Table 2. Summary of epidemiologic studies of HDL-C as a prognostic factor in prostate cancer.
| Author, year | Country | Setting | Age, years (mean or range) |
No. of subjects (cancer cases) |
Outcomes of interest |
Main results | Adjusted covariates | Conclusions | Notes |
| Cross-sectional studies | |||||||||
| Hammarsten J, 2004 (ref. 18) |
Sweden | Hospital | 73 | 299 (299) |
Cancer severity: histopathology |
Patients with high-grade cancers had a lower HDL-C (1.10 mmol/L) than those with low-grade cancers (1.28 mmol/L). |
BPH growth rate, uric acid, alanine aminotransferase (these were used only in analyzing the subpopulation with PSA < 50 ng/mL) |
Positive +
Patients with more-severe cancer had lower HDL-C. |
Low HDL-C was analyzed as a manifestation of hyperinsulinemia in this study. |
| Prabhat P, 2010 (ref. 19) |
India | Hospital | 67.5 | 50 (50) |
Cancer severity: histopathology |
Patients with high-grade cancers had a lower HDL-C level (0.84 mmol/L) than those with non-high-grade cancers (0.95 mmol/L). | No adjusted factors |
Positive +
Patients with more-severe cancer had lower HDL-C. |
This was a small pilot study. Low HDL-C was considered as a metabolic abnormality, as were obesity and hyperinsulinemia. |
| Nested case-control studies | |||||||||
| Jacobs EJ, 2012 (ref. 20) |
USA | General | 50–79 | 14 241 (236) |
Cancer severity: information from registry system |
No significant association between low HDL-C and aggressive cancer (OR: 0.92 [95% CI: 0.54–1.57] in the 4th [≥1.32 mmol/L of HDL-C] vs. 1st quartiles [<0.93 mmol/L] or OR per SD of 0.32 mmol/L: 95% CI: 0.97 [0.82–1.16]). |
Physical activity, education, PSA testing history, family history of prostate cancer, heart attack, use of cholesterol-lowering drugs, aspirin use, acetaminophen use, BMI, diabetes. |
No −
HDL-C level was not associated with development of aggressive cancer. |
Age- and race-matched design. Follow-up period of cohort: 6–10 years. |
| Cohort studies | |||||||||
| Hammarsten J, 2005 (ref. 21) |
Sweden | Hospital | Deaths (cases): 74, survivors (cases): 71 |
320 (320; deaths: 54) |
Mortality of cancer: information of registry and physician network system |
Patients who died had a lower HDL-C level (1.18 mmol/L) than those who were alive (1.25 mmol/L). |
No adjusted factors |
Positive +
Low HDL-C predicted cancer death. |
Follow-up period of cohort: 1233 days. Low HDL-C was analyzed as a manifestation of hyperinsulinemia in this study. |
| Martin RM, 2009 (ref. 14) |
Norway | General | ≥20 | 29 364 (687; deaths: 110) |
Cancer severity; mortality of cancer: information from registry system |
No significant association was found between a low HDL-C and localized (HR per SD of 0.3 mmol/L: 0.92 [95% CI: 0.80–1.05]) or advanced cancer (HR: 1.08 [0.92–1.25]). No significant association was found between a low HDL-C and the cancer death (HR: 1.03 [0.87–1.23]). |
Age, height, smoking, marital status, education, physical activity, International Prostate Symptom Score |
No −
HDL-C level did not predict development of localized/advanced cancer or cancer death. |
Follow-up period of cohort: 9.3 years. Low HDL-C was analyzed as a component of the metabolic syndrome in this study. This study also investigated cancer incidence (see Table 1). |
| Mondul AM, 2011 (ref. 16) |
Finland | General | 50–69 | 29 093 (2041) |
Cancer severity: medical records or information from registry system |
A low HDL-C level was suggested to be positively associated with non-aggressive cancer (<40 mg/dL, referent; 40–<60 mg/dL, HR: 0.88 [95% CI: 0.76–1.02]; ≥60 mg/dL, HR: 0.85 [0.67–1.07]), aggressive cancer (<40 mg/dL, referent; 40–<60 mg/dL, HR: 1.02 [0.83–1.25]; ≥60 mg/dL, HR: 0.89 [0.65–1.22]) and stage ≥3 (<40 mg/dL, referent; 40–<60 mg/dL, HR: 0.87 [0.65–1.17]; ≥60 mg/dL, HR: 0.85 [0.60–1.19]). |
Age, serum α-tocopherol, family history of prostate cancer, education, urban residence (an additional adjustment used intervention, cigarettes, physical activity, BMI, marital status, total energy, total fat, fruit, vegetable, red meat, alcohol, dietary retinol, vitamin A, vitamin D, calcium) |
No − but borderline
Low HDL-C nonsignificantly but suggestively predicted cancer development, regardless of severity. |
Follow-up period of cohort: 21 years after a randomized controlled trial with α-tocopherol, β-carotene, or both. The study was an expansion of prior study by Ahm, 2009 (ref. 13). This study also investigated cancer incidence (see Table 1). |
HDL-C: high-density lipoprotein cholesterol, PSA: prostate-specific antigen, BMI: body mass index, OR: odds ratio, HR: hazard ratio.