title: Total cholesterol as a risk factor for coronary heart disease and stroke in women compared with men: A systematic review and meta-analysis.
abstract: BACKGROUND
  Raised total cholesterol is a strong risk factor for cardiovascular disease (CVD). It remains unknown whether sex differences exist in the relationship between total cholesterol and CVD outcomes.
  
  
  METHODS
  PubMed was searched in December 2014 for cohort studies reporting on the relationship between total cholesterol and coronary heart disease (CHD) and total stroke, separately in men and women. Random effects meta-analyses with inverse variance weighting were used to obtain adjusted pooled sex-specific relative risks (RR) and women-to-men ratio of RRs (RRRs).
  
  
  RESULTS
  Data from 97 cohorts, 1,022,276 individuals, and 20,176 CHD and 13,067 stroke cases were included. The pooled RR (95% confidence interval) for CHD associated with a 1-mmol/L increase in total cholesterol was 1.20 (1.16; 1.24) in women and 1.24 (1.20; 1.28) in men, resulting in a RRR of 0.96 (0.93; 0.99). Corresponding RRs for the risk of total stroke were 1.01 (0.98; 1.05) in women, and 1.03 (1.00; 1.05) in men, with a pooled RRR of 0.99 (0.93; 1.04). Pooled RRRs (95% CI) comparing individuals in the highest TC category to those in the lowest, such as the highest versus lowest third, were 0.87 (0.79; 0.96) for CHD and 0.86 (0.76; 0.97) for total stroke.
  
  
  CONCLUSIONS
  Raised total cholesterol is a strong risk factor for CHD, with evidence of a small, but significantly stronger, effect in men compared to women. Raised total cholesterol had little effect on the risk of total stroke in both sexes.
authors.affiliation: The George Institute for Global Health, University of Oxford, Oxford, United Kingdom. Electronic address: sanne.peters@georgeinstitute.ox.ac.uk.
authors.forename: Sanne A E
authors.initials: SA
authors.lastname: Peters
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, The University of Queensland, Brisbane, Australia.
authors.forename: Yankuba
authors.initials: Y
authors.lastname: Singhateh
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, The University of Queensland, Brisbane, Australia.
authors.forename: Diana
authors.initials: D
authors.lastname: Mackay
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, The University of Queensland, Brisbane, Australia; School of Public Health, Curtin University, Perth, Australia.
authors.forename: Rachel R
authors.initials: RR
authors.lastname: Huxley
authors.affiliation: The George Institute for Global Health, University of Oxford, Oxford, United Kingdom; The George Institute for Global Health, The University of Sydney, Sydney, Australia; Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Woodward
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D002784:Cholesterol / Q000097:blood*; D003327:Coronary Disease / Q000097:blood* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012737:Sex Factors; D020521:Stroke / Q000097:blood* / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002784:Cholesterol
keywords: Coronary heart disease; Men; Meta-analysis; Stroke; Systematic review; Total cholesterol; Women