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. 1995 Aug 12;311(7002):409–413. doi: 10.1136/bmj.311.7002.409

Low serum total cholesterol concentrations and mortality in middle aged British men.

G Wannamethee 1, A G Shaper 1, P H Whincup 1, M Walker 1
PMCID: PMC2550486  PMID: 7640584

Abstract

OBJECTIVE--To examine the relation between low serum total cholesterol concentrations and causes of mortality. DESIGN--Cohort study of men followed up for an average of 14.8 years (range 13.5-16.0 years). SETTING--One general practice in each of 24 British towns. SUBJECTS--7735 men aged 40-59 at screening selected at random from the 24 general practices. MAIN OUTCOME MEASURES--Deaths from all causes, cardiovascular causes, cancer, and non-cardiovascular, non-cancer causes. RESULTS--During the mean follow up period of 14.8 years there were 1257 deaths from all causes, 640 cardiovascular deaths, 433 cancer deaths, and 184 deaths from other causes. Low serum cholesterol concentrations (< 4.8 mmol/l), present in 5% (n = 410) of the men, were associated with the highest mortality from all causes, largely due to a significant increase in cancer deaths (age adjusted relative risk 1.6 (95% confidence interval 1.1 to 2.3); < 4.8 v 4.8-5.9 mmol/l) and in other non-cardiovascular deaths (age adjusted relative risk 1.9 (1.1 to 3.1)). Low serum cholesterol concentration was associated with an increased prevalence of several diseases and indicators of ill health and with lifestyle characteristics such as smoking and heavy drinking. After adjustment for these factors in the multivariate analysis the increased risk for cancer was attenuated (relative risk 1.4 (0.9 to 2.0) and the inverse association with other non-cardiovascular, non-cancer causes was no longer significant (relative risk 1.5 (0.9 to 2.6); < 4.8 v 4.8-5.9 mmol/l). The excess risks of cancer and of other non-cardiovascular deaths were most pronounced in the first five years and became attenuated and non-significant with longer follow up. By contrast, the positive association between serum total cholesterol concentration and cardiovascular mortality was seen even after more than 10 years of follow up. CONCLUSION--The association between comparatively low serum total cholesterol concentrations and excess mortality seemed to be due to preclinical cancer and other non-cardiovascular diseases. This suggests that public health programmes encouraging lower average concentrations of serum total cholesterol are unlikely to be associated with increased cancer or other non-cardiovascular mortality.

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Selected References

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  1. Alvarez C., Ramos A. Lipids, lipoproteins, and apoproteins in serum during infection. Clin Chem. 1986 Jan;32(1 Pt 1):142–145. [PubMed] [Google Scholar]
  2. Chen Z., Peto R., Collins R., MacMahon S., Lu J., Li W. Serum cholesterol concentration and coronary heart disease in population with low cholesterol concentrations. BMJ. 1991 Aug 3;303(6797):276–282. doi: 10.1136/bmj.303.6797.276. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cook D. G., Shaper A. G., MacFarlane P. W. Using the WHO (Rose) angina questionnaire in cardiovascular epidemiology. Int J Epidemiol. 1989 Sep;18(3):607–613. doi: 10.1093/ije/18.3.607. [DOI] [PubMed] [Google Scholar]
  4. Cowan L. D., O'Connell D. L., Criqui M. H., Barrett-Connor E., Bush T. L., Wallace R. B. Cancer mortality and lipid and lipoprotein levels. Lipid Research Clinics Program Mortality Follow-up Study. Am J Epidemiol. 1990 Mar;131(3):468–482. doi: 10.1093/oxfordjournals.aje.a115521. [DOI] [PubMed] [Google Scholar]
  5. Garcia-Palmieri M. R., Sorlie P. D., Costas R., Jr, Havlik R. J. An apparent inverse relationship between serum cholesterol and cancer mortality in Puerto Rico. Am J Epidemiol. 1981 Jul;114(1):29–40. doi: 10.1093/oxfordjournals.aje.a113171. [DOI] [PubMed] [Google Scholar]
  6. Harris T., Feldman J. J., Kleinman J. C., Ettinger W. H., Jr, Makuc D. M., Schatzkin A. G. The low cholesterol-mortality association in a national cohort. J Clin Epidemiol. 1992 Jun;45(6):595–601. doi: 10.1016/0895-4356(92)90131-6. [DOI] [PubMed] [Google Scholar]
  7. Hiatt R. A., Fireman B. H. Serum cholesterol and the incidence of cancer in a large cohort. J Chronic Dis. 1986;39(11):861–870. doi: 10.1016/0021-9681(86)90034-2. [DOI] [PubMed] [Google Scholar]
  8. Hulley S. B., Walsh J. M., Newman T. B. Health policy on blood cholesterol. Time to change directions. Circulation. 1992 Sep;86(3):1026–1029. doi: 10.1161/01.cir.86.3.1026. [DOI] [PubMed] [Google Scholar]
  9. Isles C. G., Hole D. J., Gillis C. R., Hawthorne V. M., Lever A. F. Plasma cholesterol, coronary heart disease, and cancer in the Renfrew and Paisley survey. BMJ. 1989 Apr 8;298(6678):920–924. doi: 10.1136/bmj.298.6678.920. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Iso H., Naito Y., Kitamura A., Sato S., Kiyama M., Takayama Y., Iida M., Shimamoto T., Sankai T., Komachi Y. Serum total cholesterol and mortality in a Japanese population. J Clin Epidemiol. 1994 Sep;47(9):961–969. doi: 10.1016/0895-4356(94)90110-4. [DOI] [PubMed] [Google Scholar]
  11. Jacobs D., Blackburn H., Higgins M., Reed D., Iso H., McMillan G., Neaton J., Nelson J., Potter J., Rifkind B. Report of the Conference on Low Blood Cholesterol: Mortality Associations. Circulation. 1992 Sep;86(3):1046–1060. doi: 10.1161/01.cir.86.3.1046. [DOI] [PubMed] [Google Scholar]
  12. Kagan A., McGee D. L., Yano K., Rhoads G. G., Nomura A. Serum cholesterol and mortality in a Japanese-American population: the Honolulu Heart program. Am J Epidemiol. 1981 Jul;114(1):11–20. doi: 10.1093/oxfordjournals.aje.a113157. [DOI] [PubMed] [Google Scholar]
  13. Law M. R., Thompson S. G., Wald N. J. Assessing possible hazards of reducing serum cholesterol. BMJ. 1994 Feb 5;308(6925):373–379. doi: 10.1136/bmj.308.6925.373. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Manolio T. A., Ettinger W. H., Tracy R. P., Kuller L. H., Borhani N. O., Lynch J. C., Fried L. P. Epidemiology of low cholesterol levels in older adults. The Cardiovascular Health Study. Circulation. 1993 Mar;87(3):728–737. doi: 10.1161/01.cir.87.3.728. [DOI] [PubMed] [Google Scholar]
  15. Neaton J. D., Blackburn H., Jacobs D., Kuller L., Lee D. J., Sherwin R., Shih J., Stamler J., Wentworth D. Serum cholesterol level and mortality findings for men screened in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Arch Intern Med. 1992 Jul;152(7):1490–1500. [PubMed] [Google Scholar]
  16. Oliver M. F. National cholesterol policies. Eur Heart J. 1993 May;14(5):581–583. doi: 10.1093/eurheartj/14.5.581. [DOI] [PubMed] [Google Scholar]
  17. Phillips A., Shaper A. G., Whincup P. H. Association between serum albumin and mortality from cardiovascular disease, cancer, and other causes. Lancet. 1989 Dec 16;2(8677):1434–1436. doi: 10.1016/s0140-6736(89)92042-4. [DOI] [PubMed] [Google Scholar]
  18. Salmond C. E., Beaglehole R., Prior I. A. Are low cholesterol values associated with excess mortality? Br Med J (Clin Res Ed) 1985 Feb 9;290(6466):422–424. doi: 10.1136/bmj.290.6466.422. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Schatzkin A., Hoover R. N., Taylor P. R., Ziegler R. G., Carter C. L., Larson D. B., Licitra L. M. Serum cholesterol and cancer in the NHANES I epidemiologic followup study. National Health and Nutrition Examination Survey. Lancet. 1987 Aug 8;2(8554):298–301. doi: 10.1016/s0140-6736(87)90890-7. [DOI] [PubMed] [Google Scholar]
  20. Shaper A. G., Pocock S. J., Walker M., Cohen N. M., Wale C. J., Thomson A. G. British Regional Heart Study: cardiovascular risk factors in middle-aged men in 24 towns. Br Med J (Clin Res Ed) 1981 Jul 18;283(6285):179–186. doi: 10.1136/bmj.283.6285.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Shaper A. G., Wannamethee G., Weatherall R. Physical activity and ischaemic heart disease in middle-aged British men. Br Heart J. 1991 Nov;66(5):384–394. doi: 10.1136/hrt.66.5.384. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Sherwin R. W., Wentworth D. N., Cutler J. A., Hulley S. B., Kuller L. H., Stamler J. Serum cholesterol levels and cancer mortality in 361,662 men screened for the Multiple Risk Factor Intervention Trial. JAMA. 1987 Feb 20;257(7):943–948. [PubMed] [Google Scholar]
  23. Smith G. D., Shipley M. J., Marmot M. G., Rose G. Plasma cholesterol concentration and mortality. The Whitehall Study. JAMA. 1992 Jan 1;267(1):70–76. [PubMed] [Google Scholar]
  24. Stamler J., Stamler R., Brown W. V., Gotto A. M., Greenland P., Grundy S., Hegsted D. M., Luepker R. V., Neaton J. D., Steinberg D. Serum cholesterol. Doing the right thing. Circulation. 1993 Oct;88(4 Pt 1):1954–1960. doi: 10.1161/01.cir.88.4.1954. [DOI] [PubMed] [Google Scholar]
  25. Stemmermann G. N., Chyou P. H., Kagan A., Nomura A. M., Yano K. Serum cholesterol and mortality among Japanese-American men. The Honolulu (Hawaii) Heart Program. Arch Intern Med. 1991 May;151(5):969–972. [PubMed] [Google Scholar]
  26. Thelle D. S., Shaper A. G., Whitehead T. P., Bullock D. G., Ashby D., Patel I. Blood lipids in middle-aged British men. Br Heart J. 1983 Mar;49(3):205–213. doi: 10.1136/hrt.49.3.205. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Walker M., Shaper A. G. Follow-up of subjects in prospective studies based in general practice. J R Coll Gen Pract. 1984 Jul;34(264):365–370. [PMC free article] [PubMed] [Google Scholar]
  28. Wannamethee G., Shaper A. G. Blood lipids: the relationship with alcohol intake, smoking, and body weight. J Epidemiol Community Health. 1992 Jun;46(3):197–202. doi: 10.1136/jech.46.3.197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Wannamethee G., Shaper A. G. Body weight and mortality in middle aged British men: impact of smoking. BMJ. 1989 Dec 16;299(6714):1497–1502. doi: 10.1136/bmj.299.6714.1497. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Wannamethee G., Shaper A. G., Macfarlane P. W. Heart rate, physical activity, and mortality from cancer and other noncardiovascular diseases. Am J Epidemiol. 1993 Apr 1;137(7):735–748. doi: 10.1093/oxfordjournals.aje.a116734. [DOI] [PubMed] [Google Scholar]

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