Low Total Cholesterol is Associated with Higher Mortality in Patients with Coronary Heart Disease

Several studies have shown an association between low total cholesterol (TC) and increased mortality. Among 13,753 patients (pts) of both genders with coronary artery disease (CAD) aged 45-70 yrs (mean 61 yrs) screened for the Bezafibrate Infarction Prevention (BIP) Study, 554 pts (4.0%) had low TC (≤160 mg/dl) mean (147 ± 12 mg/dl). Age, clinical findings and medical treatments were similar in pts with low TC and pts with TC > 160 mg/dl (mean 222 ± 36 mg/dl). The former had lower mean HDL-C (32.5 ± 8.6 mg/dl) and triglyceride levels (119 ± 66 mg/dl) in comparison to pts with TC > 160 mg/dl (37.9 ± 10.0 mg/dl and 164 ± 93 mg/dl respectively). Three year mortality rates after screening were as follows for both groups: Multivariate logistic analysis adjusting for age, gender, past history, clinical and laboratory findings, yielded relative risk for total mortality among pts. with low TC of 1.48 (90% Confidence Interval 1.14-1.93). Conclusion: In this large group of pts with CAD, low TC was associated with excess total and cardiac mortality. Longer follow-up and further investigation are necessary to clarify the meaning of this association.