Total cholesterol concentration and mortality at a relatively young age: Do men and women differ?

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Abstract
Objective: To investigate the relation between total cholesterol concentration and mortality from coronary heart disease, cardiovascular diseases, non-cardiovascular causes, and all causes. Design: Population based cohort study. Subjects: 23000 men and 26000 women aged 30-54 years examined between 1974 and 1980. Main outcome measures : Mortality for the above mentioned end points for fifths of cholesterol distribution, and relative risks estimated by using Cox's proportional hazard (survival) analysis. Adjustment was made for age, smoking, systolic blood pressure, and body mass index. Results: Mortality from coronary heart disease in men was five times higher than that in women. A strong positive association between total cholesterol concentration and mortality from coronary heart disease and cardiovascular diseases was observed in both men and women. The relative risk for the highest compared with the lowest fifth of the cholesterol distribution was for mortality from coronary heart disease (3.0 (95% confidence interval 1.8 to 5.1) in men and 3.8 (1.1 to 13.1) in women) and for mortality from cardiovascular disease (2.8 (1.8 to 4.2) in men and 2.9 (1.4 to 6.0) in women). No increase of non-cardiovascular mortality at low cholesterol concentration was observed. All cause mortality was significantly higher in the highest compared with the lowest fifth of the cholesterol distribution: relative risk 1.6 (1.3 to 2.0) in men and 1.5 (1.1 to 1.9) in women. Conclusion: Total cholesterol concentration is a strong predictor of mortality from coronary heart disease, cardiovascular diseases, and all causes in women as well as in men. Low cholesterol concentrations are not associated with increased mortality from non-cardiovascular causes.