title: Cholesterol and the risk of grade-specific prostate cancer incidence: evidence from two large prospective cohort studies with up to 37 years' follow up.
abstract: BACKGROUND
  High cholesterol may be a modifiable risk factor for prostate cancer but results have been inconsistent and subject to potential "reverse causality" where undetected disease modifies cholesterol prior to diagnosis.
  
  
  METHODS
  We conducted a prospective cohort study of 12,926 men who were enrolled in the Midspan studies between 1970 and 1976 and followed up to 31st December 2007. We used Cox-Proportional Hazards Models to evaluate the association between baseline plasma cholesterol and Gleason grade-specific prostate cancer incidence. We excluded cancers detected within at least 5 years of cholesterol assay.
  
  
  RESULTS
  650 men developed prostate cancer in up to 37 years' follow-up. Baseline plasma cholesterol was positively associated with hazard of high grade (Gleason score≥8) prostate cancer incidence (n = 119). The association was greatest among men in the 2nd highest quintile for cholesterol, 6.1 to < 6.69 mmol/l, Hazard Ratio 2.28, 95% CI 1.27 to 4.10, compared with the baseline of < 5.05 mmol/l. This association remained significant after adjustment for body mass index, smoking and socioeconomic status.
  
  
  CONCLUSIONS
  Men with higher cholesterol are at greater risk of developing high-grade prostate cancer but not overall risk of prostate cancer. Interventions to minimise metabolic risk factors may have a role in reducing incidence of aggressive prostate cancer.
authors.affiliation: Institute of Health & Wellbeing, Public Health, University of Glasgow, 1 Lilybank Gardens, Glasgow G12 8RZ, UK. k.shafique.1@research.gla.ac.uk
authors.forename: Kashif
authors.initials: K
authors.lastname: Shafique
authors.forename: Philip
authors.initials: P
authors.lastname: McLoone
authors.forename: Khaver
authors.initials: K
authors.lastname: Qureshi
authors.forename: Hing
authors.initials: H
authors.lastname: Leung
authors.forename: Carole
authors.initials: C
authors.lastname: Hart
authors.forename: David S
authors.initials: DS
authors.lastname: Morrison
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002784:Cholesterol / Q000097:blood*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000097:blood* / Q000453:epidemiology* / Q000473:pathology; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D055815:Young Adult
chemical_list: D002784:Cholesterol