Wannamethee G, Shaper A G, Whincup P H, Walker M
Department of Public Health, Royal Free Hospital School of Medicine, London.
BMJ. 1995 Aug 12;311(7002):409-13. doi: 10.1136/bmj.311.7002.409.
To examine the relation between low serum total cholesterol concentrations and causes of mortality.
Cohort study of men followed up for an average of 14.8 years (range 13.5-16.0 years).
One general practice in each of 24 British towns.
7735 men aged 40-59 at screening selected at random from the 24 general practices.
Deaths from all causes, cardiovascular causes, cancer, and non-cardiovascular, non-cancer causes.
During the mean follow up period of 14.8 years there were 1257 deaths from all causes, 640 cardiovascular deaths, 433 cancer deaths, and 184 deaths from other causes. Low serum cholesterol concentrations (< 4.8 mmol/l), present in 5% (n = 410) of the men, were associated with the highest mortality from all causes, largely due to a significant increase in cancer deaths (age adjusted relative risk 1.6 (95% confidence interval 1.1 to 2.3); < 4.8 v 4.8-5.9 mmol/l) and in other non-cardiovascular deaths (age adjusted relative risk 1.9 (1.1 to 3.1)). Low serum cholesterol concentration was associated with an increased prevalence of several diseases and indicators of ill health and with lifestyle characteristics such as smoking and heavy drinking. After adjustment for these factors in the multivariate analysis the increased risk for cancer was attenuated (relative risk 1.4 (0.9 to 2.0) and the inverse association with other non-cardiovascular, non-cancer causes was no longer significant (relative risk 1.5 (0.9 to 2.6); < 4.8 v 4.8-5.9 mmol/l). The excess risks of cancer and of other non-cardiovascular deaths were most pronounced in the first five years and became attenuated and non-significant with longer follow up. By contrast, the positive association between serum total cholesterol concentration and cardiovascular mortality was seen even after more than 10 years of follow up.
The association between comparatively low serum total cholesterol concentrations and excess mortality seemed to be due to preclinical cancer and other non-cardiovascular diseases. This suggests that public health programmes encouraging lower average concentrations of serum total cholesterol are unlikely to be associated with increased cancer or other non-cardiovascular mortality.
研究低血清总胆固醇浓度与死亡原因之间的关系。
对男性进行队列研究，平均随访14.8年（范围13.5 - 16.0年）。
英国24个城镇中的每个城镇的一家普通诊所。
从24家普通诊所中随机选取的7735名年龄在40 - 59岁之间接受筛查的男性。
各种原因导致的死亡、心血管疾病导致的死亡、癌症导致的死亡以及非心血管、非癌症原因导致的死亡。
在平均14.8年的随访期内，共有1257例各种原因导致的死亡，其中640例为心血管疾病死亡，433例为癌症死亡，184例为其他原因导致的死亡。5%（n = 410）的男性血清胆固醇浓度较低（< 4.8 mmol/L），这些男性各种原因导致的死亡率最高，主要是由于癌症死亡显著增加（年龄调整相对风险1.6（95%置信区间1.1至2.3）；< 4.8 mmol/L与4.8 - 5.9 mmol/L相比）以及其他非心血管疾病死亡增加（年龄调整相对风险1.9（1.1至3.1））。低血清胆固醇浓度与多种疾病的患病率增加以及健康不佳指标相关，还与吸烟和酗酒等生活方式特征相关。在多变量分析中对这些因素进行调整后，癌症风险增加有所减弱（相对风险1.4（0.9至2.0）），与其他非心血管、非癌症原因的负相关不再显著（相对风险1.5（0.9至2.6）；< 4.8 mmol/L与4.8 - 5.9 mmol/L相比）。癌症和其他非心血管疾病死亡的额外风险在最初五年最为明显，随着随访时间延长而减弱且不再显著。相比之下，血清总胆固醇浓度与心血管疾病死亡率之间的正相关即使在随访超过10年后仍可见。
相对较低的血清总胆固醇浓度与额外死亡率之间的关联似乎是由于临床前癌症和其他非心血管疾病。这表明鼓励降低血清总胆固醇平均浓度的公共卫生项目不太可能与癌症或其他非心血管疾病死亡率增加相关。
