blood pressure.”

When people reach a certain age it is important to consider the benefit-to-risk ratio of the medications they are taking. We had the honor to interview two physicians who truly understand the value of “deprescribing.” Here is a link to our interview:

Talking to Your Mother’s Physician:

We encourage you to take the BMJ Open article with you and possibly the one from Nutrients as well when you and your mother visit her doctor. To prepare you for the conversation, we are sending you our Guide to Cholesterol Control and Heart Health.