Very Low Cholesterol Levels Associated with Aggressive Attitudes

Very low LDL cholesterol (the “bad” kind) has become the mantra of doctors today. Their eagerness to help patients avoid heart attacks and strokes has led to a change in treatment philosophy concerning LDL levels. Whereas not so long ago the usual recommended level for LDL was less than 100 mg/dL, doctors may now urge some people with risk factors such as high blood pressure to sink LDL to the extremely low level of 70. However, because the brain is made up of fat and cholesterol, there is some concern that lowering cholesterol might be detrimental. And indeed, early observational studies of men showed a slight association between low cholesterol levels and adverse effects on brain function, cognitive performance and mood — specifically a small but notable increase in suicide, accidents and violent behavior.

Cardiologist C. Noel Bairey Merz, MD, director of the Women’s Heart Center at Cedars-Sinai Medical Center in Los Angeles, who studies gender differences, was interested in learning whether low cholesterol in women has an association similar to that in men. As chair of the multi-center Women’s Ischemia Syndrome Evaluation (WISE) study on chest pain and suspected coronary heart disease, she and her research colleagues examined data on 498 women to determine whether there was any association between low cholesterol levels and cognitive/mood responses among women taking lipid-lowering drugs compared with those who were not. She also compared the women with LDL cholesterol of less than 100 with those who had higher levels. Effects were measured by asking the participants to respond to 48 questions to determine levels of aggression, hostility, cynicism and depression. The major difference identified in the low-cholesterol group of women versus the others was that their answers were rated as more aggressive.

WHAT MAKES A WOMAN AGGRESSIVE?

Dr. Bairey Merz told me that the problem with observational studies, including this one, is that there is no way to determine cause and effect. She said one possibility is that women who are more aggressive are more direct about their feelings and needs and seek out ways to get them met… therefore, perhaps they are assertive with their doctors and more likely to get prescriptions. Also there could be a biological connection between low cholesterol and more aggressive behavior. More studies are required to further examine the issues around low cholesterol levels (with and without medication) and behavior.