Cancer Survival and Cholesterol Levels

Insights from a Major 2025 Study.

Cholesterol. For decades, cholesterol was demonized in the medical literature. How many billions of egg yolks were trashed in favor of “lower cholesterol”. And yet basic biology shows the importance of cholesterol. Cholesterol is the back bone building block for all steroid hormones (testosterone, estrogen, etc.), vitamin D (which regulates 20% of the human genome), and is crucial for brain function. Cholesterol is so important in human health that a healthy adult liver will generate the equivalent of 6-8 egg yolks in cholesterol per day. In the 1960s, “healthy acceptable” serum cholesterol was 300. Today that number is 200. 39 million Americans are on statins helping to generate $19 billion in global sales. We now know there is a connection between cancer survival and cholesterol levels, and that lowering cholesterol carries a risk.

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Is moderately higher cholesterol protective?

In late 2025, a landmark prospective cohort study published in Engineering challenges the conventional “lower is always better” approach to cholesterol management. The research, titled “Low and Decreasing Cholesterol Levels and Risk of All-Cause and Cause-Specific Mortality: A Prospective and Longitudinal Cohort Study” (available on ScienceDirect, PII: S2095809925003649), analyzed over 480,000 adults from Chinese cohorts and the UK Biobank. It reveals a U-shaped relationship between cholesterol levels and mortality, with low or decreasing cholesterol strongly linked to higher risks of all-cause and cancer mortality — suggesting that moderately higher cholesterol could be protective, especially in the context of cancer.

Cholesterol is only found in animal foods, with meat, high fat dairy, liver, and egg yolks as primary sources. In this study, low cholesterol (below 4.14 mmol/l = 161 mg/dl in America) was associated with a 49% increase in all cause mortality, including heart attack, stroke, and cancer. Elevated cholesterol (above 6.21 mmol/l = 242 mg/dl) had zero associated risk for heart attack, stroke, or cancer. Clearly, lowering serum cholesterol can be hazardous.

Low Cholesterol Linked to Higher Cancer Mortality

This large-scale study tracked untreated adults over 9.7–12.9 years:

U-shaped associations: Nonlinear links (P ≤ 0.0161) between total cholesterol (TC), LDL-C, and non-HDL-C and mortality.
High cholesterol: Primarily tied to increased coronary heart disease (CHD) mortality.
Low cholesterol: Strongly associated with higher all-cause and cancer mortality.
Decreasing cholesterol: Drops over ~4 years correlated with elevated all-cause and cancer mortality in Chinese cohorts (P ≤ 0.0100).
Persistently low levels: Low TC/LDL-C/non-HDL-C at baseline and follow-up linked to higher all-cause mortality across populations.

Headlines from the study:
“High cholesterol was primarily associated with CHD mortality, while low cholesterol associated with all-cause and cancer mortality.”
“Decreasing cholesterol levels over four years were associated with higher all-cause and cancer mortality.”

Higher Cholesterol: Potential Protective Role in Cancer Mortality

The study’s cancer findings highlight a potential benefit of avoiding very low cholesterol levels:

Low baseline or declining TC/LDL-C robustly predicts higher cancer death risk.
This implies moderately higher cholesterol (within optimal ranges) may correlate with better cancer outcomes, possibly because cholesterol supports immune function, cell repair, or energy needs during illness.
In cancer contexts, low cholesterol (hypocholesterolemia) is common and prognostic of poorer survival — tumors consume cholesterol for growth, or inflammation/malnutrition drives levels down.

Supporting evidence from other studies:

A meta-analysis of cancer survivors found higher total cholesterol (TC) and HDL-C as protective factors for overall survival.
In newly diagnosed cancer patients (2024 study), very low TC (<97 mg/dL) had higher all-cause mortality risk (HR 1.54) than very high (>233 mg/dL, HR 1.28), compared to mid-ranges.
Multiple cohorts show inverse associations: Lower cholesterol predicts higher non-cardiovascular (including cancer) mortality.

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For cancer patients specifically:

Higher preoperative TC/HDL-C often links to better prognosis and longer survival.
Aggressive cholesterol-lowering (e.g., via statins in low-risk cases) may unintentionally worsen outcomes if levels drop too low.

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Broader Implications for Cancer Patients and Prevention

In oncology, low cholesterol is a known poor prognostic marker:

Cancer cells hijack cholesterol for membrane synthesis and signaling.
Higher levels may support anti-tumor immunity or resilience.
The 2025 study adds weight: Preventing declines (e.g., via nutrition) could matter for longevity.

Balancing Cholesterol: The Mediterranean Diet Approach

To maintain optimal levels without extremes, the Mediterranean diet remains top-rated for heart and overall health. It modestly lowers LDL/triglycerides while raising HDL, promoting balance.

Benefits:

Reduces CVD risk (PREDIMED trial: 30% fewer events).
Supports healthy cholesterol ratios via olive oil (monounsaturates), fish (omega-3s), nuts, veggies, and fiber.
Anti-inflammatory effects may indirectly aid cancer prevention/prognosis.
Avoids extreme low-fat pitfalls that crash cholesterol.
Supports healthy immunity
Supports healthy microbiome.

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Tips to start:

Daily: Extra virgin olive oil, plenty of plants.
Weekly: Fish, moderate dairy/poultry.
Limit: Red meat, sweets.
Combine with exercise and regular testing.

Serum Cholesterol, Heart Disease & Statins

Cancer Survival and Cholesterol Levels

For decades science has known the essential role of cholesterol in human health. The lipid/fat model of heart disease has been challenged at the highest levels of academia. Cholesterol clogged arteries are indicative of underlying metabolic issues, such as oxidation of the lining of the blood vessels, elevated homocysteine, chronic inflammation, stress, inactivity, and more. Cholesterol is the messenger in heart disease, not the villain.

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