http://repub.eur.nl/res/aut/7958/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/9343/ 2000-01-01T00:00:00Z OBJECTIVE: Investigators from several studies have reported a positive relationship between low cholesterol levels and death due to violent causes (eg, suicide and accidents), possibly mediated by depressive symptoms, aggression or hostility, or impulsivity. We set out to establish whether middle-aged men with chronically low cholesterol levels (< or =4.5 mmol/liter) have a higher risk of having depressive symptoms, according to scores on the Beck Depression Inventory, compared with a reference group of men with cholesterol levels between 6 and 7 mmol/liter. A similar comparison was also made for measures of anger, hostility, and impulsivity. METHODS: Cholesterol measurements were obtained as part of a population-based cholesterol screening study in 1990-1991. These levels were remeasured in 1993-1994. Only those whose cholesterol level remained in the same range were included in the study. Depressive symptoms were assessed by using the Beck Depression Inventory; anger, by questionnaires based on the Spielberger Anger Expression Scale and State-Trait Anger Scale; hostility, by the Buss-Durkee Hostility Inventory; and impulsivity, by the Eysenck and Eysenck Impulsivity Questionnaire. RESULTS: Men with chronically low cholesterol levels showed a consistently higher risk of having depressive symptoms (Beck Depression Inventory score > or =15 or > or =17) than the reference group, even after adjusting for age, energy intake, alcohol use, and presence of chronic diseases. No differences in anger, hostility, and impulsivity were observed between the two groups. CONCLUSIONS: Men with a lower cholesterol level (< or =4.5 mmol/liter) have a higher prevalence of depressive symptoms than those with a cholesterol level between 6 and 7 mmol/liter. These data may be important in the ongoing debate on the putative association between low cholesterol levels and violent death. http://repub.eur.nl/res/pub/22045/ 1995-11-22T00:00:00Z A high serum cholesterol level is a well documented risk factor for atherosclerotic cardiovascular disease. Consequently, a low serum cholesterol has in general been viewed as beneficial. However, since the early 70s, results from several cohort studies and randomized trials have suggested that low or lowered cholesterol may increase the risk of dying from non-atherosclerotic causes. A number of reviews discussing the putative association between low serum cholesterol levels and increased mortality has been published. These reviews focused mainly on the possibility of a causal relation between low cholesterol and mortality from cancer. Although cancer mortality remains an important issue, the scope of recent studies on the association between low or lowered cholesterol and mortality has broadened towards all non-cardiovascular causes of death including accidents, violence and suicide. In the present paper the evidence is reviewed for an association between low or lowered cholesterol levels and aggression, impulsivity and (mortality from) suicide. Both studies addressing 'naturally' occurring low cholesterol levels and studies in which a low cholesterol was the result of (drug) intervention are discussed. This distinction is important from an etiological point of view, notably because a 'naturally' occurring low cholesterol reflects the lower end of the cholesterol distribution while lowered cholesterol levels of patients with hypercholesterolemia are still in the upper part of the distribution. Moreover, the duration of being 'exposed' to lower cholesterol levels is longer in those with 'naturally' occurring low cholesterol levels compared to those with 'lowered' cholesterol concentrations. The currently most important hypothesis to explain an association between naturally occurring low cholesterol and violent death, involving dietary induced serotonin changes as a mediating factor, is discussed in detail.