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Serum cholesterol concentrations in parasuicide
Abstract
To evaluate whether people who have committed parasuicide have low serum cholesterol concentrations.
Results of blood tests in subjects admitted to hospital for parasuicide compared with those of a control group of non-suicidal subjects; comparison in subgroup of parasuicide subjects of two sets of blood test results (one set from admission for parasuicide and the other from admission for some other illness).
General hospital, Ferrara, Italy.
331 parasuicide subjects aged 44 (SD 21) years (109 with two sets of blood test results) and 331 controls.
Serum cholesterol concentrations and possible association with parasuicide, considering sex, violence of method of parasuicide, and underlying psychiatric disorder.
Lower serum cholesterol concentrations (4.96 (SD 1.16) mmol/l) were found in the parasuicide subjects than in the controls (5.43 (1.30); P < 0.001), regardless of sex and degree of violence of parasuicide method. Both men and women with two sets of blood test results had lower cholesterol concentrations after parasuicide. Linear regression analysis showed that the difference in cholesterol concentrations was significantly related to the length of time between the taking of the two sets of blood samples.
The study showed low cholesterol concentrations after parasuicide. This finding agrees with previous studies, which suggest an association between low cholesterol concentration and suicide.
... Lower TC levels have been implicated in increasing suicidality by several authors (Sarchiapone et al., 2001;Atmaca et al., 2002;Sullivan et al., 1994;Olié et al., 2011), especially in the male gender (Golier et al., 1995). Gallerani et al. (1995) found lower TC in 331 cases of parasuicides, compared to healthy controls. Sullivan et al. (1994) found a significant relationship between lower TC levels and increased suicidality. ...
Aim
Present study aimed at determining lipid profiles in acutely symptomatic drug-naïve/drug-free patients of Schizophrenia, comparing them with healthy controls and exploring relationships between various lipid fractions, aggression, suicidality and impulsivity in this population.
Materials and Methods
This was a cross-sectional hospital-based study, comparing patients with Schizophrenia (M = 46,F = 14; mean age 32.40 ± 6.6 years; 48 drug-free for 10.50 ± 9.2 weeks) with 60 age-sex matched healthy controls. Upon recruitment, fasting venous blood samples of all subjects were analysed for Total Cholesterol, HDL, LDL, VLDL and TG levels; and patients were rated on PANSS for symptom severity, Modified Overt Aggression Scale for aggression, Impulsivity Rating Scale for impulsivity and Scale for Suicide Ideation for suicidality.
Results
The socio-demographic characteristics of the patients were comparable to controls. In patients, Total Cholesterol, HDL and LDL levels were found to be significantly lower (p < 0.01) than the control group. When explored further in patients, lower total cholesterol and LDL levels showed significant negative correlations with scores on impulsivity (p < 0.01) and suicidality (p < 0.05); and TG level showed a negative correlation with impulsivity (p < 0.05).
Conclusions
This study adds to a growing literature on a complex relationship between lipid fractions and impulsivity, suicidality and aggression in Schizophrenia; providing interesting insights into the biochemical basis of human behaviour and confirming these in a developing-world population. The implications are many, including a need to review judiciously the promotion of weight loss and cholesterol reduction programs in constitutionally vulnerable population; at least during their acutely-symptomatic states.
... El cerebro humano concentra la mayor parte del colesterol del cuerpo por lo que no parece lógico que una dieta baja en grasa y en colesterol sea lo más conveniente para la salud. Se han encontrado algunos estudios que asocian un comportamiento más violento (10,11) y mayor riesgo de suicidio a aquellos con menores niveles de colesterol según (12,13). ...
Para la comunidad científica hasta hace algunos años era irrebatible la idea de que las grasas saturadas y el coleste-rol son perjudiciales. Existía el consenso de que hay que limitar las grasas saturadas a un 10% del total de grasas diarias que se ingiere y el colesterol a no más de 300 mg diarios ya que de no ser así puede promover y facilitar la aparición de enfermedades cardiovasculares. Esta idea tiene sus orígenes en la famosa pirámide nutri-cional, la cual constituye uno de los conceptos básicos de nutrición, que siempre se pone de ejemplo gráfico y muy visual para explicar cómo debemos diseñar una dieta sana y equilibrada (Figura 1). El origen y recomenda-ciones que promueve dicha pirámide fueron establecidas en los Esta-dos Unidos, alrededor de los años 50, en los traba-jos realizados por Ancel-Keys, director del Labora-torio de Higiene Fisiológi-ca de la Universidad de Minnesota (1). El Dr. Keys planteaba la hipótesis de que el exce-so de grasas en la dieta era la causa de las elevadas tasas de infartos y enfermedades cardiovasculares en los Esta-dos Unidos, así que, en 1951 comenzó a recoger datos de distintos países del mundo, en cuanto al tipo de alimenta-ción que llevaban y el porcentaje y tipos de enfermedades que padecían. En 1953 publicó un estudio (2) en base a los datos de seis países (Australia, Canadá, Irlanda, Japón, Italia y Estados Unidos), con distinto porcentaje de consu-mo de grasa en la dieta y tasas de enfermedades cardiovasculares muy variables, y demostraba que " cuanto mayor es el consumo de grasas en la dieta, mayor es el número de muertes por arterios-clerosis y enfermedades cardíacas " (Figura 2). Esta publicación y poste-riormente, el famoso " Estudio de los siete paí-ses " (3), que desarrolló entre 1956 y 1970, le die-ron tanta fama al Dr. Keys que incluso la prestigiosa revista Time le dedicó una por-tada, destacando a Keys como " la cara de la sabiduría dietética de América " ; fue en esta entrevista donde Keys afir-mó que: " La dieta equilibrada y sana para el corazón incluía aumentar el consumo de los hidratos de carbono del 40% a casi el 70%, y reducir la grasa del 40% al 15% ". En 1957, los Doctores Yerushalmy y Hilleboe descubrieron que el Dr. Keys disponía de datos de 22 países (4), pero que sola-mente publicó los concernientes a seis países que demostra-ban su hipótesis. Los datos de los restantes países rechazaban la hipótesis propuesta por Keys, por lo que el porcentaje de grasas en la dieta no era la causa directa de las enfermedades cardio− vasculares (Figura 3). No obstante, este conoci-miento no fue propia-mente divulgado y anali-zado por los comités científicos con el rigor necesario y prevalecieron los estudios de Keys. A partir de este momen-to las grasas saturadas y el colesterol fueron demoni-zados y pasaron a ser con-siderados el origen de todos los males. Los estudios de Ancel sirvieron de base para crear la famosa dieta mediterránea, la cual se promueve como ejemplo de dieta saludable al recomendar: Un consumo elevado de vege-tales y frutas, consumir aceites vegetales en detrimento de grasas animales, priorizar bajo consumo de proteína animal. Pero como suele suceder, hay ciertos comportamientos ali-mentarios que escapan a esta propuestade dieta saludable y las poblaciones presentan una salud excepcional. Las paradojas alimentarias Existe una situación peculiar conocida como la paradoja fran-cesa, en la que los franceses consumen en su dieta una alta cantidad de mantequilla (grasa saturada) y presentan buenos índices de salud cardiovascular. Este comportamiento suele justificarse en la comunidad médica aludiendo al hecho de que al ingerir aceite de oliva y vino tinto las personas adquieren sustancias con un alto poder antioxidante como el resveratrol (presente en el vino tinto) que ejercen una función cardiopro-tectora. Sin embargo, a esto hay que añadir que para que el reseveratrol ejerza algún efecto protector es necesario consu-mir casi 700 botellas de vino al día (5). Como contraposición también a esta posible explicación a la paradoja francesa está la paradoja alpina, la cual resulta interesante pues los suizos consumen los quesos más grasos del mundo, y de nuevo, bue-nos índices de salud cardiovascular y no consumen ni aceite de oliva ni vino tinto. Figura 1. Pirámide nutricional oficial propuesta por el Departamento de Agricultura de Estados Unidos (USDA) en 1992. Fig 2: Correlación entre el total de grasa consumida como porciento del total de calorías y la mortalidad por enfermedades cardiovasculares. Figura 3: Mortalidad por enfermedades cardiovasculares con respecto al porciento de calorías ingeridas procedentes de las grasas (4).
... A recent case-control study found that serum cholesterol concentrations were significantly lower in parasuicide subjects than in 331 sexand age-matched controls (p<0.001) (Gallerani et al., 1995). Mufti et al. (1998) reported that low serum cholesterol levels were strongly associated with violent behavior in 20 psychiatric patients. ...
... Inoltre, l'utilizzo di agonisti serotoninergici nel ratto si è dimostrato efficace nell'inibire l'aggressività indotta da testosterone. Basse concentrazioni plasmatiche di colesterolo sembrerebbero facilitare il verificarsi di agiti aggressivi auto ed etero-diretti; infatti, esse condizionerebbero un'alterazione della permeabilità neuronale, con conseguente aumento della velocità del reuptake di serotonina e una ridotta disponibilità di tale monoamina nello spazio intersinaptico (27). ...
Aggression is a transnosographic dimension of many psychiatric disorders. According to their aims and manifestations, aggressive behaviours may be considered as adaptive (defensive aggression) or maladaptive (impulsive and proactive pathological aggression). The specific neurobiological mechanisms underlying aggression haven't been clarified yet. Aggression and impulsivity seem to be influenced by the unbalance between serotonin inhibitory action and dopamine activating action on behaviour. Pharmacological treatment of aggressive behaviours consist in acute and preventive, long-term interventions. Typical and atypical antipsychotics, benzodiazepines, mood stabilizers, β-blockers and SSRI, entered in mono-therapy or in combination, are the most frequently used medications. The object of our study is to review, analyzing scientific literature, the use of typical and atypical antipsychotics for the treatment of aggression in children and adolescents.
Introduction: Empirical studies have documented the impact
of membrane cholesterol on serotonergic function which might
influence the suicidality in various psychiatric disorders. Most
studies in last two decades demonstrated low cholesterol as
potential predictor of suicidality in depression but trends of
metabolic disorders and current status of hypercholesterolemia
and biochemical abnormalities in suicidal spectrum population
is scarce.
Aim: The present study was aimed to comprehensively
evaluate the blood levels of cholesterol and other biochemical
abnormalities (serum electrolytes, proteins, blood pH etc.,)
irrespective of any psychiatric disorders in suicide attempters.
Materials and Methods: A cross-sectional study was
conducted on a total of 202 patients who visited our
emergency hospital services with the suicidal attempt from
1st January 2019 till 31st December 2019 for a period of 12
Months. Blood evaluation and analysis were done on the
same day of hospitalisation for complete blood counts,
serum electrolytes, proteins and cholesterol levels. Clinical
and standardised psychological evaluations for psychiatric
diagnosis were performed. The results were analysed and
compared using descriptive and inferential statistics based
on SPSS software 21.01.
Results: Out of 202 total suicide attempters, 120 (59.4%) were
males and 82 (40.6%) were females with most patients 111
(54.9%) falling in the age range of 20-29; while 175 (86.6%) of
patients had their first ever suicide or deliberate harm. A total
of 169 (83.7%) of patients had normal complete blood counts
but 106 (52.5%) showed acidic pH (
Objective: In the multiaxial DSM system, aggressiveness does not appear as a core organizer of any disorder. However, its importance is indicated by the fact that aggressive behavior is an indicator for the DSM and measures adaptation or disadaptation of patients affected by various disorders; this is reflected by the fact that the danger to damage oneself or another is associated with the lowest scores on the Global Assessment of Functioning scale. In our study we had the objective to descrive the distribution of the aggressiveness dimension in various psychiatric disorders, to analyse their biological correlates and to identify possible pharmacotherapeutic interventions. Method: Through a careful search performed on textbooks, journals and other scientific publications, we carried-out an extensive review of the literature on aggressiveness and psychiatric disorders in the past twenty years. Results: In a transnosographic view, the aggressiveness dimension, articulated in multiple manifestations and with a wide phenomenological «spectrum», finds itself able to characterize all currently classified psychiatric disorders. Among Mood Disorders, mania and the male model of depression present a higher amount of aggressiveness. Among Anxiety Disorders, aggressiveness appears to prevail in Obsessive-Compulsive Disorder. Furthermore, it is frequently represented in both Schizophrenia and overall Psychotic Disorders. In Substance-Related Disorders, aggressive behavior is associated in both an increase of abuse conduct and some forms of abstinence. Antisocial and Borderline Personality Disorders, mostly if the latter occurs with comorbid Bulimia Nervosa, are characterized by aggressive traits more frequently than other Personality Disorders. Regarding the pathogenesis of aggressiveness, an involvement of the endogenous opioid system has been hypothesized. Endogenous opioids are released following self-harming actions, and trigger a positive reinforcement mechanism. The noradrenergic and dopaminergic systems also exert an important function in the regulation of aggressive behavior, in particular the outwardly directed one. However, the most numerous and empirically validated data regard the serotonergic system (Tab. I). Different brain areas proved to be involved in generating aggressiveness; the olfactory system, the amygdala, the septal area, the lateral hypothalamus, the rafé nuclei, right hemisphere, the frontal lobe, the medio-temporal lobe, the rostral portion of the cerebellar vermis. Studies carried out on drug treatment of aggressive behavior, show the efficacy of much dissimilar drugs. Overall, the evidence favoring serotonergic regulation of aggressive behavior allows to hypothesize a privilege for the use of the SSRIs in the treatment of aggressiveness in a dimensional and transnosographic perspective. Conclusions: Given the wide distribution of the aggressiveness dimension in various psychiatric disorders, the need for a higher ability to diagnose it and subtype it qualitatively within the disorders where it occurs most frequently becomes increasingly evident. This would allow to design more specific and targeted clinical treatment guidelines for the aggressiveness dimension.
The concept of identity is a set of physical characteristics, functional or psychic, normal or pathological-that define an individual. "Cheiloscopy" is a method of identification of a person based on the characteristic arrangement of lines on the lips. This study was conducted on 300 individuals of either sex (M: F: 100:200) to study the predominating pattern of lip prints in the North Indian Population. Materials used were dark colored lipstick, cellophane tape and white bond paper. The lips of the subject were thoroughly cleaned and lipstick was applied uniformly. Lip prints were taken on the glued portion of cellophane tape and then stuck on to a white bond paper. Then each of these lip prints were scanned using an image scanner set at a resolution of 300ppi. Type I, I'& II lip prints, when taken together found to be most predominant almost all the regions in both the sexes except in LUM region where type III replaced type II. In our study no two individuals or more than two individuals had similar types of lip prints patterns.
Suicide is emerging as a major public health problem globally for all ages. it has been hypothesized that lowered levels of total serum cholesterol may cause a decrease in brain serotonin thereby leading to enhanced suicidal tendency in depression. The present study was conducted with an aim to find out the correlation of serum cholesterol level with serotonin level in cases of suicidal death and matched controls. Blood samples for cholesterol and serotonin levels were obtained from the 88 dead bodies during autopsy and 9 healthy volunteers who served as controls. Serum cholesterol and serotonin levels in the suicidal death cases were significantly lower than in the controls. Moreover, we found a significant positive correlation between these two variables in suicidal deaths. These findings indicate that the serotonergic system may be associated to serum cholesterol in suicidal deaths. However further investigation is necessary to establish these two variables as predictors of suicidality.
Objective: High blood cholesterol is one of the significant risk factors for cardiovascular diseases. Increased cholesterol levels contribute to atherosclerosis, which causes platelet aggregation and increases the risk of blood clots in the arteries. Previous research has investigated relationships of elevated serum cholesterol with anxiety disorders. The current study aims to assess levels of serum lipid, lipoprotein concentrations and platelets in individuals with high and low anxiety. Methods: Of a total of 1,038 subjects, 142 healthy men were randomly selected. All participants were asked to complete the Spielberger's self-reported state-trait anxiety inventory (STAI). Participants with scores higher than 46 and lower than 34 were included in high anxiety group (n=28) and low anxiety group (n=69), respectively. Levels of fasting serum lipids, including total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglycerides and platelets were compared between the two groups. The data were analyzed using independent samples t-test and correlation coefficient test. Results: The levels of total cholesterol and LDL cholesterol were significantly higher in the high anxiety group (P<0.001). There were no significant differences in the levels of triglycerides, HDL cholesterol, and platelets. Conclusion: High anxiety increases total cholesterol and LDL which are risk factors for cardiovascular diseases.
Background:
We conducted a systematic review and meta-analysis to determine the association between serum lipid levels and suicidality, as evidence from previous studies has been inconsistent.
Methods:
We identified relevant studies by searching Medline, Web of Science, EMBASE, and the Cochrane Database of Systematic Reviews (1980 to Dec. 5, 2014). Studies assessing the association between serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and/or triglycerides (TG) levels and suicidality were included. We used a random-effects model to take into account heterogeneity among studies.
Results:
We included 65 studies with a total of 510 392 participants in our analysis. Compared with the nonsuicidal patients, suicidal patients had significantly lower serum TC (weighted mean difference [WMD] -22.35, 95% confidence interval [CI] -27.95 to -16.75), LDL-C (WMD -19.56, 95% CI -26.13 to -12.99) and TG (WMD -23.40, 95% CI -32.38 to -14.42) levels, while compared with the healthy controls, suicidal patients had significantly lower TC (WMD -24.75, 95% CI -27.71 to -21.78), HDL-C (WMD -1.75, 95% CI -3.01 to -0.48) and LDL-C (WMD -3.85, 95% CI -7.45 to -0.26) levels. Furthermore, compared with the highest serum TC level category, a lower serum TC level was associated with a 112% (95% CI 40%-220%) higher risk of suicidality, including a 123% (95% CI 24%-302%) higher risk of suicide attempt and an 85% (95 CI 7%-221%) higher risk of suicide completion. The cut-off values for low and high serum TC level were in compliance with the categories reported in the original studies.
Limitations:
A major limitation of our study is the potential heterogeneity in most of the analyses. In addition, the suicidal behaviour was examined using different scales or methods across studies, which may further explain heterogeneity among the studies.
Conclusion:
We identified an inverse association between serum lipid levels and suicidality. More mechanistic studies are needed to further explain this association.
Background.—
With increased efforts to lower serum cholesterol levels, it is important to quantify associations between serum cholesterol level and causes of death other than coronary heart disease, for which an etiologic relationship has been established.
Methods.—
For an average of 12 years, 350 977 men aged 35 to 57 years who had been screened for the Multiple Risk Factor Intervention Trial were followed up following a single standardized measurement of serum cholesterol level and other coronary heart disease risk factors; 21 499 deaths were identified.
Results.—
A strong, positive, graded relationship was evident between serum cholesterol level measured at initial screening and death from coronary heart disease. This relationship persisted over the 12-year follow-up period. No association was noted between serum cholesterol level and stroke. The absence of an association overall was due to different relationships of serum cholesterol level with intracranial hemorrhage and nonhemorrhagic stroke. For the latter, a positive, graded association with serum cholesterol level was evident. For intracranial hemorrhage, cholesterol levels less than 4.14 mmol/L (<160 mg/dL) were associated with a twofold increase in risk. A serum cholesterol level less than 4.14 mmol/L (<160 mg/dL) was also associated with a significantly increased risk of death from cancer of the liver and pancreas; digestive diseases, particularly hepatic cirrhosis; suicide; and alcohol dependence syndrome. In addition, significant inverse graded associations were found between serum cholesterol level and cancers of the lung, lymphatic, and hematopoietic systems, and chronic obstructive pulmonary disease. No significant associations were found of serum cholesterol level with death from colon cancer, with accidental deaths, or with homicides. Overall, the inverse association between serum cholesterol level and most cancers weakened with increasing follow-up but did not disappear. The association between cholesterol level and death due to cancer of the lung and liver, chronic obstructive pulmonary disease, cirrhosis, and suicide weakened little over follow-up.
Conclusions.—
The association of serum cholesterol with specific causes of death varies in direction, strength, gradation, and persistence. Further research on the determinants of low serum cholesterol level in populations and long-term follow-up of participants in clinical trials are necessary to assess whether inverse associations with noncardiovascular disease causes of death are consequences of noncardiovascular disease, whether serum cholesterol level and noncardiovascular disease are both consequences of other factors, or whether these associations are causal.(Arch Intern Med. 1992;152:1490-1500)
Background.—
Serum lipid levels vary widely within individuals, but the causes of these fluctuations are poorly understood. One area of research concerns elevations in cholesterol concentration in response to emotional stress. In a laboratory-based experiment, we compared the effects of acute mental stress and postural change (standing) on serum cholesterol concentration. In addition, plasma volume was indirectly monitored to determine whether cholesterol changes with mental stress, if present, were a function of hemoconcentration.
Methods.—
Twenty-six men attended two laboratory sessions, each consisting of baseline (30 minutes), task (20 minutes), and recovery (30 minutes) periods. Subjects rested in the supine position during the baseline and recovery periods. During the task period of one session, subjects performed a mental task (Stroop test and mental arithmetic); during the other session, the subjects stood for the task period.
Results.—
Both mental stress and standing elicited significant elevations in heart rate, blood pressure, and plasma catecholamine concentrations, relative to the baseline and recovery periods. Both the mental and orthostatic tasks also significantly increased serum cholesterol concentration (by 0.10 and 0.57 mmol/L [3.7 and 21.9 mg/dL], respectively), as well as hemoglobin level and hematocrit. Cholesterol elevations with standing were reversible, while those resulting from mental stress persisted through the recovery period. When values were corrected for concomitant hemoconcentration, no net change in serum cholesterol level occurred during either task.
Conclusions.—
Acute mental stress can produce rapid elevations in serum cholesterol concentration. It can also increase hemoglobin concentration and hematocrit (ie, reduce plasma volume). Therefore, increases in serum cholesterol level after acute mental stress are analogous to those with standing and may reflect hemoconcentration rather than altered lipoprotein metabolism.(Arch Intern Med. 1992;152:775-780)
The WHO/EURO multicentre study on parasuicide is a new, coordinated, multinational, European study that covers two broad areas of research: monitoring trends in the epidemiology of parasuicide (epidemiological monitoring study); and follow-up investigations of parasuicide populations, with a view to identifying the social and personal characteristics predictive of future suicidal behaviour (repetition prediction project). This article provides background information on the development and organization of the multicentre study, and presents selected findings from the epidemiological monitoring project, based on a preliminary examination of data collected in 15 centres on parasuicides aged 15 years and over treated in health facilities in defined catchment areas during the year 1989. The overall parasuicide incidence varied considerably across the centres, from a high (event) rate of 414 per 100,000 males in Helsinki to a low of 61 among males in Leiden. The highest female event rate was 595 in Pontoise, and the lowest 95 in Guipuzcoa. The mean event rate across all centres was 167 among males and 222 among females. Parasuicide incidence tended to be elevated among 15- to 34-year-olds, with lowest rates among those aged 55 years and over. With one exception (Helsinki), the female parasuicide rate was higher than the male rate, the F:M ratio ranging from 0.71:1 to 2.15:1, with a median of 1.5:1 (events). Short-term repetition rates (as measured by the event:person ratio) differed between centres, from 1.03 to 1.30 (median = 1.12) among males, and from 1.07 to 1.26 (median = 1.13) among females. Although we warn against generalizing from our findings to make statements about differences in parasuicide between countries, we argue that the differences between centres are valid and should be addressed in further research.
Serum cholesterol fasting concentrations were measured in 274 subjects with personality disorders, who had committed offences. Of these subjects, 139 were found to possess the antisocial personality (sociopathy or psychopathy). With standardized ages, the group of subjects with antisocial personality had a clearly lower mean level of serum cholesterol than the group with other personality disorders which was used as a control group. The use of a mean male population with standardized ages as a control group further emphasized the low values of the serum cholesterol of the antisocial personality group.
We describe a single-reagent, enzymatic procedure for triglycerides in serum, which may be performed in 5 min per sample with use of an Abbott ABA-100 analyzer system. This procedure is compared to the semi-automated enzymatic procedure with the ABA-100, which requires 30 min per sample.
Primary prevention trials which have shown that the lowering of serum cholesterol concentrations in middle-aged subjects by diet, drugs, or both leads to a decrease in coronary heart disease have also reported an increase in deaths due to suicide or violence. There has been no adequate explanation for this association. I have reviewed the relevant published work and describe a physiological mechanism that might account for this curious finding. One of the functions of serotonin in the central nervous system is the suppression of harmful behavioural impulses. When mouse brain synaptosomal membrane cholesterol is increased there is a pronounced increase in the number of serotonin receptors. Low membrane cholesterol decreases the number of serotonin receptors. Since membrane cholesterol exchanges freely with cholesterol in the surrounding medium, a lowered serum cholesterol concentration may contribute to a decrease in brain serotonin, with poorer suppression of aggressive behaviour.
A higher than expected number of violent deaths and suicides in coronary prevention trials has provoked interest in the possibility that low serum cholesterol concentrations are associated in the general population with personality characteristics predisposing to aggressive and suicidal behaviour. We have investigated this possibility in the Edinburgh Artery Study. We measured serum lipid concentrations in blood samples taken from fasting subjects and assessed personality characteristics on the Bedford Foulds Personality Deviance Scales in a random sample of 1592 men and women aged 55-74 years, selected from age-sex registers of ten general practices in Edinburgh. Serum cholesterol concentration was not significantly associated with aggression in men, but it was associated in multivariate analysis (though not univariate analysis) with denigratory attitudes towards others among women. However, serum triglyceride concentration was related, especially in men, to hostile acts (r = 0.13, p < 0.001) and domineering attitude (r = 0.12, p < 0.001) independently of age, total and HDL cholesterol, cigarette smoking, and alcohol consumption. Subjects taking part in prevention trials have higher triglyceride concentrations than the general population and the relation between serum triglyceride concentration and aggression merits further investigation.
To determine whether total serum cholesterol concentration predicts mortality from injuries including suicide.
Cohort study of men and women who had their serum cholesterol concentration measured as part of a general health survey in Värmland, Sweden in 1964 or 1965 and were followed up for an average of 20.5 years.
Adults participating in health screening in 1964-5 (26,693 men and 27,692 women). The study sample was restricted to subjects aged 45-74 years during any of the 20.5 years of follow-up.
Serum cholesterol concentration. Deaths from all injuries and suicides during three periods of follow up (0-6 years, 7-13 years, and 14-21 years) according to the Swedish mortality register in subjects aged 45-74. Adjustment was made for prevalent cancer (identified from the Swedish cancer register) at the time of a suicide.
A strong negative relation between cholesterol concentration and mortality from injuries was found in men during the first seven years of follow up. The relative risk in the lowest 25% of the cholesterol distribution was 2.8 (95% confidence interval 1.52 to 4.96) compared with the top 25%. Most of the excess risk was caused by suicide with a corresponding relative risk of 4.2 (p for trend = 0.001). Correction for prevalent cancer did not change the results. Events occurring during the latter two thirds of the 20.5 years of follow up were not predicted. In women no relation between cholesterol concentration and mortality from injuries was found.
Together with observations from intervention trials the findings support the existence of a relation between serum cholesterol concentration and suicide. The causality of such a relation is, however, not resolved.
Serum lipid levels vary widely within individuals, but the causes of these fluctuations are poorly understood. One area of research concerns elevations in cholesterol concentration in response to emotional stress. In a laboratory-based experiment, we compared the effects of acute mental stress and postural change (standing) on serum cholesterol concentration. In addition, plasma volume was indirectly monitored to determine whether cholesterol changes with mental stress, if present, were a function of hemoconcentration.
Twenty-six men attended two laboratory sessions, each consisting of baseline (30 minutes), task (20 minutes), and recovery (30 minutes) periods. Subjects rested in the supine position during the baseline and recovery periods. During the task period of one session, subjects performed a mental task (Stroop test and mental arithmetic); during the other session, the subjects stood for the task period.
Both mental stress and standing elicited significant elevations in heart rate, blood pressure, and plasma catecholamine concentrations, relative to the baseline and recovery periods. Both the mental and orthostatic tasks also significantly increased serum cholesterol concentration (by 0.10 and 0.57 mmol/L [3.7 and 21.9 mg/dL], respectively), as well as hemoglobin level and hematocrit. Cholesterol elevations with standing were reversible, while those resulting from mental stress persisted through the recovery period. When values were corrected for concomitant hemoconcentration, no net change in serum cholesterol level occurred during either task.
Acute mental stress can produce rapid elevations in serum cholesterol concentration. It can also increase hemoglobin concentration and hematocrit (ie, reduce plasma volume). Therefore, increases in serum cholesterol level after acute mental stress are analogous to those with standing and may reflect hemoconcentration rather than altered lipoprotein metabolism.
With increased efforts to lower serum cholesterol levels, it is important to quantify associations between serum cholesterol level and causes of death other than coronary heart disease, for which an etiologic relationship has been established.
For an average of 12 years, 350,977 men aged 35 to 57 years who had been screened for the Multiple Risk Factor Intervention Trial were followed up following a single standardized measurement of serum cholesterol level and other coronary heart disease risk factors; 21,499 deaths were identified.
A strong, positive, graded relationship was evident between serum cholesterol level measured at initial screening and death from coronary heart disease. This relationship persisted over the 12-year follow-up period. No association was noted between serum cholesterol level and stroke. The absence of an association overall was due to different relationships of serum cholesterol level with intracranial hemorrhage and nonhemorrhagic stroke. For the latter, a positive, graded association with serum cholesterol level was evident. For intracranial hemorrhage, cholesterol levels less than 4.14 mmol/L (less than 160 mg/dL) were associated with a twofold increase in risk. A serum cholesterol level less than 4.14 mmol/L (less than 160 mg/dL) was also associated with a significantly increased risk of death from cancer of the liver and pancreas; digestive diseases, particularly hepatic cirrhosis; suicide; and alcohol dependence syndrome. In addition, significant inverse graded associations were found between serum cholesterol level and cancers of the lung, lymphatic, and hematopoietic systems, and chronic obstructive pulmonary disease. No significant associations were found of serum cholesterol level with death from colon cancer, with accidental deaths, or with homicides. Overall, the inverse association between serum cholesterol level and most cancers weakened with increasing follow-up but did not disappear. The association between cholesterol level and death due to cancer of the lung and liver, chronic obstructive pulmonary disease, cirrhosis, and suicide weakened little over follow-up.
The association of serum cholesterol with specific causes of death varies in direction, strength, gradation, and persistence. Further research on the determinants of low serum cholesterol level in populations and long-term follow-up of participants in clinical trials are necessary to assess whether inverse associations with noncardiovascular disease causes of death are consequences of noncardiovascular disease, whether serum cholesterol level and noncardiovascular disease are both consequences of other factors, or whether these associations are causal.