title: Colorectal cancer risk and dyslipidemia: a case-cohort study nested in an Italian multicentre cohort.
abstract: BACKGROUND
  Dyslipidemia is an established risk factor for many diseases, but its effect on colorectal cancer risk is less clear. We investigated the association of colorectal cancer risk with plasma triglycerides, total, HDL, and LDL cholesterol in four Italian EPIC centers.
  
  
  METHODS
  We conducted a case-cohort study on participants recruited to four Italian EPIC centers (Turin, Varese, Naples, and Ragusa; 34,148 subjects). A random subcohort of 850 subjects was obtained and 286 colorectal cancer cases were diagnosed. Triglycerides, total and HDL cholesterol were determined in plasma samples obtained at baseline and stored at -196°C; LDL cholesterol was calculated. Hazard ratios (HR) with 95% confidence intervals (CI), adjusted for potential confounders, were estimated by Cox regression models using the Prentice method.
  
  
  RESULTS
  The highest tertiles of total (HR 1.66, 95%CI 1.12-2.45) and LDL cholesterol (HR 1.87, 95%CI 1.27-2.76) were associated with increased colorectal cancer risk compared to lowest tertiles. Risks were greater for men than women, and for postmenopausal than premenopausal women. Highest tertiles of total and LDL cholesterol were also significantly associated with increased risks of colon cancer, distal colon cancer, and rectal cancer, but not proximal colon cancer.
  
  
  CONCLUSIONS
  Our findings suggest that high levels of total and LDL cholesterol increase colorectal cancer risk, particularly in men and postmenopausal women. However additional studies are needed to clarify the role of plasma lipids in these cancers, particularly in view of the conflicting findings of previous studies.
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy. Electronic address: claudia.agnoli@istitutotumori.mi.it.
authors.forename: Claudia
authors.initials: C
authors.lastname: Agnoli
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy. Electronic address: sara.grioni@istitutotumori.mi.it.
authors.forename: Sara
authors.initials: S
authors.lastname: Grioni
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy. Electronic address: sabina.sieri@istitutotumori.mi.it.
authors.forename: Sabina
authors.initials: S
authors.lastname: Sieri
authors.affiliation: Center for Cancer Prevention (CPO-Piemonte), Via Santena 7, 10126 Turin, Italy; Human Genetics Foundation, Via Nizza 52, 10126 Turin, Italy. Electronic address: carlotta.sacerdote@cpo.it.
authors.forename: Carlotta
authors.initials: C
authors.lastname: Sacerdote
authors.affiliation: Human Genetics Foundation, Via Nizza 52, 10126 Turin, Italy; Imperial College of London, South Kensigton Campus, London SW7 2AZ, UK. Electronic address: p.vineis@imperial.ac.uk.
authors.forename: Paolo
authors.initials: P
authors.lastname: Vineis
authors.affiliation: Cancer Registry, Department of Prevention, ASP 7, Via Dante 109, 97100 Ragusa, Italy. Electronic address: rtumino@tin.it.
authors.forename: Rosario
authors.initials: R
authors.lastname: Tumino
authors.affiliation: Cancer Registry, Department of Prevention, ASP 7, Via Dante 109, 97100 Ragusa, Italy. Electronic address: giurda.regtumragusa@tiscali.it.
authors.forename: Maria Concetta
authors.initials: MC
authors.lastname: Giurdanella
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy. Electronic address: valeria.pala@istitutotumori.mi.it.
authors.forename: Valeria
authors.initials: V
authors.lastname: Pala
authors.affiliation: Department of Clinical and Experimental Medicine, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy. Electronic address: amattiel@unina.it.
authors.forename: Amalia
authors.initials: A
authors.lastname: Mattiello
authors.affiliation: Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, Via Armanni 5, 80138 Naples, Italy. Electronic address: paolo.chiodini@unina.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Chiodini
authors.affiliation: Laboratory of Genetic and Environmental Epidemiology, Fondazione di Ricerca e Cura "Giovanni Paolo II", Catholic University, Largo Gemelli 1, 86100 Campobasso, Italy. Electronic address: licia.iacoviello@moli-sani.org.
authors.forename: Licia
authors.initials: L
authors.lastname: Iacoviello
authors.affiliation: Laboratory of Genetic and Environmental Epidemiology, Fondazione di Ricerca e Cura "Giovanni Paolo II", Catholic University, Largo Gemelli 1, 86100 Campobasso, Italy. Electronic address: amalia.decurtis@moli-sani.org.
authors.forename: Amalia
authors.initials: A
authors.lastname: De Curtis
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy. Electronic address: cattaneo_leo@yahoo.com.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Cattaneo
authors.affiliation: National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands; Division of Human Nutrition, Wageningen University, P.O. Box 8129, 6700 EV Wageningen, The Netherlands. Electronic address: franzel.van.duijnhoven@rivm.nl.
authors.forename: Fränzel J B
authors.initials: FJ
authors.lastname: van Duijnhoven
authors.affiliation: Department of Clinical and Experimental Medicine, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy. Electronic address: spanico@unina.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Panico
authors.affiliation: Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy. Electronic address: vittorio.krogh@istitutotumori.mi.it.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Krogh
mesh_terms: D016022:Case-Control Studies; D015331:Cohort Studies; D015179:Colorectal Neoplasms / Q000097:blood* / Q000453:epidemiology*; D050171:Dyslipidemias / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
keywords: Cholesterol; Colorectal cancer; Prospective study; Triglycerides