High cholesterol is well known as a risk factor for heart disease. Surprisingly, though, some research has shown that high cholesterol does not increase the risk of dying from heart disease in elderly people.

Does that mean that you can quit worrying about cholesterol in your golden years? Think again, says Johns Hopkins cardiologist Seth Martin, M.D., M.H.S., director of the Lipid Clinic at the Ciccarone Center for the Prevention of Heart Disease. 

Here’s what you need to know about cholesterol in late life.

Negative Impact of High Cholesterol

Studying cholesterol in older adults is trickier than it sounds, Martin says. Many people who have high cholesterol die from complications of heart disease before reaching an advanced age. Those who live into their 70s or 80s despite high cholesterol might have other factors that increased their longevity. That bias could skew the research results.

“If someone has made it to that age and hasn’t had problems from their cholesterol, they may have gotten lucky with genes or other protective factors,” he says. But that doesn’t mean high cholesterol is harmless — or that their luck won’t run out.

In addition, high cholesterol is one of many factors that work together to contribute to cardiovascular disease, along with elements such as  high blood pressure, diabetes, smoking and inactivity. Cholesterol might not always be the single most important factor, Martin says, but it’s a piece of the puzzle that patients and doctors should not ignore.

Treatment Gets Personal

There’s no one-size-fits-all approach for managing high cholesterol in older adults. “There’s not just one number we follow, but rather we consider the full picture,” says Martin.

For instance, he says, clinicians have to consider the other prescription drugs a patient is taking. Older adults often take many medications, and some medications might interact negatively with statin drugs typically prescribed to lower cholesterol.

Medical guidelines suggest that in treating patients over age 75, clinicians should pay extra attention to the potential for negative drug interactions.

Those guidelines are just a starting point, however. In some patients, other health problems might take priority. In those cases, the side effects of the statins might outweigh the benefits. In others who have fewer competing health risks and want to make cardiovascular disease treatment a priority, it might make sense to treat high cholesterol more aggressively. “It requires extra care and discussion to figure out the best decision for each patient, in partnership with the patient and his or her family,” Martin says.