LOW-CHOLESTEROL AND RISK OF NONCORONARY MORTALITY

Based on a systematic review of over to cohort studies, a clear associ ation exists, for both men and women, between particularly low cholest erol levels and the rate of non-coronary mortality. The excess in wome n appears mainly confined to non-cancer causes, particularly respirato ry and digestive diseases, while there is also an excess of deaths fro m cancer seen in men with low cholesterol levels. Higher mortality rat es from trauma, haemorrhagic stroke and cirrhosis have also been obser ved. Much of this association is Known to be as a consequence of the d isease with a fall in cholesterol levels seen after developing a varie ty of inflammatory diseases. However, the excess risk of non-coronary heart disease deaths is still apparent by excluding deaths within five years suggesting that effect-cause is nor the only explanation. Confo unding still remains the most likely explanation for the association w ith an underlying chronic disease or risk factor causing both the low cholesterol and the fatal event. However, there is still the possibili ty that same of the increased risk is due to the low cholesterol. This makes it important that appropriately controlled trials of both drug and dietary interventions demonstrate net clinical benefit among those with low levels of coronary risk before cholesterol-lowering strategi es are adopted more widely in these groups.