Dr. Jacobs et C. Iribarren, Invited commentary: Low cholesterol and nonatherosclerotic disease risk: Apersistently perplexing question, AM J EPIDEM, 151(8), 2000, pp. 748-751
Citations number
36
Categorie Soggetti
Envirnomentale Medicine & Public Health","Medical Research General Topics
In contrast to clinical trials using statin drugs, which suggest that chole
sterol lowering from high to moderate levels is safe, many, but not all, pr
ospective studies report higher nonatherosclerotic disease rates in people
with low serum total cholesterol, even after deleting deaths in the 5 years
after cholesterol determination. A perplexing and unanswered question is w
hether low cholesterol is causally related to nonatherosclerotic disease ri
sk. Cholesterol is reduced during the acute phase reaction; a stale of immu
ne activation that persists for more than 5 years may explain the prospecti
ve observations. Higher cholesterol may be a marker for other protective su
bstances such as fat-soluble antioxidants. Low cholesterol might mark poor
nutrition, for example, during depression. Alternatively, higher cholestero
l levels may result in enhanced delivery of lipids to cells during the immu
ne response or tissue repair or may enhance defense against endotoxins and
viruses. Although we believe that populationwide efforts to lower cholester
ol should continue, we think that important biology may be reflected in the
repeatedly observed associations of low cholesterol with nonatheroscleroti
c disease, The authors urge that research continue to elucidate any biologi
c bases of these relations.