总是一堆破事儿，很久没写文章了。今天终于抽出时间，跟大家聊聊关于胆固醇的最新研究。
说起胆固醇，大多数人都会下意识地觉得它是「坏东西」，或者觉得高了肯定不好。
但是，现实生活中，很多小伙伴发现，运动健身、健康饮食一段时间以后体检，报告提示胆固醇变高，甚至有医生建议吃降脂药。
然后开始疑惑，是不是健身没练对、东西没吃对？
不过，2023年7月发表在知名期刊PLOS ONE的研究显示，胆固醇高的人反而更长寿，尤其对男性来说。
具体来说，较高的总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C）与男性全因死亡风险较低和生存时间较长独立相关。
这样的结果，与先前的报告一起，让专家们纷纷呼吁对血脂异常和健康风险的证据进行严格的重新评估，不要把胆固醇妖魔化，也不要把降脂药神圣化。
传统观念认为，总胆固醇(TC)和低密度脂蛋白胆固醇（LDL-C）非常可怕，它们越高，患心血管疾病（尤其是动脉粥样硬化）的风险就越高。所以胆固醇如果一直很高，就得赶紧吃降脂药。
然而，大量文献表明，胆固醇对心血管疾病风险的预测能力较差。也就是说，胆固醇高的人不一定更容易患心血管疾病，心血管疾病患者的胆固醇水平也不是普遍的高[1, 2, 4–6]。
此外，越来越多的证据表明，胆固醇高反而可能是更健康、更长寿的指征[7-19]。
例如，韩国曾经对1280万人进行大规模研究，发现胆固醇高的人更健康、更长寿。具体来说，总胆固醇（TC）每增加39 mg/dL，全因死亡风险降低8%，而胆固醇太低的人群，死亡风险增加10%至240%[9]。
美国[11]、丹麦 [7]等国的研究也发现了类似的结论。研究还发现，所谓的「坏胆固醇」（LDL-C）高的人，更不容易患卒中和癌症[7, 13，28，31]。
中国也发现了类似的情况。2020年，南方医科大学等单位曾对中国4981名男性和5529名女性进行研究，论文发表在BMJ Open上。结果令人意外：
所谓的「坏胆固醇」（LDL-C）与女性死亡率之间没有关联，但LDL-C较高的男性死亡率显著降低。换句话说，在中国男性中，「坏胆固醇」（LDL-C）高的人，更可能长寿！
最近，美国科研团队又对美国1479名男性退伍老兵进行研究，再次发现类似的结果：胆固醇越高，死亡风险越低；胆固醇越低，死亡风险越高。
具体来说，与总胆固醇（TC）<200 mg/dL相比，200 - 239 mg/dL和≥240 mg/dL水平分别与死亡率降低13%和37%相关；与低密度脂蛋白胆固醇（LDL-C） <130 mg/dL相比，130 - 189 mg/dL和≥190 mg/dL的死亡率分别降低26%和32%。
在连续风险模型中，总胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C）水平每增加10 mg/dL，死亡风险分别降低10%和9%。
研究人员指出，胆固醇在细胞和机体水平上都有许多重要的生理作用，而在某些情况下，胆固醇水平不足可能导致体内平衡失调并促进疾病。
胆固醇是一种结构材料，约占所有细胞血浆的20%，占所有细胞膜的60-80%。
在机体水平上，胆固醇是所有类固醇激素的前体，包括糖皮质激素和矿物质皮质激素、性激素和维生素D，以及调节碳水化合物代谢、钠平衡、生殖和骨骼稳态的激素。
胆固醇也是胆汁酸的前体，胆汁酸是肠道吸收膳食脂质以及调节能量和葡萄糖的重要机制[27]。
总之，胆固醇对我们真的太重要了，高点真不一定是坏事，各项研究都显示胆固醇高的人更可能长寿，也就不足为奇了。
小帅说
虽然这些观察结果并不表明因果关系，需要进一步调查。但考虑到这么多的科研文献[7-19]、这么多的国家、这么多的受试者，共同结论都指向「高胆固醇更可能长寿」，就非常值得关注。
如今，大多数人还是一谈到胆固醇高就害怕，包括大多数医生都是如此，因为各种「官方指南」上就是这么写的。
然而，现有的「官方指南」并不是科学的终点。研究人员指出，需要对现有证据进行严格的荟萃分析，并重新评估血脂异常指南以指导治疗，以确保血脂异常的循证管理。
可是，为什么已经有这么多研究数据表明「高胆固醇更可能长寿」，而官方指南还在建议降低胆固醇呢？考虑到降脂药是每年上百亿美元的大生意，这样的现状就有点让人细思恐极了。
在国内，也只有少数前沿医学专家会反思胆固醇的相关迷思。我总结了一份医学专家名单，如果你或你的亲朋有相关问题，不妨找这些专家聊聊，很可能有真正的帮助。
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声明：本文内容仅为信息分享，不可作为医疗、投资建议。
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