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Serum cholesterol and mortality in a Japanese-American population: the Honolulu Heart program
Insights
Serum cholesterol levels show a complex relationship with mortality. High cholesterol is linked to heart disease deaths, while low cholesterol is associated with increased cancer mortality, particularly colon cancer.
Area of Science:
- Epidemiology
- Cardiovascular Disease Research
- Oncology Research
Background:
- Understanding the long-term impact of baseline serum cholesterol on mortality is crucial for public health.
- Previous studies have suggested associations between cholesterol and various mortality outcomes, but the nature of these relationships requires further elucidation.
Purpose of the Study:
- To investigate the association between baseline serum cholesterol levels and subsequent 9-year mortality in a cohort of Japanese-American men.
- To differentiate the impact of cholesterol on coronary heart disease mortality versus cancer mortality.
Main Methods:
- A cohort study design was employed, analyzing 9-year mortality data.
- Baseline serum cholesterol levels were measured and correlated with cause-specific mortality.
- Analyses were conducted excluding early mortality (first two years) and known prevalent cancer cases to control for pre-existing conditions.
Main Results:
- Baseline serum cholesterol was positively associated with coronary heart disease mortality.
- An inverse relationship was observed between serum cholesterol and total cancer mortality, including specific sites like colon and lung cancer, and hematopoietic malignancies, even after excluding early deaths.
- Total mortality exhibited a quadratic relationship with serum cholesterol, with increased risk at both high (due to heart disease) and low (due to cancer) levels.
Conclusions:
- Serum cholesterol levels have a dual impact on mortality, increasing risk for cardiovascular disease at high levels and for certain cancers at low levels.
- The findings highlight the importance of considering non-linear relationships and potential confounding factors when assessing cholesterol's role in overall mortality.
Abstract:
The authors have examined the relation of baseline serum cholesterol level to subsequent 9-year mortality in a cohort of Japanese-American men. The baseline serum cholesterol level was positively related to coronary heart disease mortality. It was inversely related to total cancer mortality and to mortality from cancers of the esophagus, colon, liver and lung and to malignancies of the lymphatic and hematopoietic system. When mortality in the first two years after examination was removed from consideration in an attempt to allow for existing clinical or subclinical disease, the inverse relation to cancer persisted but was statistically significant only for colon cancer and lung cancer among the common sites as well as for malignancies of the lymphatic and hematopoietic system. When known prevalence cases of cancer were eliminated from the computation, the inverse relation between cholesterol level and cancer mortality persisted significantly only for colon among the common cancer sites. The relation of baseline serum cholesterol level to total mortality in this cohort was quadratic; that is, there was an excess of deaths associated with serum cholesterol level at the high end of the distribution (mainly due to coronary heart disease) and at the low end (mainly due to cancer).