title: Role of smoking in the U-shaped relation of cholesterol to mortality in men. The Framingham Study.
abstract: Elevated mortality has been reported at extremes of the serum total cholesterol distribution, with increased coronary mortality reported at high total cholesterol levels and increased cancer and non-cardiovascular/non-cancer mortality at low total cholesterol levels. The authors used data collected on 1,959 males aged 35-69 years from the fourth Framingham Study examination to analyze the relations between total serum cholesterol levels and 409 coronary deaths, 325 cancer deaths, and 534 other deaths for a 32-year follow-up. Age- and risk factor-adjusted Cox regressions were computed. Nonlinear (U-shaped) relations were investigated with the use of quadratic regression and with dummy variables using the 160-199 mg/dl group as the comparison group. Subset analyses investigated the relation in smokers and men who drank > or = 14 alcoholic drinks per week. All analyses were repeated removing those with existing cardiovascular disease and cancer and those who died during the first 5 years of follow-up. A significant U-shaped relation with all-cause mortality was noted, as were an inverse relation to cancer mortality and a monotonic increasing relation with coronary disease mortality. In subset analyses, the association of low serum cholesterol (< 160 mg/dl) with cancer mortality was observed in men who smoked cigarettes. Compared with the 160-199 mg/dl group, the relative risk was 3.72 (p = 0.0001, 95% confidence interval 1.91-7.25). Studies of the relation of low total serum cholesterol levels, cigarette smoking, and cancer are needed.
authors.affiliation: Department of Mathematics, Boston University, MA 02215, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: D'Agostino
authors.forename: A J
authors.initials: AJ
authors.lastname: Belanger
authors.forename: W B
authors.initials: WB
authors.lastname: Kannel
authors.forename: M
authors.initials: M
authors.lastname: Higgins
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects / Q000097:blood; D002423:Cause of Death; D002784:Cholesterol / Q000097:blood*; D015331:Cohort Studies; D003327:Coronary Disease / Q000401:mortality; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000139:chemically induced / Q000401:mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects* / Q000097:blood
chemical_list: D002784:Cholesterol