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Assessing possible hazards of reducing serum cholesterol
M R Law, S G Thompson, N J Wald Department of Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, St Bartholomew's Medical College, London EC1M 6BQ Correspondence to: Dr Law.
Abstract
Objective : To assess whether low serum cholesterol concentration increases mortality from any cause. Design - Systematic review of published data on mortality from causes other than ischaemic heart disease derived from the 10 largest cohort studies, two international studies, and 28 randomised trials, supplemented by unpublished data on causes of death obtained when necessary.
Main outcome measures : Excess cause specific mortality associated with low or lowered serum cholesterol concentration.
Results : The only cause of death attributable to low serum cholesterol concentration was haemorrhagic stroke. The excess risk was associated only with concentrations below about 5 mmol/l (relative risk 1.9, 95% confidence interval 1.4 to 2.5), affecting about 6% of people in Western populations. For non-circulatory causes of death there was a pronounced difference between cohort studies of employed men, likely to be healthy at recruitment, and cohort studies of subjects in community settings, necessarily including some with existing disease. The employed cohorts showed no excess mortality. The community cohorts showed associations between low cholesterol concentration and lung cancer, haemopoietic cancers, suicide, chronic bronchitis, and chronic liver and bowel diseases; these were most satisfactorily explained by early disease or by factors that cause the disease lowering serum cholesterol concentration (depression causes suicide and lowers cholesterol concentration, for example). In the randomised trials nine deaths (from a total of 687 deaths not due to ischaemic heart disease in treated subjects) were attributed to known adverse effects of the specific treatments, but otherwise there was no evidence of an increased mortality from any cause arising from reduction in cholesterol concentration.
Conclusions : There is no evidence that low or reduced serum cholesterol concentration increases mortality from any cause other than haemorrhagic stroke. This risk affects only those people with a very low concentration and even in these will be outweighed by the benefits from the low risk of ischaemic heart disease.
Assessing possible hazards of reducing serum cholesterol -- Law et al. 308 (6925): 373 -- BMJThere is an excess risk of haemorrhagic stroke at very low serum cholesterol concentrations (the lowest 6% in Western countries), but this is outweighed by the low risk of ischaemic heart disease and is not a practical public health concern.
Commentary: Having too much evidence (depression, suicide, and low serum cholesterol) -- Law 313 (7058): 651 -- BMJSome cross sectional studies show an association between low serum cholesterol concentration and depression,12 and, given this, there is also an association between low serum cholesterol and suicide.8 But the associations may arise because low serum cholesterol causes depression or because it is a consequence of depression (simply because depressed people eat less). Cross sectional studies cannot determine which is the cause and which the consequence. Other observational evidence indicates that the low cholesterol concentration is a consequence of the depression since (a) there was no excess mortality with low serum cholesterol in prospective studies of working men (less likely to have serious psychiatric illness on entry to the studies by virtue of being in work),8 (b) the excess mortality in the prospective studies was short term with no significant excess after six years,8 and (c) treating depression has been shown to increase serum cholesterol concentration.13 The recent observational studies have merely introduced variations on the same theme: low serotonin concentrations (which accompany and may cause depression) are, not surprisingly, also associated with low cholesterol,2 14 people who attempt suicide have low serum cholesterol concentrations,3 and, in this week's issue, men with declining serum cholesterol concentrations are particularly likely to commit suicide.1 If these were the only studies one could not distinguish cause from consequence. The randomised trials resolve the matter, providing compelling evidence that low cholesterol concentration does not cause depression, accidents, or suicide.
srry niet op gelet1 Oktober is 2 maanden geleden? Heb je nu ook al een contrarian view over tijd? Kom de thread nu pas tegen maar zie weer eens die onzinnige Ravsnkov studies staan en reageer dus.
die link leek me ook wel verdacht, aangezien de "ikonaka's" kan die hun naam niet uitspreken, totaal geen last hebben van depressieThe randomised trials resolve the matter, providing compelling evidence that low cholesterol concentration does not cause depression, accidents, or suicide.
zoiets wou ik nog posten, maar dan toch niet gedaanOkinawans.
Tja ik heb een laag serum cholesterol gehalte, dan ben je wat sneller geprikkeld![]()

Nog een vraagje. Weet iemand waar ik informatie kan vinden over de voedingsbestanddelen. Op de verpakking staat meestal wel een heleboel informatie, maar vaak geraak ik gewoon niet uit aan wat ze willen zeggen. Zo zou ik 3 maand geleden wel gedacht hebben dat geharde plantaardige olieen goed voor de gezondheid waren... plantaardig klinkt nu eenmaal niet zo ongezond!!!
Iemand die mij een suggestie kan geven qua te gebruiken zoektermen en / of betrouwbare bronnen kan mij al veel vooruit helpen!
Groeten!
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