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Annals of Oncology Advance Access published online on January 22, 2009
Annals of Oncology, doi:10.1093/annonc/mdn736
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org

Time-dependent association of total serum cholesterol and cancer incidence in a cohort of 172 210 men and women: a prospective 19-year follow-up study

A. M. Strasak1,*, R. M. Pfeiffer2, L. J. Brant3, K. Rapp4, W. Hilbe5, W. Oberaigner6, S. Lang7, W. Borena1, H. Concin8, G. Diem8, E. Ruttmann9, B. Glodny10, K. P. Pfeiffer1, H. Ulmer1,8 and the VHM&PP Study Group

1 Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Innsbruck, Austria
2 Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda
3 Gerontology Research Center, National Institute on Aging, Baltimore
4 Institute of Epidemiology, Ulm University, Ulm, Germany
5 Department of Haematology and Oncology, Innsbruck Medical University, Innsbruck
6 Cancer Registry of Tyrol, Department of Clinical Epidemiology of the Tyrolean State Hospitals Ltd, Innsbruck
7 Institute of Statistics, University of Innsbruck, Innsbruck
8 Agency for Preventive and Social Medicine, Bregenz
9 Departments of Cardiac Surgery
10 Departments of Radiology, Innsbruck Medical University, Innsbruck, Austria

* Correspondence to: Dr A. M. Strasak, Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Schoepfstrasse 41, 6020 Innsbruck, Austria. Tel: +43-512-9003-70921; Fax: +43-512-9003-73922; E-mail: alexander.strasak{at}i-med.ac.at

Background: The relationship between serum cholesterol and cancer incidence remains controversial.

Patients and methods: We investigated the association of total serum cholesterol (TSC) with subsequent cancer incidence in a population-based cohort of 172 210 Austrian adults prospectively followed up for a median of 13.0 years. Cox regression, allowing for time-dependent effects, was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) for the association of TSC with cancer.

Results: We observed pronounced short-term associations of TSC and overall cancer incidence in both men and women. For malignancies diagnosed shortly (<5 months) after baseline TSC measurement, the highest TSC tertile (>235.0 mg/dl in men and >229.0 in women) compared with the lowest tertile (<194.0 mg/dl in men and <190.0 in women) was associated with a significantly lower overall cancer risk [HR = 0.58 (95% CI 0.43–0.78, Ptrend = 0.0001) in men, HR = 0.69 (95% CI 0.49–0.99, Ptrend = 0.03) in women]. However, after roughly 5 months from baseline measurement, overall cancer risk was not significantly associated with TSC. The short-term inverse association of TSC with cancer was mainly driven by malignancies of the digestive organs and lymphoid and hematopoietic tissue.

Conclusion: The short-term decrease of cancer risk seen for high levels of TSC may largely capture preclinical effects of cancer on TSC.

cancer incidence, prospective study, reverse causality, time dependency, total serum cholesterol

Received for publication September 19, 2008. Revision received November 6, 2008. Accepted for publication November 6, 2008.


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