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Associations among 25-year trends in diet, cholesterol and BMI from 140,000 observations in men and women in Northern Sweden

Ingegerd Johansson*, Lena Maria Nilsson, Birgitta Stegmayr, Kurt Boman, Göran Hallmans and Anna Winkvist

Nutrition Journal 2012, 11:40  doi:10.1186/1475-2891-11-40

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Low cholesterol is associated with highest mortality; worse in women?

eddie vos   (2012-07-05 04:27)  www.health-heart.org email

The authors[1] express ��deep concern�� about cholesterol levels in northern Swedes increasing since 2007 as well as about the ��long-term deleterious effects of a high cholesterol level...��

Such concerns are not based on mortality data and where in fact low cholesterol levels are associated with early death in most of the world��s data sets and of which 2 studies are particularly relevant to central and northern Europeans. The first is from adjacent northern Norway[2] while the second one is a long-term follow-up study in Austria that in participants equals the one of the authors[3].

The study in Norway found the highest mortality in men and women in the lowest quartile for Total Cholesterol (TC) with, in women, the mortality risk (adjusted for age, smoking, and systolic blood pressure) dropping linearly to the top quartile (TC = less than 5 mM/L -vs- TC = greater than 7 mM/L; Figure 2 in[2]). The trend in men is not as clear with the lowest mortality happening in the second quartile of TC = 5 to 5.9 mM/L.

The Austrian study also found the highest mortality in the lowest quartile for TC and that only in women under the age of 50 was not statistically significant. On the other hand, in women over the age of 50, the risk of early death of being in the bottom quartile for TC equaled the risk of smoking (about +60%; p = less than 0.001; Table 4B in[3]).

The concept that lower cholesterol levels are healthy has to be re-examined since being in the low cholesterol quartiles may predict ill health[3] and early death[2,3].

The authors cite the famed 4S cholesterol-lowering Scandinavian trial[42in1] but that ended with 3 more female heart patient deaths on simvastatin than there were on placebo; in fact, there are no cholesterol-lowering studies ever done even suggesting a mortality benefit in women (references in [4]). In other words, the statin trials have conclusively proven that lowering cholesterol in women does not reduce mortality -- and the we know that "naturally" having low cholesterol is a mortality risk in older Europeans.

It would therefore be useful if the authors could comment on the foregoing and on cholesterol and on all-cause mortality in their own data set.

1. Johansson I, Nilsson L, Stegmayr B, Boman K, Hallmans G, Winkvist A. Associations among 25-year trends in diet, cholesterol and BMI from 140,000 observations in men and women in Northern Sweden. Nutr J. 2012 Jun 11;11(1):40. Medline 22686621

2. Petursson H, Sigurdsson JA, Bengtsson C, Nilsen TI, Getz L. Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study. J Eval Clin Pract. 2012 May 29. Medline 22639974.

3. Ulmer H, Kelleher C, Diem G, Concin H. Why Eve is not Adam: prospective follow-up in 149650 women and men of cholesterol and other risk factors related to cardiovascular and all-cause mortality. J Womens Health (Larchmt). 2004 Jan-Feb;13(1):41-53. Medline 15006277

4. Vos E, Rose C. Questioning the benefits of statins. Can Med Ass'n J. Nov. 8, 2005. 173(10) 1207 DOI:10.1503/cmaj.1050120 www.cmaj.ca/cgi/reprint/173/10/1210.pdf

Competing interests

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