| For medical practitioners and the general public - Cholesterol Journal Article Catalog. |
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| Low serum cholesterol and the risk of cancer: an analysis of the published prospective studies Law, M. R. and S. G. Thompson (1991), Cancer Causes Control 2(4): 253-61. Abstract: Data were analyzed from 33 prospective studies to assess the evidence for a long-term association of low serum cholesterol with cancer. In subjects with cancer diagnosed within two years of the cholesterol measurement or causing death within five years (n = 4,661), the level of serum cholesterol was on average lower than in controls by 0.18 (SE = 0.02) mmol/l in men and 0.11 (SE = 0.04) mmol/l in women; this effect can be attributed to preclinical cancer. For cancers presenting after these intervals (n = 22,030), the average differences were smaller but statistically significant (0.04 SE = 0.01 mmol/1 P less than 0.001) in men, and 0.03 SE = 0.01 mmol/1 P = 0.005 in women), equivalent to about a 15 percent increase in cancer incidence in the lowest cholesterol quintile. This cannot be attributed entirely to preclinical cancer. In men, there was significant (P = 0.01) heterogeneity between studies as to the extent of a long-term association. The heterogeneity could be substantially explained by socioeconomic status, the association being pronounced in studies of manual workers but absent in studies of professional men. The overall long-term association was attributable mainly to lung cancer in men, and partly to hemopoietic cancers (representing prolongation of survival by treatment). Colon cancer and other cancers unrelated to smoking showed no long-term association with low cholesterol. The data collectively do not justify concern that lowering serum cholesterol to reduce ischemic heart-disease risk might cause cancer. The long-term association with lung cancer is probably caused by smoking and we propose a mechanism. |
| Low serum cholesterol and the risk of cerebral haemorrhage Puddey, I. B. (1996), Atherosclerosis 119(1): 1-6. Abstract: In addressing the potential for any hazards associated with lowering serum cholesterol, a recent meta-analysis by Law and colleagues (Br Med J 1994;308:373) concluded that that there was no evidence that a low or reduced serum cholesterol concentration increases mortality from any cause other than haemorrhagic stroke. In this review, the evidence for this unexpected association will be addressed, and possible mechanisms discussed. Overall implications of the phenomenon, particularly for the hypertensive patient, will be addressed in the context of the anticipated consequences of lipid-lowering therapy for all stroke, haemorrhagic and non-haemorrhagic, as well as ischaemic heart disease (IHD). |
| Low serum cholesterol and violent death Benton, D. and J. Fordy (1992), Bmj 305(6856): 772-3. |
| Low serum cholesterol and violent death Goble, A. J. and M. C. Worcester (1992), Bmj 305(6856): 773. |
| Low serum cholesterol as a risk factor for hemorrhagic stroke in men: a community-based mass screening in Okinawa, Japan Okumura, K., K. Iseki, et al. (1999), Jpn Circ J 63(1): 53-8. Abstract: The relation between the level of total serum cholesterol and stroke is controversial. The relation between serum total cholesterol and subtypes of stroke was examined in the participants of a community-based mass screening program in Okinawa, Japan. A total of 38,053 subjects, whose serum level of cholesterol had been determined during a mass screening carried out in 1983, were examined to see whether they had experienced stroke during a 3-year period from 1988 to 1991. Of them, 315 subjects aged 33-93 years (174 men, 141 women) had had a stroke during that period. The types of stroke were cerebral infarction in 164, cerebral hemorrhage in 111, subarachnoid hemorrhage in 19, and others in 21. In men, the odds ratio of cerebral hemorrhage was 0.71 (95% confidence interval, 0.55-0.95), and the odds ratio of cerebral hemorrhage associated with serum level of cholesterol < or =167 mg/dl, 168-191 mg/dl, 192-217mg/dl, and > or =218mg/dl were 1.00 (reference), 0.70 (0.38-1.30), 0.77 (0.55-1.08), 0.73 (0.56-0.96), respectively. Lower serum cholesterol was an independent predictor of cerebral hemorrhage in men. |
| Low serum cholesterol concentration and risk of suicide Ellison, L. F. and H. I. Morrison (2001), Epidemiology 12(2): 168-72. Abstract: Recent reports have suggested a link between low serum total cholesterol and risk of death from suicide. We examined this association using participants in the 1970-1972 Nutrition Canada Survey. We determined the mortality experience of Nutrition Canada Survey participants older than 11 years of age at baseline through 1993 by way of record linkage to the Canadian National Mortality Database. The relation between low serum total cholesterol and mortality from suicide was assessed using a stratified analysis (N = 11,554). There were 27 deaths due to suicide. Adjusting for age and sex, we found that those in the lowest quartile of serum total cholesterol concentration (<4.27 mmol/liter) had more than six times the risk of committing suicide (rate ratio = 6.39; 95% confidence interval = 1.27-32.1) as did subjects in the highest quartile (>5.77 mmol/liter). Increased rate ratios of 2.95 and 1.94 were observed for the second and third quartiles, respectively. The effect persisted after the exclusion from the analysis of the first 5 years of follow-up and after the removal of those who were unemployed or who had been treated for depression. These data indicate that low serum total cholesterol level is associated with an increased risk of suicide. |
| Low serum cholesterol concentration and serotonin metabolism in men Steegmans, P. H., D. Fekkes, et al. (1996), Bmj 312(7025): 221. |
| Low serum cholesterol concentration and short term mortality from injuries in men and women Lindberg, G., L. Rastam, et al. (1992), Bmj 305(6848): 277-9. Abstract: OBJECTIVE--To determine whether total serum cholesterol concentration predicts mortality from injuries including suicide. DESIGN--Cohort study of men and women who had their serum cholesterol concentration measured as part of a general health survey in Varmland, Sweden in 1964 or 1965 and were followed up for an average of 20.5 years. SUBJECTS--Adults participating in health screening in 1964-5 (26,693 men and 27,692 women). The study sample was restricted to subjects aged 45-74 years during any of the 20.5 years of follow-up. MAIN OUTCOME MEASURES--Serum cholesterol concentration. Deaths from all injuries and suicides during three periods of follow up (0-6 years, 7-13 years, and 14-21 years) according to the Swedish mortality register in subjects aged 45-74. Adjustment was made for prevalent cancer (identified from the Swedish cancer register) at the time of a suicide. RESULTS--A strong negative relation between cholesterol concentration and mortality from injuries was found in men during the first seven years of follow up. The relative risk in the lowest 25% of the cholesterol distribution was 2.8 (95% confidence interval 1.52 to 4.96) compared with the top 25%. Most of the excess risk was caused by suicide with a corresponding relative risk of 4.2 (p for trend = 0.001). Correction for prevalent cancer did not change the results. Events occurring during the latter two thirds of the 20.5 years of follow up were not predicted. In women no relation between cholesterol concentration and mortality from injuries was found. CONCLUSIONS--Together with observations from intervention trials the findings support the existence of a relation between serum cholesterol concentration and suicide. The causality of such a relation is, however, not resolved. |
| Low serum cholesterol in children with fever Garbagnati, E. (1993), Acta Paediatr 82(1): 98. |
| Low serum cholesterol in suicide attempters Kunugi, H., N. Takei, et al. (1997), Biol Psychiatry 41(2): 196-200. Abstract: Previous studies have shown an association between low serum cholesterol concentration and suicide; however, conflicting results have also been reported. To examine this potential association, cholesterol levels in 99 patients admitted to an emergency ward following an attempted suicide were compared with those in 74 nonsuicidal psychiatric inpatients, and those in 39 psychiatrically normal individuals with accidental injuries. Cholesterol concentrations in suicide attempters were found to be significantly lower compared with both psychiatric and normal controls, when sex, age, psychiatric diagnosis, and physical conditions (serum total protein and red blood cell count) were adjusted for. This significant relationship was observed in mood disorders and personality or neurotic disorders, but not in schizophrenia spectrum disorders. These results support the previous claim that lower cholesterol level is associated with an increased risk of suicidal behavior. |
| Low serum cholesterol in violent but not in non-violent suicide attempters Alvarez, J. C., D. Cremniter, et al. (2000), Psychiatry Res 95(2): 103-8. Abstract: Many previous studies have suggested that low or lowered serum cholesterol levels may increase the risk of mortality not due to somatic disease: principally, suicide and violent death. Because violent death is rare, some studies have investigated afterwards the relation between cholesterol levels and either suicide attempts in psychiatric populations or violence in criminally violent populations. However, none of these studies have compared cholesterol levels in violent and non-violent suicide attempters. The blood of 25 consecutive drug-free patients following a violent suicide attempt and of 27 patients following a non-violent suicide attempt by drug overdose was drawn in the 24 h following admission. Patients with a diagnosis of alcohol abuse and with cholesterol-lowering therapy were excluded. Age, sex, body mass index, psychiatric diagnosis and the physical conditions of the suicide attempt were investigated. Thirty-two healthy subjects were used as a control group. There were no differences between the groups in age, frequency of psychiatric diagnoses or body mass index. There was more women in the group of non-violent suicide attempters than in that of violent suicide attempters (P<0.001). In analyses controlling for sex and age, the serum cholesterol concentration was 30% lower (F(2,82)=15.8; P<0.0001) in the group of violent suicide attempters (147+/-54 mg/dl) than in the group of non-violent suicide attempters (209+/-38 mg/dl) or control subjects (213+/-46 mg/dl). Our results showed that low serum cholesterol level is associated with the violence of the suicide attempt and not with the suicide attempt itself. Further investigations are necessary to determine the usefulness of this easily accessible parameter as a potential risk indicator for violent acts such as violent suicidal behavior in susceptible individuals. |
| Low serum cholesterol increases the risk of noncardiovascular events: an antagonist viewpoint Jones, P. H. (1994), Cardiovasc Drugs Ther 8(6): 871-4. Abstract: Considerable debate concerning the apparent association of low serum cholesterol levels with enhanced noncardiovascular disease mortality has been aired in both scientific and lay publications within the past year. This debate has resulted in some medical experts calling for a moratorium on efforts to reduce serum cholesterol, particularly with drugs, and for a more conservative approach to screening and modifying cholesterol levels for the primary prevention of coronary heart disease (CHD). Observational studies, including the Framingham Heart Study, the Multiple Risk Factor Intervention Trial, the Whitehall Study, and the International Collaborative Group, have not substantiated a cause and effect relationship between "naturally" occurring low serum cholesterol and noncardiovascular disease mortality, such as cancer. Intervention trials designed to lower high serum cholesterol levels by diet and drugs have also not been conclusively shown to produce excess harm that offsets the benefit of reduced CHD events. Several primary and secondary CHD prevention trials, with sufficient numbers of subjects to provide the statistical power to detect potential detrimental effects of lowering cholesterol levels, are currently in progress and will be very helpful in resolving the concern about noncardiovascular disease mortality. |
| Low serum cholesterol is correlated to suicidality in a Korean sample Kim, Y. K., H. J. Lee, et al. (2002), Acta Psychiatr Scand 105(2): 141-8. Abstract: OBJECTIVE: The aim of this study was to examine further the association between low total serum cholesterol and suicidal behaviour. METHOD: We measured the serum cholesterol levels in 231 patients admitted to an emergency room following a suicide attempt, in 231 age-,sex- and diagnosis-matched non-suicidal psychiatric controls, and in 231 age- and sex-matched normal controls. The suicide attempt patients were divided into five grades according to the degree of injury. RESULTS: The mean total cholesterol level of the suicide attempt patients was significantly lower than that of the psychiatric and normal controls.When the suicide attempt patients and non-suicidal psychiatric controls were divided by diagnosis, this significant relationship held true for major depressive disorders and personality disorders, but not for schizophrenia and bipolar disorders. Cholesterol level and the severity of suicide attempt were inversely correlated. CONCLUSION: The results suggest that cholesterol level may serve as a marker for suicide risk. Possible explanations are discussed. |
| Low serum cholesterol is not associated with depression in the elderly: data from an Australian community study McCallum, J., L. Simons, et al. (1994), Aust N Z J Med 24(5): 561-4. Abstract: BACKGROUND: Low serum cholesterol may contribute to depressive symptoms in the elderly. AIMS: To test the relationship between depressive symptoms and low serum cholesterol in an elderly cohort. METHODS: This was an examination of cross-sectional data in a community study of 1237 men and 1568 women aged 60+ years in Dubbo, NSW. Quintiles of serum cholesterol were defined for men and women. The Center for Epidemiological Studies Depression Scale was used as a continuous, dependent variable in multiple regression analyses. RESULTS: Low serum cholesterol was not associated with depressive symptoms in older men or women. Health status, measured by poorer self-ratings, recent hospitalisation, higher disability levels and higher consumption of prescribed and self-prescribed drugs, predicted depressive symptoms. As well, the significance in the statistical model of financial difficulties, low self esteem, low feelings of self efficacy, the adequacy of practical help and emotional support, and recent widowhood, confirmed the importance of social origins of depressive symptoms. |
| Low serum cholesterol level and attempted suicide Golier, J. A., P. M. Marzuk, et al. (1995), Am J Psychiatry 152(3): 419-23. Abstract: OBJECTIVE: Several studies suggest that a low cholesterol concentration is associated with a greater than normal risk of mortality from suicide. The authors sought to determine whether a low cholesterol level is associated with a history of serious suicide attempts among psychiatric inpatients. METHOD: Lifetime history of attempted suicide of 650 patients, aged 18-59 years, consecutively admitted to a psychiatric hospital was assessed by semistructured interview. The seriousness of an attempt was rated on the basis of the resulting medical injury. Serum cholesterol levels, obtained from the admission biochemical profiles, were divided into quartiles. RESULTS: Compared to men with low cholesterol levels (defined as less than or equal to the 25th percentile), men with cholesterol levels above the 25th percentile were less likely to have ever made a serious suicide attempt when age, weight, race, socioeconomic status, alcohol use, and depression were controlled for. There was no association between cholesterol level and attempted suicide in women. CONCLUSIONS: Male psychiatric patients with low cholesterol levels were twice as likely to have ever made a medically serious suicide attempt than men with cholesterol levels above the 25th percentile. Low cholesterol concentration should be further investigated as a potential biological marker of suicide risk. |
| Low serum cholesterol level and the risk of cancer of the colon Jedrychowska, I. and A. Czupryna (1990), Pol Tyg Lek 45(34-35): 691-4. Abstract: The study aimed at assessing a degree of low serum cholesterol relationship to carcinoma of the colon. The study involved 137 patients with carcinoma of the colon and 54 patients serving as a control group. Serum cholesterol and total proteins levels were assayed and nutritional status of the patients was analysed. It was found that serum cholesterol was significantly lower in patients with both advanced and mild cancer of the colon in comparison with a control group. Similar tendency was noted in the group of female patients with cancer of the colon but the difference between the patients with not advanced cancer and control group was statistically insignificant. Serum total proteins did not differ in patients with cancer of the colon and control group. In the group of male patients (with both stages of the cancer) in whom low serum cholesterol was noted (below 5.2 mM/L) a risk of cancer was 3-7 times higher. In female patients relative risk of cancer was significantly higher only in the advanced stages of the disease. |
| Low serum cholesterol levels and depressive state in human dock visitors Terao, T., N. Iwata, et al. (2000), Acta Psychiatr Scand 101(3): 231-4. Abstract: OBJECTIVE: The purpose of the present study was to investigate an association between serum cholesterol levels and depressive state. METHOD: Physical examinations and mental assessments were performed for 13702 human dock visitors. We obtained 13571 sets of complete data for serum total cholesterol, the scores for depressive state and possible confounders such as sex, age, body weight, body mass index (BMI), recent weight loss, total protein and concomitant medical diagnoses. RESULTS: Their depressive state varied significantly across the serum cholesterol levels after adjusting age and gender. After controlling all the above confounding variables the significance still remained, not only in the categorical analysis but also in the continuous analysis. CONCLUSION: The present findings suggest that there is an association between cholesterol and depressive state. |
| Low serum cholesterol levels and morning suicide Friedman, E. H. (1993), Arch Intern Med 153(10): 1268, 1271. |
| Low serum cholesterol levels predict high perioperative mortality in patients supported by a left-ventricular assist system Richartz, B. M., B. Radovancevic, et al. (1998), Cardiology 89(3): 184-8. Abstract: BACKGROUND: Although the use of a left-ventricular assist system (LVAS) provides circulatory support for end-stage heart failure patients awaiting heart transplantation, this procedure is accompanied by a relatively high perioperative mortality. The aim of this retrospective study was to identify those patients preoperatively which have the highest perioperative mortality. METHODS AND RESULTS: Forty-five consecutive patients undergoing LVAS implantation were evaluated for preoperative risk factors, including body mass index, hemodynamic data, and blood chemistry studies by multivariate analysis. They were divided into (1) patients who were successfully transplanted (n = 25) and (2) patients who died before transplantation (n = 20). The nonsurvivors were subclassified into patients who died within 14 days after surgery (n = 11) and patients who died after 2 weeks of device implantation (n = 9). Hemodynamic parameters were the same in both groups, but total cholesterol was significantly lower in the nonsurvivors than in the survivors (90 +/- 7 vs. 144 +/- 8 mg/dl, respectively, p < 0.0001). The sensitivity of predicting perioperative death with a serum cholesterol below 100 mg/dl was 100%, the specificity of predicting survival with a serum cholesterol above 120 mg/dl was 87%. CONCLUSION: In this small retrospective study, there was a correlation between total cholesterol levels and survival of patients with advanced heart failure on mechanical support. A cholesterol level below 100 mg/dl was accompanied by a high perioperative mortality. In contrast, a cholesterol level above 120 mg/dl was accompanied by a 87% chance of survival. The results suggest a predictive value of cholesterol which is independent of the hemodynamic status. |
| Low serum cholesterol, cancer and other noncardiovascular disorders Epstein, F. H. (1992), Atherosclerosis 94(1): 1-12. Abstract: There has been much concern and discussion whether reduction of serum cholesterol by diet or drugs, while preventing coronary heart disease, might cause an increase in the risk of dying from noncardiovascular disorders, in particular cancer. A review of the evidence from ecological, cross-cultural comparisons, prospective epidemiological cohort studies and intervention trials provides no indication for a cause-and-effect association between low serum cholesterol or serum cholesterol lowering and the risk of cancer, except possibly at very low levels. An inverse relationship between noncardiovascular-noncancer mortality and serum cholesterol level does exist but the link is unlikely to be causal; for better understanding, there is a need for studying the biological, lifestyle and social correlates of this association. Continuing observations should pay attention to the accuracy of information on specific causes of noncardiovascular deaths, especially mortality not due to disease. Further research needs to include investigations into the determinants of low serum cholesterol levels and their possible influence on biological functions. It is concluded that the current recommendations for coronary heart disease prevention, aimed at lowering elevated serum cholesterol levels in individuals (the 'high-risk strategy') and in populations at high risk (the 'population strategy') require no basic modification in the light of present knowledge on the relationships between cholesterol and noncardiovascular disease mortality. |