This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fagot-Campagna, A. Articles by Knowler, W. C. Search for Related Content PubMed PubMed Citation Articles by Fagot-Campagna, A. Articles by Knowler, W. C. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB CHOLESTEROL

(Circulation. 1997;96:1408-1415.)
© 1997 American Heart Association, Inc.

Articles

Serum Cholesterol and Mortality Rates in a Native American Population With Low Cholesterol Concentrations

A U-Shaped Association

Anne Fagot-Campagna, MD, MPH; Robert L. Hanson, MD, MPH; K. M. Venkat Narayan, MD, MSc; Maurice L. Sievers, MD; David J. Pettitt, MD; Robert G. Nelson, MD, MPH; ; William C. Knowler, MD, DrPH

From the National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Ariz.

Correspondence to Anne Fagot-Campagna, National Institute of Diabetes and Digestive and Kidney Diseases, 1550 E Indian School Rd, Phoenix, AZ 85014. E-mail fax{at}cu.nih.gov

Background Low serum cholesterol concentrations are associated with high death rates from cancer, trauma, and infectious diseases, but the meaning of these associations remains controversial. The present report evaluates whether low cholesterol is likely to be a causal factor for mortality from all causes or from specific causes.

Methods and Results Among 4553 Pima Indians 20 years old, a population with low serum cholesterol (median, 4.50 mmol/L), 1077 deaths occurred during a mean follow-up of 12.8 years. Trauma was the most common cause. The relationship between serum cholesterol measured at 2-year intervals and age- and sex-standardized mortality rates was U-shaped. Cholesterol was related positively to mortality from cardiovascular diseases and diabetes (including nephropathy) and negatively to mortality from cancer and alcohol-related diseases. The relationship was U-shaped for mortality from infectious diseases, and cholesterol was not related to mortality from trauma. Change in cholesterol from one examination to the next was positively related to mortality from diabetes. In proportional-hazards models adjusted for potential confounders, the relationship between baseline cholesterol and mortality was U-shaped for all causes and diabetes and positive for cardiovascular diseases. Other relationships were nonsignificant. Among 3358 subjects followed 5 years, the relationship was significant and positive only for mortality from cardiovascular diseases.

Conclusions Despite a high exposure risk for Pima Indians, if low cholesterol level is a causal factor, the relationships between low serum cholesterol and high mortality rates probably result from diseases lowering cholesterol rather than from a low cholesterol causing the diseases.

Key Words: cholesterol • risk factors • mortality

This article has been cited by other articles:

				G. Zuliani, A. Cherubini, A. R. Atti, A. Ble, C. Vavalle, F. Di Todaro, C. Benedetti, S. Volpato, M. G. Marinescu, U. Senin, et al. Low Cholesterol Levels Are Associated With Short-Term Mortality in Older Patients With Ischemic Stroke J. Gerontol. A Biol. Sci. Med. Sci., March 1, 2004; 59(3): M293 - M297. [Abstract] [Full Text] [PDF]

				B. V. Howard, D. C. Robbins, M. L. Sievers, E. T. Lee, D. Rhoades, R. B. Devereux, L. D. Cowan, R. S. Gray, T. K. Welty, O. T. Go, et al. LDL Cholesterol as a Strong Predictor of Coronary Heart Disease in Diabetic Individuals With Insulin Resistance and Low LDL : The Strong Heart Study Arterioscler Thromb Vasc Biol, March 1, 2000; 20(3): 830 - 835. [Abstract] [Full Text] [PDF]

				M. L. Sievers, P. H. Bennett, J. Roumain, and R. G. Nelson Effect of Hypertension on Mortality in Pima Indians Circulation, July 6, 1999; 100(1): 33 - 40. [Abstract] [Full Text] [PDF]