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Why is Low Blood Cholesterol Associated with Risk of Nonatherosclerotic Disease Death?

Why is Low Blood Cholesterol Associated with Risk of Nonatherosclerotic Disease Death? There is strong and congruent evidence that serum cholesterol and its lipoprotein components play a critical role in the development of coronary heart disease (CHD) through a causal role in atherogenesis. Recent evidence shows that reduction of serum total cholesterol ( TC), particularly the low-density lipoprotein (LDL) cholesterol fraction, reduces the incidence of CHD (1-14), by arresting or reversing the progression of atherosclerois (15-17). Methodologically and historically, two studies were weighted particularly heavily in development of US TC-lowering policies. The Lipid Research Clinics Coronary Primary Prevention Trial found a 19% reduction in CHD incidence, by reducing TC with a combination of diet plus cholestyramine, compared with TC lowering with diet alone (5). The Helsinki study of TC lowering, which used gemfibrizol compared with placebo, found a 34% reduction in CHD incidence (6). For many years, however, there has been some evidence that total mortality is elevated at low TC levels (18-21) and that all-cause mortality risk may be increased by cholesterol lowering (1-7). This article reviews evidence concerning these relations and discusses whether the observations can be attributed to confounding or are causal. 0163-7525/93/0510-0095$02.00 JACOBS Research into low TC level and disease risk should seek to understand the http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Annual Review of Public Health Annual Reviews

Why is Low Blood Cholesterol Associated with Risk of Nonatherosclerotic Disease Death?

Jacobs, D R
Annual Review of Public Health , Volume 14 (1) – May 1, 1993
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Publisher
Annual Reviews
Copyright
Copyright 1993 Annual Reviews. All rights reserved
Subject
Review Articles
ISSN
0163-7525
eISSN
1545-2093
DOI
10.1146/annurev.pu.14.050193.000523
pmid
8323608
Publisher site
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Abstract

There is strong and congruent evidence that serum cholesterol and its lipoprotein components play a critical role in the development of coronary heart disease (CHD) through a causal role in atherogenesis. Recent evidence shows that reduction of serum total cholesterol ( TC), particularly the low-density lipoprotein (LDL) cholesterol fraction, reduces the incidence of CHD (1-14), by arresting or reversing the progression of atherosclerois (15-17). Methodologically and historically, two studies were weighted particularly heavily in development of US TC-lowering policies. The Lipid Research Clinics Coronary Primary Prevention Trial found a 19% reduction in CHD incidence, by reducing TC with a combination of diet plus cholestyramine, compared with TC lowering with diet alone (5). The Helsinki study of TC lowering, which used gemfibrizol compared with placebo, found a 34% reduction in CHD incidence (6). For many years, however, there has been some evidence that total mortality is elevated at low TC levels (18-21) and that all-cause mortality risk may be increased by cholesterol lowering (1-7). This article reviews evidence concerning these relations and discusses whether the observations can be attributed to confounding or are causal. 0163-7525/93/0510-0095$02.00 JACOBS Research into low TC level and disease risk should seek to understand the

Journal

Annual Review of Public Health – Annual Reviews

Published: May 1, 1993

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