Cholesterol and mortality – a study from China

Objective: To investigate the association between total cholesterol and mortality and examined whether the association varied by health status in elderly Chinese

Methods: We used multivariable Cox regression to examine the adjusted total cholesterol with all-cause mortality by health status in a population-based cohort study of all 80,088 enrollees, aged 65 years or above, from July 2008 to December 2010 at all 52 Comunitiy health Centers of Guangdong, China.

Results: After a mean follow-up of 3.0 years, there were 5,355 deaths in  participants with complete information. Cholesterol was significantly positive associated with the CHD mortality (HR= 1.12, 95%CI 1.04-1.21), but negative associated with all-cause (HR=0.91 95%CI 0.89-0.94) and non-CVD mortality, such as cancer and respiratory disease mortality. The association of total cholesterol with all-cause mortality varied by baseline health status (5 categories) (P=0.01). Higher cholesterol associated with significant decreased all-cause mortality in the unhealthy but not health people.

Conclusions: The cholesterol-death association was positive for coronary heart disease but not other cardiovascular diseases, and inverse for cancer, respiratory diseases in both sexes. It appeared to benefit mainly older people in poor health. The harmful effect of cholesterol on mortality may have been over-estimated in elderly people because of reverse causality. Lower TC might not an independent risk factor for increased mortality, but a mark in Chinese older people

Keywords: Cholesterol; elderly; mortality; reverse causality