Summary
Plasma cholesterol has been shown to be correlated to the incidence of cardiovascular events. This observation and experimental data on the pathogenesis of atherosclerosis have led to a number of recommendations for the treatment of elevated plasma lipids by national and international consensus panels and organizations. However, the issue whether lowering cholesterol might increase the risk for other diseases including cancer is still controversial. In this article, an attempt is made to review the currently available data on the relation between plasma cholesterol and cancer. Special emphasis is given to the results of intervention trials aimed at lowering cholesterol by diet and/or drugs, because they apply best to the human situation and are particularly relevant for the clinician. Data from animal experiments are only briefly discussed.
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Abbreviations
- CAD:
-
Coronary artery disease
- CVD:
-
Cardiovascular disease
- LDL:
-
Low density lipoprotein
- P/S ratio:
-
Ratio of polyunsaturated to saturated fatty acids
- HMGCoA:
-
3-Hydroxy-3-methylglutaryl coenzyme A
References
Beaglehole R, Foulkes MA, Prior IAM, Eyles EF (1980) Cholesterol and mortality in New Zealand Maoris. Br Med J 280:285–287
Blankenhorn DH, Nessim SA, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L (1987) Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts. JAMA 257:3233–3240
Broitman SA, Vitale JJ, Vavrousek-Jakuba E, Gottlieb LS (1977) Polyunsaturated fat, cholesterol and large bowel tumorigenesis. Cancer 40:2455–2463
Brown MS, Goldstein JL (1986) A receptor-mediated pathway for cholesterol homeostasis. Science 232:34–47
Buchwald H, Fitch L, Moore RB (1982) Overview of randomized clinical trials of lipid intervention for atherosclerotic cardiovascular disease. Contr Clin Trials 3:271–283
Cambien F, Ducimetiere P, Richard J (1980) Total serum cholesterol and cancer mortality in a middle-aged male population. Am J Epidemiol 112:388–394
Canner PL, Berge KG, Wenger NK, Stamler J, Friedman L, Prineas RJ, Friedewald W (1986) Fifteen-year mortality in coronary drug project patients: long-term benefit with niacin. J Am Coll Cardiol 8:1245–1255
Castelli WP, Garrison RJ, Wilson PWF, Abbott RD, Kalousdian S, Kannel WB (1986) Incidence of coronary heart disease and lipoprotein cholesterol levels. The Framingham Study. JAMA 256:2835–2838
Consensus Conference (1985) Lowering blood cholesterol to prevent heart disease. JAMA 253:2080–2086
Cruse P, Lewin M, Clark GG (1979) Dietary cholesterol is cocarcinogenic for human colon cancer. Lancet I:752–755
Dyer AR, Stamler J, Paul O, Shekelle RB, Schoenberger JA, Berkson DM, Lepper M, Collette P, Shekelle S, Lindberg HA (1981) Serum cholesterol and risk of death from cancer and other causes in three Chicago epidemiologic studies. J Chron Dis 34:249–260
Ederer F, Leren P, Turpeinen O, Frantz ID Jr (1971) Cancer among men on cholesterol-lowering diets. Experience from five clinical trials. Lancet II:203–206
Faggiotto A, Ross R (1984) Studies of hypercholesterolemia in the nonhuman primate. II. Fatty streak conversion to fibrous plaque. Arteriosclerosis 4:341–356
Faggiotto A, Ross R, Harker L (1984) Studies of hypercholesterolemia in the nonhuman primate. I. Changes that lead to fatty streak formation. Arteriosclerosis 4:323–340
Frick MH, Elo O, Haapa K, Heinonen OP, Heinsalmi P, Helo P, Huttunen JK, Kaitaniemi P, Koskinen P, Manninen V, Mäenpäa H, Mälkönen M, Mänttäri M, Norola S, Pasternack A, Pikkarainen J, Romo M, Sjöblom T, Nikkilä EA (1987) Helsinki heart study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. N Engl J Med 317:1237–1245
Garcia-Palmieri MR, Sorlie PD, Costas R Jr, Havlik RJ (1981) An apparent inverse relationship between serum cholesterol and cancer mortality in Puerto Rico. Am J Epidemiol 114:29–40
Gerrity RG, Naito HK, Richardson M, Schwartz W (1979) Dietary induced atherogenesis in swine: morphology of the intima in prelesion stages. Am J Pathol 95:775–792
Grundy SM (1987) Dietary therapy for different forms of hyperlipoproteinemia. Circulation 76:523–528
Hiatt RA, Fireman BH (1986) Serum cholesterol and the incidence of cancer in a large cohort. J Chron Dis 39:861–870
Hiatt RA, Friedman GD, Bawol RD, Ury HK (1982) Breast cancer and serum cholesterol. JNCI 68:885–889
International Collaborative Group (1982) Circulating cholesterol level and risk of death from cancer in men aged 40 to 69 years. JAMA 248:2853–2859
Kagan A, McGee DL, Yano K, Rhoads GG, Nomura A (1981) Serum cholesterol and mortality in a Japanese-American population: the Honululu heart program. Am J Epidemiol 114:11–20
Kark JD, Smith AH, Hames CG (1980) The relationship of serum cholesterol to the incidence of cancer in Evans County, Georgia. J Chron Dis 33:311–322
Keys A, Aravanis C, Blackburn H, Buzina R, Dontas AS, Fidanza F, Karvonen MJ, Menotti A, Nedeljkovic S, Punsar S, Toshima H (1985) Serum cholesterol and cancer mortality in the seven countries study. Am J Epidemiol 121:870–883
Keys A, Menotti A, Karvonen MJ, Aravanis C, Blackburn H, Buzina R, Djordjevic BS, Dontas AS, Fidanza F, Keys MH, Kromhout D, Nedeljkovic S, Punsar S, Seccareccia F, Toshima H (1986) The diet and 15-year death rate in the seven countries study. Am J Epidemiol 124:903–915
Kozarevic D, McGee D, Vojvodic N, Gordon T, Racic Z, Zukel W, Dawber T (1981) Serum cholesterol and mortality. The Yugoslavia cardiovascular disease study. Am J Epidemiol 114:21–28
Levy RI, Brensike JF, Epstein SE, Kelsey SF, Passamani ER, Richardson JM, Loh IK, Stone NJ, Aldrich RF, Battaglini JW, Moriarity DJ, Fisher ML, Friedman L, Friedewald W, Detre KM (1984) The influence of changes in lipid values induced by cholestyramine and diet on progression of coronary artery disease: the results of the NHLBI type II coronary intervention study. Circulation 69:325–337
Lipid Research Clinics Program (1984) The lipid research clinics coronary primary prevention trial results. I. Reduction in incidence of coronary heart disease. JAMA 251:351–364
Lipid Research Clinics Program (1984) The lipid research clinics coronary primary prevention trial results. II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA 251:365–374
Mannes GA, Maier A, Thieme C, Wiebecke B, Paumgartner G (1987) Relation between the frequency of colorectal adenoma and the serum cholesterol level. N Engl J Med 315:1634–1638
Morris DL, Borhani NO, Fitzsimons E, Hardy RJ, Hawkins CM, Kraus JF, Labarthe DR, Mastbaum L, Payne GH (1983) Serum cholesterol and cancer in the hypertension detection and follow-up program. Cancer 52:1754–1759
Oliver MF (1983) Should we not forget about mass control of coronary risk factors? Lancet II:37–38
Oliver MF, Heady JA, Morris JN, Cooper J (1978) A cooperative trial in the primary prevention of ischemic heart disease using clofibrate. Br Heart J 40:1069–1076
Pearce ML, Dayton S (1971) Incidence of cancer in men on a diet high in polyunsaturated fat. Lancet I:464–467
Peterson B, Trell E (1983) Premature mortality in middle-aged men: serum cholesterol as a risk factor. Klin Wochenschr 63:795–801
Peterson B, Trell E, Henningsen N-C, Hood B (1984) Risk factors for premature death in middle-aged men. Br Med J 288:1264–1268
Reddy BS, Narisawa T, Weisburger JH (1976) Effect of a diet with high levels of protein and fat on colon carcinogenesis in F344 rats treated with 1.2-dimethylhydrazine. JNCI 57:567–569
Rose G, Blackburn H, Keys A, Taylor HL, Kannel WB, Paul O, Reid DD, Stamler J (1974) Colon cancer and blood-cholesterol. Lancet I:181–183
Rose G, Shipley MJ (1980) Plasma lipids and mortality: a source of error. Lancet I:523–526
Ross R (1986) The pathogenesis of atherosclerosis – an update. N Engl J Med 314:488–500
Salonen JT (1982) Risk of cancer and death in relation to serum cholesterol. A longitudinal study in an Eastern Finnish population with high overall cholesterol level. Am J Epidemiol 116:622–630
Schatzkin A, Hoover RN, Taylor PR, Ziegler RG, Carter CL, Larson DB, Licitra LM (1987) Serum cholesterol and cancer in the NHANES I epidemiologic follow-up study. Lancet II:298–301
Sherwin RW, Wentworth DN, Cutler JA, Hulley SB, Kuller LH, Stamler J (1987) Serum cholesterol levels and cancer mortality in 361662 men screened for the Multiple Risk Factor Intervention Trial. JAMA 257:943–948
Sorlie PD, Feinleib M (1982) The serum cholesterol-cancer relationship: an analysis of time trends in the Framingham study. JNCI 69:989–996
Stamler J, Wentworth D, Neaton JG (1986) Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? JAMA 256:2823–2828
Stemmermann GN, Nomura AMY, Heilbrun LK, Pollack ES, Kagan A (1981) Serum cholesterol and colon cancer incidence in Hawaiian Japanese men. JNCI 67:1179–1182
Study Group, European Atherosclerosis Society (1987) Strategies for the prevention of coronary heart disease: a policy statement of the European Atherosclerosis Society. Eur Heart J 8:77–88
Turpeinen O (1979) Effect of cholesterol-lowering diet on mortality from coronary heart disease and other causes. Circulation 59:1–7
Törnberg SA, Holm L-E, Carstensen JM, Eklund GA (1987) Risks of cancer of the colon and rectum in relation to serum cholesterol and beta-lipoprotein. N Engl J Med 315:1629–1633
Wallace RB, Rost C, Burmeister LF, Pomrehn PR (1982) Cancer incidence in humans: relationship to plasma lipids and relative weight. JNCI 68:915–918
Westlund K, Nicolaysen R (1972) Ten-year mortality and morbidity related to serum cholesterol. Scand J Clin Lab Invest 30 [Suppl 127]:3–24
Willett WC, Stampfer MJ, Colditz GA, Rosner BA, Hennekens CH, Speizer FE (1987) Dietary fat and the risk of breast cancer. N Engl J Med 316:22–28
Williams RR, Sorlie PD, Feinleib M, McNamara PM, Kannel WB, Dawber TR (1981) Cancer incidence by levels of cholesterol. JAMA 245:247–252
Wingard DL, Criqui MH, Holdbook MJ, Barrett-Connor E (1984) Plasma cholesterol and cancer morbidity in an adult community. J Chron Dis 37:401–406
Wissler RW, Vesselinovitch D (1977) Atherosclerosis in nonhuman primates. Adv Vet Sci Comp Med 21:351–420
Yaari S, Goldbourt U, Even-Zohar S, Neufeld HN (1981) Associations of serum high density lipoprotein and total cholesterol with total, cardiovascular and cancer mortality in 7-year prospective study of 10000 men. Lancet II:1011–1015
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This article is dedicated to Prof. Wilhelm Dörr on the occasion of his 75th anniversary.
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Lackner, K.J., Schettler, G. & Kübler, W. Plasma cholesterol, lipid lowering, and risk for cancer. Klin Wochenschr 67, 957–962 (1989). https://doi.org/10.1007/BF01721426
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DOI: https://doi.org/10.1007/BF01721426