Low cholesterol leads to a 50% increased rate of digestive system deaths

This post includes a synopsis of a study published in Circulation 1992;86;1026-1029

Study title and authors:
Health policy on blood cholesterol. Time to change directions
SB Hulley, JM Walsh and TB Newman
From the Division of Clinical Epidemiology (S.B.H., T.B.N.), Department of Epidemiology and Biostatistics; General Internal Medicine Section (J.M.B.W.), Department of Medicine, Department of Veterans Affairs Medical Center; Division of General Pediatrics (T.B.N.), Department of Pediatrics, and Department of Laboratory Medicine (T.B.N.), School of Medicine, University of California San Francisco.

This paper can be accessed at: http://circ.ahajournals.org/cgi/reprint/86/3/1026

Hulley reviewed a study that included 68,406 deaths.

He found:
(a) men with cholesterol below 160 mg/dl had a 20% higher rate of cancer deaths compared with those with higher cholesterol levels.

(b) men with cholesterol below 160 mg/dl had a 40% higher rate of noncardiovascular, noncancer deaths compared with those with higher cholesterol levels.
(c) men with cholesterol below 160 mg/dl had a 35% increased rate of injury deaths compared with those with higher cholesterol levels.
(d) men with cholesterol below 160 mg/dl had a 15% increased rate of respiratory system deaths compared with those with higher cholesterol levels.

(e) men with cholesterol below 160 mg/dl had a 50% increased rate of digestive system deaths compared with those with higher cholesterol levels.
(f) Among women, the patterns of the association between low blood cholesterol and increased rates of various causes of noncardiovascular deaths were similar to those in men, except that the excess in cancer mortality was smaller (about 5%).
(g) There is no association between high blood cholesterol and cardiovascular deaths in women.

Hulley concluded that these findings: "Indicate the need for a change in direction for cholesterol policy... and indicates that we should draw back from universal screening and treatment of blood cholesterol".

Low cholesterol is a risk factor for suicide

This post includes a summary of a paper pPublished in the Annals of the New York Academy of Sciences 1997; 836:57-80

Study title and authors:
Assessing the observed relationship between low cholesterol and violence-related mortality. Implications for suicide risk.
Kaplan JR, Muldoon MF, Manuck SB, Mann JJ
Comparative Medicine Clinical Research Center, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, North Carolina 27157-1040, USA.

This paper can be accessed at: http://www.ophsource.org/periodicals/ophtha/medline/record/MDLN.9616794

Kaplan reviewed the evidence concerning cholesterol levels and suicide or traumatic death.

The review found:
(a) Accumulating evidence suggests that naturally low or clinically reduced cholesterol is associated with increased nonillness mortality (principally suicide and accidents).
(b) Other evidence suggests that such increases in suicide and traumatic death may be caused by the adverse changes in behaviour and mood that sometimes accompany low or reduced cholesterol.
(c) A study on monkeys revealed that reductions in cholesterol levels increased the tendency of the monkeys to engage in impulsive or violent behaviour through a mechanism involving central serotonergic activity.
(d) It is speculated that the cholesterol-serotonin-behavior association represents a mechanism evolved to increase hunting or competitive foraging behavior in the face of nutritional threats signaled by a decline in total serum cholesterol.

Kaplan concluded: "The epidemiological and experimental data could be interpreted as having two implications for public health: (1) low-cholesterol may be a marker for risk of suicide or traumatic death and (2) cholesterol lowering may have adverse effects for some individuals under some circumstances".

Lowering cholesterol levels lead to an increase in death from accidents, violence, trauma and suicide

This post includes a summary of a study published in the British Medical Journal 1990 Aug 11;301(6747):309-14

Study title and authors:
Lowering cholesterol concentrations and mortality: a quantitative review of primary prevention trials.

Muldoon MF, Manuck SB, Matthews KA.

Department of Medicine, University of Pittsburgh, PA 15260.

This paper can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/2144195

This study was an analysis of six trials, average duration 4.8 years, of the consequences of cholesterol reduction by diet or drugs. The objective of the study was to determine the effects of lowering cholesterol concentrations on total and cause specific mortality. The analysis included 4,847 Male participants, average age 47.5 years, who were studied for 119,000 person years.

The study found:
(a) Those who were subject to cholesterol reduction had a 7% increased risk of death compared to those who did not undergo cholesterol reduction.
(b) Those who were subject to cholesterol reduction had a 15% decreased risk of death from heart disease compared to those who did not undergo cholesterol reduction.
(c) Those who were subject to cholesterol reduction had a 43% increased risk of death from cancer compared to those who did not undergo cholesterol reduction.
(d) Those who were subject to cholesterol reduction had a 76% increased risk of death from accidents, violence, trauma and suicide compared to those who did not undergo cholesterol reduction.

Muldoon concluded: "An explanation for the increased rate of suicide and accidental or violent death.. reflects a direct relation between reduction of serum cholesterol concentration and increased suicide and accidental or violent death. There is some experimental evidence that modifying the fat in the diet has both neurochemical and behavioural consequences".