We have all seen the advertisements on TV concerning the health risks of high cholesterol. The latest are for Repatha which is used when a statin doesn’t work well enough to lower LDL into normal range. There have been multiple studies done over decades that verify these risks. They are real and they matter because the cost of having a heart attack is staggering. These costs include not only the direct cost (your doctors, hospital stay, cardiac rehabilitation and prescriptions). They also include indirect costs (time away from work for the patient and lost productivity for the employee and the employer). The figures I could find on the internet for the cost of a severe heart attack are in the $1 million range and those for a less severe attack in the $750,000 range. These include initial and long term costs over a 20 year period. The reason I looked? I am one of the patients taking Repatha. Statins don’t work on me so I was wondering why my insurance is willing to pay part of the $16,000/year cost. In order to decrease risk, doctors push to get LDL as low as possible. The thinking is: If under 100 mg/dl is a good thing, why not shoot for really low level? My cardiologist was hoping for 20 mg/dl, I gave her 75.
There might be a problem with ultra-low LDL. Cholesterol is not a waste product in your body. It’s a building block that is used to make hormones that regulate growth, sex, health and your body’s ability to react to stress. Cholesterol is part of the myelin sheath that allows signals to rapidly travel down nerves to tell your muscles what to do. Cholesterol is used by your brain to help support function. We need cholesterol to live, grow, have children and be healthy. This is a touchy subject. The Mayo clinic states that LDL levels below 40 mg/dl may actually increase the risk of hemorrhagic stroke and cancer. LDL transports cholesterol from the liver to other organs where is used.
In the adrenal glands, cholesterol becomes aldosterone. This helps kidneys handle sodium which controls your blood pressure. Cortisol is also made in your adrenal glands. Small amounts of cortisol are made on a daily basis and help control metabolism, blood glucose levels, and immune responses. Cortisol works with aldosterone to support blood pressure. During pregnancy, cortisol helps support the developing baby.
Cholesterol is the basic building block of all the sex hormones – testosterone, progesterone and three different forms of estrogen. Large amounts of these are made in the testicles in men and ovaries in women. Yes, men make some estrogen and women make some testosterone. The brain and large bones also make estrogen from cholesterol. Why? It turns out that estrogen helps build stronger bones and helps delay the onset of Alzheimer’s Dementia. 
Why should we care? Because we are more than the sum of our organs and diseases. Specialists look at specific problems. It’s what they are trained to do. Even our primary caregivers are trained to look at and solve problems. Never feel that you should not have your questions answered or your concerns listened to. I often saw patients stop therapy because of a loss of sense of self. They were feeling less than. We make the decisions whether doctors realize it or not. Understanding how it all works makes us all safer.
 Estrogen synthesis and signaling pathways during aging: from periphery to brain: www.ncbi.nlm.nih.gov