J Korean Med Sci.  2012 Jan;27(1):58-63. 10.3346/jkms.2012.27.1.58.

Low Cholesterol is Associated with Mortality from Cardiovascular Diseases: A Dynamic Cohort Study in Korean Adults

Affiliations
  • 1Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea.
  • 2Institute of Radiation Effect & Epidemiology, Seoul National University College of Medicine, Seoul, Korea. yoahn@snu.ac.kr
  • 3Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea.

Abstract

This study was conducted to evaluate the association of single serum total cholesterol (TC) measurement with cardiovascular diseases (CVD) deaths in Korean adults. The study subjects were taken from the multi-site collaborative dynamic prospective cohort for epidemiologic investigation on cancer risk in residents nearby nuclear power plants in Korea. A total of 12,740 adults aged 40 to 69 yr who underwent a mass screening examination were followed up from 1993 to 2008. Occurring CVD deaths were confirmed by the death certificates in the National Statistical Office, Korea. Groups with the lowest group having TC < 160 mg/dL as well as the highest group having >= 240 mg/dL were associated with higher CVD mortality in Cox proportional hazards analysis adjusting for age, sex, smoking and drinking status, body mass index, level of blood pressure, triglyceride and high density lipoprotein cholesterol. The distribution of adjusted hazard ratios showed the U-shaped curve. Based on the results of this study, caution should be taken in prescribing statins for primary prevention among people at low cardiovascular risk in Korean adults.

Keyword

Cholesterol; Cardiovascular Diseases; Mortality; Stroke; Cohort Studies

MeSH Terms

Adult
Age Factors
Aged
Alcohol Drinking
Blood Pressure
Body Mass Index
Cardiovascular Diseases/*blood/epidemiology/*mortality
Cholesterol/*blood
Cohort Studies
Female
Humans
Male
Middle Aged
Proportional Hazards Models
Prospective Studies
Republic of Korea/epidemiology
Risk Factors
Sex Factors
Smoking
Triglycerides/blood

Figure

  • Fig. 1 Distribution of total cholesterol levels in study participants.


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Reference

1. Cardiovascular disease. WHO. accessed on 31 July 2011. Available at http://www.who.int/cardiovascular_diseases/en/.
2. Integrated management of cardiovascular risk. WHO. accessed on 31 July 2011. Available at http://www.who.int/cardiovascular_diseases/media/en/635.pdf.
3. Menotti A, Lanti M. Coronary risk factors predicting early and late coronary deaths. Heart. 2003. 89:19–24.
4. Menotti A, Giampaoli S. A single risk factor measurement predicts 35-year mortality from cardiovascular disease. G Ital Cardiol. 1998. 28:1354–1362.
5. Menotti A, Lanti M, Kromhout D, Kafatos A, Nedeljkovic S, Nissinen A. Short and long term association of a single serum cholesterol measurement in middle-aged men in prediction of fatal coronary and other cardiovascular events: a cross-cultural comparison through Europe. Eur J Epidemiol. 2005. 20:597–604.
6. Taylor F, Ward K, Moore TH, Burke M, Davey Smith G, Casas JP, Ebrahim S. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2011. (1):CD004816.
7. Cai J, Pajak A, Li Y, Shestov D, Davis CE, Rywik S, Li Y, Deev A, Tyroler HA. Total cholesterol and mortality in China, Poland, Russia, and the US. Ann Epidemiol. 2004. 14:399–408.
8. Simes RJ. Low cholesterol and risk of non-coronary mortality. Aust N Z J Med. 1994. 24:113–119.
9. Nago N, Ishikawa S, Goto T, Kayaba K. Low cholesterol is associated with mortality from stroke, heart disease, and cancer: the Jichi Medical School Cohort Study. J Epidemiol. 2011. 21:67–74.
10. Ahn YO, Lee MC, Yoo KY, Chung JK, Park BJ, Li ZM, Choi JS, Lee CE, Lee DH, Lim HS, Choi BY, Chang SH, Oh JK, Cha CY, Chung HW. Epidemiological Investigation on Cancer Risk among Radiation Workers in Nuclear Power Plants and Residents nearby Nuclear Power Plants in Korea. 2007.3-2011.2. Ministry of Education, Science and Technology (MEST No. 2010-0000986).
11. Korean Statistical Information Service. The Statistics Korea. accessed on 31 July 2011. Available at http://www.kosis.kr/.
12. Korea Standard Classification of Cause of Death. The Statistics Korea. accessed on 31 July 2011. Available at http://www.kostat.go.kr/portal/english/news/1/8/index.board?bmode=read&aSeq=67396.
13. The Eighth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 8). National Heart Lung and Blood Institute. accessed on 31 July 2011. Available at http://www.nhlbi.nih.gov/guidelines/hypertension/jnc8/index.htm.
14. SAS software. accessed on 31 July 2011. Available at http://www.sas.com/.
15. Gaziano TA. Reducing the growing burden of cardiovascular disease in the developing world. Health Aff (Millwood). 2007. 26:13–24.
16. Wan RK, Mark PB, Jardine AG. The cholesterol paradox is flawed: cholesterol must be lowered in dialysis patients. Semin Dial. 2007. 20:504–509.
17. Jacobs D, Blackburn H, Higgins M, Reed D, Iso H, McMillan G, Neaton J, Nelson J, Potter J, Rifkind B. Report of the Conference on Low Blood Cholesterol: Mortality Associations. Circulation. 1992. 86:1046–1060.
18. Iribarren C, Reed DM, Burchfiel CM, Dwyer JH. Serum total cholesterol and mortality. Confounding factors and risk modification in Japanese-American men. JAMA. 1995. 273:1926–1932.
19. Speakman JR, Westerterp KR. Reverse epidemiology, obesity and mortality in chronic kidney disease: modelling mortality expectations using energetics. Blood Purif. 2010. 29:150–157.
20. Arena R, Lavie CJ. The obesity paradox and outcome in heart failure: is excess bodyweight truly protective? Future Cardiol. 2010. 6:1–6.
21. Kalantar-Zadeh K. What is so bad about reverse epidemiology anyway? Semin Dial. 2007. 20:593–601.
22. Güder G, Frantz S, Bauersachs J, Allolio B, Wanner C, Koller MT, Ertl G, Angermann CE, Störk S. Reverse epidemiology in systolic and nonsystolic heart failure: cumulative prognostic benefit of classical cardiovascular risk factors. Circ Heart Fail. 2009. 2:563–571.
23. Casiglia E, Mazza A, Tikhonoff V, Scarpa R, Schiavon L, Pessina AC. Total cholesterol and mortality in the elderly. J Intern Med. 2003. 254:353–362.
24. Strandberg TE, Strandberg A, Rantanen K, Salomaa VV, Pitkälä K, Miettinen TA. Low cholesterol, mortality, and quality of life in old age during a 39-year follow-up. J Am Coll Cardiol. 2004. 44:1002–1008.
25. Clarke R, Lewington S, Youngman L, Sherliker P, Peto R, Collins R. Underestimation of the importance of blood pressure and cholesterol for coronary heart disease mortality in old age. Eur Heart J. 2002. 23:286–293.
26. Liu Y, Coresh J, Eustace JA, Longenecker JC, Jaar B, Fink NE, Tracy RP, Powe NR, Klag MJ. Association between cholesterol level and mortality in dialysis patients: role of inflammation and malnutrition. JAMA. 2004. 291:451–459.
27. Clarke R, Emberson J, Fletcher A, Breeze E, Marmot M, Shipley MJ. Life expectancy in relation to cardiovascular risk factors: 38 year follow-up of 19,000 men in the Whitehall study. BMJ. 2009. 339:b3513.
28. Manolio TA, Pearson TA, Wenger NK, Barrett-Connor E, Payne GH, Harlan WR. Cholesterol and heart disease in older persons and women. Review of an NHLBI workshop. Ann Epidemiol. 1992. 2:161–176.
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