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What very few know is that more than a dozen research groups have demonstrated that low density-lipoprotein (LDL) participates in the immune system by adhering to and inactivating almost all kinds of microorganisms and their toxic products.1 For instance, compared with normal rats, hypocholesterolemic rats injected with bacteria have a markedly increased mortality which can be ameliorated by injecting purified human LDL. When covered with LDL, the bacteria accumulate and are phagocytosed by macrophages, which are subsequently converted to foam cells. This fact may explain the finding by Yusufuddin et al.2 that mortality was lower among the patients with pneumonia if their LDL-cholesterol was elevated. The same phenomenon was found in a follow-up study of about 30,000 community-dwelling adults by Guirg et al.: LDL-C was inversely associated with the risk of suffering from one or more sepsis events (Table 1).3
LDL-C quartiles Q1 Q2 Q3 Q4
Number of participants 6984 7088 6915 6896
Sepsis events (%) 451 (6.5) 399 (5.6) 304 (4.4) 261 (3.8)
Table 1. The LDL-C quartiles of those who suffered from one or more sepsis events
according to the study by Guirgis et al.3
That high LDL-C may be protective is also evident from a meta-analysis of 19 studies where the authors had followed more than 68,000 elderly people for several years.4 What they found was that those with the highest LDL-cholesterol lived the longest; non...
That high LDL-C may be protective is also evident from a meta-analysis of 19 studies where the authors had followed more than 68,000 elderly people for several years.4 What they found was that those with the highest LDL-cholesterol lived the longest; none of the studies found the opposite. After the publication of our meta-analysis, 19 more follow-up studies have been published and with similar results.5
1. Ravnskov U, McCully KS. Vulnerable plaque formation from obstruction of vasa vasorum by homocysteinylated and oxidized lipoprotein aggregates complexed with microbial remnants and LDL autoantibodies. Ann Clin Lab Sci. 2009;39:3–16.
2. Yousufuddin M, Sharma UM, Bhagra S, et al. Hyperlipidaemia and mortality among patients hospitalised with pneumonia: retrospective cohort and propensity score matched study. BMJ Open Resp Res 2021;8:e000757. doi:10.1136/ bmjresp-2020-000757
3. Guirgis FW, Donnelly JP, Dodani S et al. Cholesterol levels and long-term rates of community-acquired sepsis. Crit Care. 2016;20:408
4. Ravnskov U, Diamond DM, Hama R, et al. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review. BMJ Open. 2016; 6: e010401.
5. Ravnskov U, de Lorgeril M, Diamond DM et al. The LDL paradox: Higher LDL-cholesterol is associated with greater longevity. A Epidemiol Public Health. 2020;3: 1040-7.