Low Serum Cholesterol Levels and Morning Suicide-Reply

James D. Neaton, PhD; Jeremiah Stamler, MD
Arch Intern Med. 1993;153(10):1271. doi:10.1001/archinte.1993.00410100090017.
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Our article1 did not address the relationship between cholesterol lowering and risk of noncardiovascular death. We studied the relationship of a single cholesterol measurement to specific causes of death. It is likely that the association that we observed between the very low serum cholesterol level (<4.14 mmol/L [<160 mg/dL], present in 6% of our cohort) and a few noncardiovascular causes of death (including suicide, but not homicide or injury) is totally unrelated to the reported excess of violent deaths in some clinical trials of cholesterol-lowering drugs. When the 350 977 men in our study were screened in 1973 to 1975 for the Multiple Risk Factor Intervention Trial, no information was collected at the initial screening on either diet or drug treatment. However, for 22 080 men seen at a second screening visit, with group mean serum cholesterol level of 6.61 mmol/L (255.6 mg/dL), only 300 men (1.4%) were receiving


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