Low cholesterol levels are associated with an inreased risk of death in critically ill surgical patients.

This study was published in Critical Care Medicine 2001 Aug;29(8):1563-8

Study title and authors:
Relationship of hypolipidemia to cytokine concentrations and outcomes in critically ill surgical patients.

Gordon BR, Parker TS, Levine DM, Saal SD, Wang JC, Sloan BJ, Barie PS, Rubin AL.
Rogosin Institute, 505 East 70th Street, New York, NY 10021, USA. gordobr@mail.rockefeller.edu

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/11505128

 

The objective of the study was to determine the relationship of cholesterol levels with clinical outcomes in critically ill surgical patients. (Clinical outcomes included death, infection subsequent to intensive care unit admission, length of intensive care unit stay, and magnitude of organ dysfunction). The study included 111 patients with a variety of critical illnesses, for whom cholesterol levels were determined within 24 hours of admission to a surgical intensive care unit.

 

Average cholesterol levels of the patients were extremely low:

(i) Total cholesterol, 127 mg/dL (3.2 mmol/L)

(ii) Low-density lipoprotein (LDL) cholesterol, 75 mg/dL (1.9 mmol/L)

(iii) High-density lipoprotein (HDL) cholesterol, 29 mg/dL (.75 mmol/L)

 

Clinical outcomes were related to whether the admission cholesterol levels were above (56 patients) or below (55 patients) 120 mg/dL (3.1 mmol/L).

 

The study found:

(a) Each of the clinical outcomes occurred between 1.9- and 3.5-fold more frequently in the very low cholesterol (less than 120 mg/dL or 3.1 mmol/L) group.

(b) Nine patients died during the hospitalization. Seven of the nine patients who died were in the very low cholesterol (less than 120 mg/dL or 3.1 mmol/L) group.

 

The results of the study show that low cholesterol levels are associated with an inreased risk of death in critically ill surgical patients.

The adverse health effects of low cholesterol

This paper was published in Beijing Da Xue Xue Bao (Journal of Peking University) 2010 Oct 18;42(5):612-5

Study title and authors:
Primary and secondary hypocholesterolemia

Song JX, Ren JY, Chen H.
Department of Cardiology, Peking University People's Hospital, Beijing 100044, China.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/20957025

In this review of the literature Song examines the influence of low cholesterol levels (hypocholesterolemia) on health.

He found:
(a) Low cholesterol levels are common in the population.
(b) Physicians pay little attention to the diseases, causes and consequences of low cholesterol in clinical practice.
(c) Low cholesterol levels can result in some adverse events, such as increased death rates, intracerebral hemorrhage, cancer, infection, adrenal failure, suicide and mental disorder.
(d) Despite the adverse health consequences of low cholesterol, physicians are increasingly prescribing cholesterol lowering treatments such as statin drugs.

With all the adverse health effects of low cholesterol Song concludes: "It's high time that physicians attached more importance to hypocholesterolemia."

Links to other studies:
Stroke patients with low cholesterol are more likely to die and have poor neurological outcomes
Low cholesterol levels lead to a 20.2% increase in death rates in those who have had a stroke
Low cholesterol and serious complications after an ischemic stroke

Low cholesterol levels are associated with higher rates of many infectious diseases

This study was published in Epidemiology and Infection 1998 Oct;121(2):335-47

Study title and authors:

Cohort study of serum total cholesterol and in-hospital incidence of infectious diseases.
Iribarren C, Jacobs DR Jr, Sidney S, Claxton AJ, Feingold KR.
Kaiser Permanente Division of Research, Oakland, CA 94611, USA.

This study can be accessed at: http://www.ncbi.nlm.nih.gov/pubmed/9825784

The study assessed the association between cholesterol levels and the risk of infections (other than respiratory and HIV) requiring hospitalisation. The study included 55,300 men and 65,271 women who were followed for 15 years.

The infectious diseases analysed in this study were thus classified:

o   Intestinal Infections: Salmonella, rotavirus (virus infection that can cause gastroenteritis).

o   Viral hepatitis.

o   Acute appendicitis.

o   All digestive and liver infections: Diverticulosis, abscess of the anal and rectal region, abscess of the intestine, liver disease, gallbladder inflammation, cholangitis (bile duct infection).

o   Endocarditis (inflammation of the inner layer of the heart).

o   Kidney infections.

o   Urinary tract infections.

o   All genito - urinary infections: cystitis, prostatitis, orchitis and epididymitis (inflammation of the testicles).

o   Venereal diseases: Syphilis, gonorrhoea, chlamydia, trichomoniasis (sexually transmitted infection).

o   Muscle – skeletal infections: Arthropathy (disease of the joints), Infective myositis (skeletal muscle infection), osteomyelitis (infection of the bone or bone marrow),  periostitis (inflammation of the periosteum, a layer of connective tissue that surrounds bone).

o   Skin and subcutaneous tissue: Herpes, eczema, ringworm, thrush, carbuncle, boils, cellulitis (common skin infection caused by bacteria), lymphadenitis (swollen or enlarged lymph nodes), impetigo (bacterial skin infection), pilonidal cyst (cyst or abscess under the skin of the buttocks), pyoderma (skin infection that exudes pus).

o   Septicaemia, bacteraemia.

o   Gangrene.

o   Central and peripheral nervous system: Meningitis, encephalitis (inflammation of the brain), myelitis (inflammation of the spinal cord), abscess on the brain, abscess on the spinal cord.

o   Endotoxic shock (septic shock).

o   Gynaecological: Salpingitis (infection and inflammation in the fallopian tubes), oophoritis (inflammation of the ovaries), pelvic inflammatory disease (bacterial infection of the female upper genital tract, including the womb, fallopian tubes and ovaries), cervicitis (inflammation of the uterine cervix), vaginitis (inflammation of the vagina),  bartholin cyst or abscess, (infection of the bartholin's glands which lie next to the entrance to the vagina).

The study found for men:

(a) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 29% increased risk of been hospitalised with any infection compared to men with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(b) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 9% increased risk of been hospitalised with intestinal infections compared to men with higher cholesterol levels between 4.14-5.15 mmol/L (160-200 mmol/L).
(c) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 63% increased risk of been hospitalised with viral hepatitis compared to men with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(d) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 1% increased risk of been hospitalised with acute appendicitis compared to men with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(e) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 15% increased risk of been hospitalised with all digestive and liver infections compared to men with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(f) Men with lower cholesterol levels between 4.14-5.15 mmol/L (160-200 mmol/L) had a 22% increased risk of been hospitalised with endocarditis compared to men with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(g) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 10% increased risk of been hospitalised with kidney infections compared to men with higher cholesterol levels between 5.16-6.19 mmol/L (200-240 mg/dL).
(h) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 27% increased risk of been hospitalised with urinary tract infections compared to men with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(i) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 18% increased risk of been hospitalised with all genito-urinary infections compared to men with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(j) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 140% increased risk of been hospitalised with venereal diseases compared to men with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(k) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 28% increased risk of been hospitalised with muscle-skeletal infections compared to men with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(l) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 22% increased risk of been hospitalised with skin and subcutaneous tissue infections compared to men with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(m) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 17% increased risk of been hospitalised with Septicaemia and bacteraemia compared to men with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(n) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 20% increased risk of been hospitalised with gangrene compared to men with higher cholesterol levels between 5.16-6.19 mmol/L (200-240 mg/dL).
(o) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 67% increased risk of been hospitalised with central and peripheral nervous system infections compared to men with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(p) Men with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 128% increased risk of been hospitalised with endotoxic shock compared to men with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).

For women the study found:

(a) Women with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 30% increased risk of been hospitalised with any infection compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(b) Women with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 67% increased risk of been hospitalised with intestinal infections compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(c) Women with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 51% increased risk of been hospitalised with viral hepatitis compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(d) Women with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 22% increased risk of been hospitalised with acute appendicitis compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(e) Women with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 19% increased risk of been hospitalised with all digestive and liver infections compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(f) Women with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 137% increased risk of been hospitalised with endocarditis compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(g) Women with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 9% increased risk of been hospitalised with kidney infections compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(h) Women with lower cholesterol levels between 4.14-5.15 mmol/L (160-200 mmol/L) had a 28% increased risk of been hospitalised with urinary tract infections compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(i) Women with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 33% increased risk of been hospitalised with all genito-urinary infections compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(j) Women with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 90% increased risk of been hospitalised with venereal diseases compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(k) Women with lower cholesterol levels between 5.16-6.19 mmol/L (200-239 mg/dL) had a 4% increased risk of been hospitalised with muscle and skeletal infections compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(l) Women with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 15% increased risk of been hospitalised with skin and subcutaneous tissue infections compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(m) Women with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 39% increased risk of been hospitalised with Septicaemia and bacteraemia compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(n) Women with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 93% increased risk of been hospitalised with gangrene compared to women with higher cholesterol levels between 4.14-5.15 mmol/L (160-200 mmol/L).
(o) Women with lower cholesterol levels between 5.16-6.19 mmol/L (200-239 mg/dL) had a 9% increased risk of been hospitalised with central and peripheral nervous system infections compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(p) Women with lower cholesterol levels between 5.16-6.19 mmol/L (200-239 mg/dL) had a 44% increased risk of been hospitalised with endotoxic shock compared to women with higher cholesterol levels over 6.2 mmol/L (240 mg/dL).
(q) Women with lower cholesterol levels below 4.14 mmol/L (160 mg/dL) had a 2% increased risk of been hospitalised with gynaecological infections compared to women with higher cholesterol levels between 5.16-6.19 mmol/L (200-240 mg/dL).

The results of this study show that low cholesterol levels are associated with higher rates of many infectious diseases.