SERUM TOTAL CHOLESTEROL AND MORTALITY IN JAPANESE POPULATION

Although the relation between serum total cholesterol and coronary hea rt disease is well established, the relation with mortality from non-c oronary disease is controversial. Inverse relations of serum cholester ol with hemorrhagic stroke and cancer have stimulated the examination of cholesterol-non-coronary mortality associations. The population sur veyed is 12,187 men and women aged 40-69 years living in Yao City, a s uburb of Osaka, who undertook baseline examinations between 1975 and 1 984 and had no history of stroke and coronary heart disease at baselin e. The subjects were followed on average 8.9 years until the end of 19 88 using systematic mortality surveillance. During the follow-up, ther e were 343 deaths, comprising 170 cancer deaths (International Classif ication of Death 9th edition: ICD-9, 140-239), 21 coronary heart disea se deaths (ICD-9, 410-414), 67 other cardiovascular deaths (ICD-9, 390 -458 excluding 410-414), and 85 non-cardiovascular, non-cancer deaths. There was a significant inverse association of serum cholesterol with total and cancer mortality for men, and no significant association fo r women. The cholesterol-disease association, although not significant , was positive for coronary heart disease and other cardiovascular dis ease deaths, and inverse for non-cardiovascular, non-cancer deaths in both sexes. The inverse association of serum cholesterol with total an d cancer mortality for men remained significant after controlling for age, job classification, hypertension category, usual alcohol intake, cigarette smoking, and relative weight index. A 34 mg/dl (1 SD) lower serum cholesterol level was associated with a 21% (95% confidence inte rval (CI) = 4-2%) higher risk of total mortality and a 25% (95% CI int erval = 2-56%) higher risk of cancer death. These inverse associations were stronger in current heavy drinkers (greater than or equal to 56 g ethanol per day) than in the other men. The inverse association betw een serum cholesterol and cancer was also significant when deaths with in the first 5 years were excluded from the analysis. Wether the inver se association is explained by other factors or whether this associati on is causal requires further investigation.