An association between hypocholesterolaemia and colorectal carcinoma in an Irish population

Acquired low cholesterol: diagnosis and relevance to safety of low LDL therapeutic targets

PURPOSE OF REVIEW

Acquired hypocholesterolaemia occurs more commonly than inherited hypocholesterolaemia but has received little attention in the literature. In this review, we discuss the causes and underlying mechanisms of acquired hypocholesterolaemia and its relevance to safety of therapeutically induced decreased LDL cholesterol levels.

RECENT FINDINGS

Hypocholesterolaemia is increasingly identified as cholesterol testing becomes more widespread in the assessment of cardiovascular risk. Lower therapeutic targets for LDL cholesterol are also being achieved more regularly with the introduction of more intensive cholesterol-lowering regimens. Acquired hypocholesterolaemia may be the presenting feature of treatable diseases. Understanding its mechanisms may also provide new treatment approaches for neoplastic disease, such as breast cancer, and infections, such as tuberculosis.

SUMMARY

When hypocholesterolaemia is discovered, it is important to identify its cause. Further research into the pathogenesis of hypocholesterolaemia may provide new therapies for primary diseases underlying it.

Serum cholesterol and triglycerides: potential role in mortality prediction

The present study was performed in order to evaluate the diagnostic usefulness of serial cholesterol and triglycerides measurements in patients with severe burns. One of the main objective was to find out if these parameters are clinically relevant to determine the morbidity of a burn patient and thereby the patient's outcome. In 220 patients with thermal injuries, cholesterol and triglyceride concentrations were measured daily. Blood samples were drawn immediately upon admission and thereafter daily until patient's discharge or death. For both parameters, a characteristic course was noted: in the group of non-survivors, a decrease of cholesterol prior to death was noted, while survivors, increased prior to discharge. The time courses of both groups (survivors-non-survivors) differed statistically significantly (P=0.0068). An increase in triglycerides was observed in all non-survivors prior to death, but in the group of survivors triglycerides remained more or less unchanged. These time courses also had statistically significant differences (P=0.0004). In our 220 patients, changes in cholesterol (P<0.0001, hazard ratio 1.02) and triglycerides (P=0.0008, hazard ratio 1.01) had comparable capability to predict the severity of a burn trauma and thereby its outcome than the established parameters in the treatment of burns (total body surface area burned, age, inhalation). We consider the serial measurements of cholesterol and triglycerides as clinically relevant to assess the morbidity of a patient and thereby to estimate the patient's outcome. We think that these serial measurements provide useful information for the clinician treating patients with severe burns.

Hypocholesterolaemia in a hospital population

The purpose of this study was to observe the prevalence of hypocholesterolaemia in a hospital population and also the causes and clinical outcome of this condition. Fifty-seven patients were found with a plasma cholesterol of < or = 3.0 mmol/L, which was less than 0.50% of all plasma cholesterol requests; there were 39 men and 18 women (P < 0.05, Chi-squared test). The mean age was 53.8 [21.3] (range 3-83 years). The mean plasma cholesterol concentration was 2.28 [0.56] mmol/L (1.16-3.0) and the mean triglyceride concentration was 1.58 [1.09] mmol/L (0.49-7.35). There was a significant correlation between plasma cholesterol concentration and plasma albumin (Rs = 0.48, P < 0.01) and between plasma total protein concentration (Rs = 0.49, P < 0.01). However, there was no relationship between the concentrations of plasma cholesterol and triglyceride (Rs = 0.10, P > 0.05). Eighteen per cent of patients with hypocholesterolaemia died during their hospitalization. Thirty-nine per cent of those who had a plasma cholesterol of < or = 2.0 mmol/L died whereas 71% of those who had a plasma cholesterol concentration of < 1.5 mmol/L died. Hypocholesterolaemia was more commonly seen in the intensive care unit and in post-operative patients, those with malignancy, sepsis, acute myocardial infarction, those who had inflammatory bowel disease and diabetics on insulin. Hypocholesterolaemia may be a useful predictor of mortality in hospital patients.