Yuan Fangcheng, Wen Wanqing, Jia Guochong, Long Jirong, Shu Xiao-Ou, Zheng Wei
Cancer Epidemiol Biomarkers Prev. 2023 Apr 3;32(4):524-530. doi: 10.1158/1055-9965.EPI-22-1170.
Dyslipidemia is closely associated with metabolic syndrome, a known risk factor for colorectal cancer. However, the association of dyslipidemia with colorectal cancer risk is controversial. Most previous studies did not consider cholesterol-lowering medication use at the time of lipid measurements, which could bias findings.
We analyzed data from 384,862 UK Biobank participants to disentangle the associations between blood lipids and colorectal cancer risk. Serum levels of total cholesterol, high- and low-density lipoprotein cholesterol (HDL-C, LDL-C), and triglyceride were measured at study baseline. Multivariable-adjusted Cox models were used to estimate HRs and 95% confidence intervals (CI).
During a median follow-up time of 8.2 years, 3,150 incident primary colorectal cancer cases were identified. Triglyceride levels were positively, while HDL-C levels were inversely associated with colorectal cancer risk (both Ptrend < 0.005). No significant associations were found for total cholesterol and LDL-C. However, among nonusers of cholesterol-lowering medications, a high total cholesterol level (> 6.7 mmol/L, HR = 1.11; 95% CI, 1.00-1.24) and LDL-C level (>4.1 mmol/L, HR = 1.11; 95% CI, 0.99-1.23) was associated with an increased colorectal cancer risk compared with the referent group (5.2-6.2 mmol/L and 2.6-3.4 mmol/L for total and LDL cholesterol, respectively). Compared with nonusers, cholesterol-lowering medication users had 15% increased colorectal cancer risk (HR = 1.15; 95% CI, 1.04-1.26).
Circulating total cholesterol, LDL-C, HDL-C and triglyceride were modestly associated with colorectal cancer risk.
Our findings call for careful consideration of cholesterol-lowering medication use in future studies of blood lipid-colorectal cancer associations.
血脂异常与代谢综合征密切相关，而代谢综合征是结直肠癌已知的危险因素。然而，血脂异常与结直肠癌风险之间的关联存在争议。大多数先前的研究在测量血脂时未考虑使用降胆固醇药物的情况，这可能会使研究结果产生偏差。
我们分析了来自英国生物银行384,862名参与者的数据，以厘清血脂与结直肠癌风险之间的关联。在研究基线时测量血清总胆固醇、高密度和低密度脂蛋白胆固醇（HDL-C、LDL-C）以及甘油三酯水平。采用多变量调整的Cox模型来估计风险比（HR）和95%置信区间（CI）。
在中位随访时间8.2年期间，共识别出3150例原发性结直肠癌新发病例。甘油三酯水平与结直肠癌风险呈正相关，而HDL-C水平与结直肠癌风险呈负相关（两者Ptrend均<0.005）。未发现总胆固醇和LDL-C有显著关联。然而，在未使用降胆固醇药物的人群中，与参照组（总胆固醇为5.2 - 6.2 mmol/L，LDL胆固醇为2.6 - 3.4 mmol/L）相比，总胆固醇水平高（>6.7 mmol/L，HR = 1.11；95% CI，1.00 - 1.24）和LDL-C水平高（>4.1 mmol/L，HR = 1.11；95% CI，0.99 - 1.23）与结直肠癌风险增加相关。与未使用者相比，使用降胆固醇药物的人群患结直肠癌的风险增加了15%（HR = 1.15；95% CI，1.04 - 1.26）。
循环中的总胆固醇、LDL-C、HDL-C和甘油三酯与结直肠癌风险存在适度关联。
我们的研究结果呼吁在未来关于血脂与结直肠癌关联的研究中，要谨慎考虑降胆固醇药物的使用情况。
