Considerable debate concerning the apparent association of low serum cholesterol levels with enhanced noncardiovascular disease mortality has been aired in both scientific and lay publications within the past year. This debate has resulted in some medical experts calling for a moratorium on efforts to reduce serum cholesterol, particularly with drugs, and for a more conservative approach to screening and modifying cholesterol levels for the primary prevention of coronary heart disease (CHD). Observational studies, including the Framingham Heart Study, the Multiple Risk Factor Intervention Trial, the Whitehall Study, and the International Collaborative Group, have not substantiated a cause and effect relationship between “naturally” occurring low serum cholesterol and noncardiovascular disease mortality, such as cancer. Intervention trials designed to lower high serum cholesterol levels by diet and drugs have also not been conclusively shown to produce excess harm that offsets the benefit of reduced CHD events. Several primary and secondary CHD prevention trials, with sufficient numbers of subjects to provide the statistical power to detect potential detrimental effects of lowering cholesterol levels, are currently in progress and will be very helpful in resolving the concern about noncardiovascular disease mortality.
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Muldoon MF, Manuck SB, Matthews KA. Lowering cholesterol concentrations and mortality: A quantitative review of primary prevention trials.Br Med J 1990;301:309–314.
Smith GD, Pekkanen J. Should there be a moratorium on the use of cholesterol lowering drugs?Br Med J 1992;304:431–434.
Hulley SB, Walsh JMB, Newman TB. Health policy on blood cholesterol. Time to change directions.Circulation 1992;86:1027–1029.
Jacobs D, Blackburn H, Higgins M, et al. Report of the conference on low blood cholesterol: Mortality associations.Circulation 1992;86:1046–1060.
Anderson KM, Castelli WP, Levy D. Cholesterol and mortality: 30 years follow-up from the Framingham Study.JAMA 1987;257:2176–2180.
Klag MJ, Ford DE, Mead LA, et al. Serum cholesterol in young men and subsequent cardiovascular disease.N Engl J Med 1993;328:313–318.
Chen Z, Peto R, Collins R, et al. Serum cholesterol and coronary heart disease in populations with low cholesterol concentrations.Br Med J 1991;303:276–282.
Neaton JD, Blackburn H, Jacobs D, et al. Serum cholesterol level and mortality: Findings for men screened in the Multiple Risk Factor Intervention Trial.Arch Intern Med 1992;152:1490–1500.
Smith GD, Shipley MJ, Marmot MG, Rose G. Plasma cholesterol concentration and mortality. The Whitehall Study.JAMA 1992;267:70–76.
International Collaborative Group. Circulating cholesterol level and risk of death from cancer in men aged 40–69 years.JAMA 1982;248:2853–2859.
Lipid Research Clinics Programs: The Lipid Research Clinics coronary primary prevention trial results.JAMA 1984;251:1351–1374.
Frick MH, Elo O, Haapa K, et al. Helsinki Heart Study: Primary prevention trial with gemfibrozil in middle-aged men with dyslipidemia.N Engl J Med 1987;317:1237–1245.
Wysowski DK, Gross TP. Deaths due to accidents and violence in two recent trials of cholesterol-lowering drugs.Arch Intern Med 1990;150:2169–2172.
Rossouw JE, Canner PL, Hulley SB. Deaths from injury, violence and suicide in secondary prevention trials of cholesterol lowering.N Engl J Med 1991;325:1813.
Expert Panel. Summary of the second report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel II).JAMA 1993;269:3015–3023.
Rossouw JE, Lewis B, Rifkind BM. The value of lowering cholesterol after myocardial infarction.N Engl J Med 1990;323:1112–1119.
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Jones, P.H. Low serum cholesterol increases the risk of noncardiovascular events: An antagonist viewpoint. Cardiovasc Drug Ther 8, 871–874 (1994). https://doi.org/10.1007/BF00877406
- low cholesterol
- noncardiovascular mortality