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.

Additional Metadata
Keywords cholesterol, hematology, serotonin metabolism, violence
Promotor D.E. Grobbee (Diederick) , E. van der Does (Emiel)
Publisher Erasmus University Rotterdam
Sponsor Netherlands Prevention Fund, Rotterdam Medical Research Foundation, Netherlands heart Foundation, Netherlands Institute for Health Services
ISBN 978-90-90-08863-1
Persistent URL hdl.handle.net/1765/22045
Steegmans, P.H.A. (1995, November 22). Low serum cholesterol, serotonin metabolism, and violent death. Erasmus University Rotterdam. Retrieved from http://hdl.handle.net/1765/22045