Health policy on blood cholesterol. Time to change directions.

Abstract

U-shaped association between the level of blood A cholesterol and subsequent mortality has been reported in many studies over the past two decades.1-3The right-hand limb of the U is the well known higher risk of death from coronary heart disease (CHD) at higher levels of blood cholesterol; this positive association, shown in clinical trials to be causal and reversible, is the cornerstone of U.S. policies directed at lowering high blood cholesterol.4The left-hand limb of the U is the higher risk of deaths from non-CHD causes at lower levels of blood cholesterol; the basis for this negative association remains poorly understood, and its implications for health policy have received inadequate attention.5,6This issue of Circulation contains a report on the 1990 National Heart, Lung, and Blood Institute Conference on Low Blood Cholesterol: Mortality Associations that presents a statistical overview of available cohort stud- ies.The unprecedented size of the study (68,406 deaths)See p 1046 provides a unique opportunity to examine cause-specific mortality at the low end of the cholesterol distribution in both sexes.In the women, moreover, there are unexpected findings pertaining to the right-hand, high cholesterol limb. Low Blood Cholesterol and Noncardiovascular DeathsBeginning with the left-hand limb, the study finds a significantly increased risk of noncardiovascular death in both men and women with total cholesterol levels below 160 mg/dl for a surprisingly large and diverse set of causes.In round numbers, such men had a 20% higher age-adjusted rate of cancer deaths than those with cholesterol levels between 160 and 199 as well as a 40% higher rate of noncardiovascular noncancer deaths; the latter included increased rates of injury deaths (by 35%), respiratory system deaths (by 15%), digestive system deaths (by 50%), and "other" causes of From the Division of Clinical Epidemiology (S.B.

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• Walsh University US

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