Relationship among low cholesterol levels, depressive symptoms, aggression, hostility, and cynicism

doi:10.1016/j.jacl.2013.01.004

Journal of Clinical Lipidology

Volume 7, Issue 3, May–June 2013, Pages 208-216

https://doi.org/10.1016/j.jacl.2013.01.004 Get rights and content

Background

Treatment guidelines for lipids have become increasingly more aggressive. However, naturally low or therapeutically reduced cholesterol levels may be associated with adverse psychological health symptoms, including depression, aggression, and hostility.

Objective

To examine relationships between low total cholesterol (TC) and low-density lipoprotein (LDL) cholesterol levels and measures of psychosocial status among middle-aged adults.

Methods

A total of 1995 subjects enrolled in the Heart Strategies Concentrating on Risk Evaluation study with data on TC, LDL cholesterol, and self-reported ratings of psychological health were evaluated. To quantify ratings of depression, aggression, cynicism, and hostility, psychological measures included the Center for Epidemiologic Studies Depression Scale (CES-D) and Cook-Medley Hostility Inventory.

Results

Of 1995 participants, 25.1% were taking a lipid-lowering agent at baseline. Mean CES-D scores were similar between participants with low (<150 mg/dL) versus greater (≥150 mg/dL) TC and low (<100 mg/dL) versus higher (≥100 mg/dL) LDL cholesterol. However, among 22 participants with LDL cholesterol <70 mg/dL, the prevalence of clinically significant depressive symptomatology (CES-D score ≥16) was 31.8% compared with 12.1% in the remaining cohort (P = .005). In multivariable analysis, low LDL cholesterol (<100 mg/dL) was associated with cynicism (partial r = −0.14, P = .02) and hostility (partial r = −0.18, P = .004), but only in the subgroup of white subjects currently taking lipid-lowering medications. Low LDL cholesterol (versus non-low) was associated with greater aggression scores but only among participants currently taking psychiatric medications (3.4 ± 1.7 vs 2.8 ± 1.5, P = .02).

Conclusions

Our data indicate mixed evidence for independent relationships between low total and LDL cholesterol levels and impaired psychological health.

Section snippets

Study population

Heart SCORE is an ongoing community-based prospective cohort study with approximately equal representation of black and white patients. The initial aims of this single-site study were to improve risk stratification, identify racial disparities, and evaluate mechanisms for population differences in CVD. Baseline enrollment began on June 16, 2003, and was completed on October 11, 2006. Eligibility criteria included being 45 to 75 years of age at the baseline examination, residing in the greater

Results

The mean age of the study cohort was 59.1 ± 7.5 years; 65% were female, 43% were black, and 10% were smokers at study entry (Table 1). Of the 1995 participants, 500 (25.1%) were taking a lipid-lowering agent. In the full cohort, mean total (213 ± 43 mg/dL) and LDL (142 ± 36 mg/dL) cholesterol levels were greater than optimal values at baseline. Participants who were taking lipid-lowering medications were significantly older and more likely to be male, white, weigh more, and have a history of

Discussion

In this community-based population of middle-aged adults with a relatively high prevalence of CVD risk factors, we found mixed results for associations between low total and LDL cholesterol levels and self-report ratings of depression, aggression, cynicism, and hostility. These results included evidence for a possible association between very low LDL cholesterol levels (<70 mg/dL) and depression and more reliable evidence of lower LDL cholesterol levels being independently associated with

Conclusions

In summary, our results provide mixed evidence for an independent relationship between low total and LDL cholesterol levels and psychological health. This includes no apparent relationship between cholesterol levels and depression except possibly when LDL cholesterol levels are less than 70 mg/dL, yet with low LDL cholesterol (ie, <100 mg/dL) being independently associated with greater levels of cynicism and hostility when examined among white subjects only on lipid-lowering therapy. In light

Financial disclosures

This study was funded by the Pennsylvania Department of Health (ME-02-384). The department specifically disclaims responsibility for any analyses, interpretations or conclusions. Additional funding was provided by National Institutes of Health grant R01HL089292.

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Original ArticleRelationship among low cholesterol levels, depressive symptoms, aggression, hostility, and cynicism

Background

Objective

Methods

Results

Conclusions

Section snippets

Study population

Results

Discussion

Conclusions

Financial disclosures

Atherosclerosis

Psychiatry Res

J Psychiatr Res

J Affect Disord

J Lipid Res

Lancet

Psychiatry Res

J Am Coll Cardiol

Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III)

JAMA

Relative and cumulative effects of lipid and blood pressure control in the Stroke Prevention by Aggressive Reduction in Cholesterol Levels Trial

Stroke

HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events

N Engl J Med

Serum cholesterol in aggressive conduct disorder: a preliminary study

Biol Psychiatry

Low serum cholesterol concentration and risk of suicide

Epidemiology

Assessing the observed relationship between low cholesterol and violence-related mortality. Implications for suicide risk

Ann N Y Acad Sci

Serum cholesterol level and mortality findings for men screened in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group

Arch Intern Med

Statin use and risk of depression in patients with coronary heart disease: longitudinal data from the heart and soul study

J Clin Psychiatry

American College of Sports Medicine: Guidelines for Exercise Testing and Prescription

Original Article
Relationship among low cholesterol levels, depressive symptoms, aggression, hostility, and cynicism