What cause of mortality can we predict by cholesterol screening in the Japanese general population?

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Abstract.  Okamura T, Kadowaki T, Hayakawa T, Kita Y, Okayama A, Ueshima H (Shiga University of Medical Science, Shiga, Japan; Iwate Medical University, Morioka, Iwate, Japan). What cause of mortality can we predict by cholesterol screening in the Japanese general population? J Intern Med 2003; 253: 169–180.Objective.  In a population with a markedly lower coronary mortality such as in Japan, the benefit of cholesterol screening may be different from Western populations. We attempted to assess the importance of cholesterol screening in Japan.Design.  A 13.2‐year cohort study for cause‐specific mortality.Setting.  Three hundred randomly selected districts throughout Japan in which the National Survey on Circulatory Disorders 1980 was performed.Subjects.  A total of 9216 community dwelling persons aged 30 years and over, with standardized serum cholesterol measurement and without a past history of cardiovascular disease.Results.  There were 1206 deaths, which included 462 deaths due to cardiovascular disease with 79 coronary heart diseases. Hypercholesterolemia (>6.21 mmol L−1) showed a significant positive relation to coronary mortality (relative risk; 2.93, 95% confidence interval; 1.52–5.63) but not to stroke. Although hypocholesterolemia (−1) was significantly associated with an increased risk of liver cancer, noncardiovascular, noncancer disease and all‐cause mortality, these associations, except for liver cancer, disappeared after excluding deaths in the first 5 years of the follow‐up. The multivariate adjusted attributable risk of hypercholesterolaemia for coronary disease was 0.98 per 1000 person‐years, which was threefold higher than that of hypocholesterolemia for liver cancer: 0.32 per 1000 person‐years. The attributable risk percentage of hypercholesterolaemia was 66% for coronary heart disease.Conclusion.  Similar to Western populations, it is recommended to provide screening for hypercholesterolaemia in Japan, especially for males, although its attributable risk for coronary disease might be small.

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