Investigators from several studies have reported a positive relationship between low cholesterol levels and death due to violent causes (eg, suicide and accidents), possibly mediated by depressive symptoms, aggression or hostility, or impulsivity. We set out to establish whether middle-aged men with chronically low cholesterol levels (≤4.5 mmol/liter) have a higher risk of having depressive symptoms, according to scores on the Beck Depression Inventory, compared with a reference group of men with cholesterol levels between 6 and 7 mmol/liter. A similar comparison was also made for measures of anger, hostility, and impulsivity.
Cholesterol measurements were obtained as part of a population-based cholesterol screening study in 1990–1991. These levels were remeasured in 1993–1994. Only those whose cholesterol level remained in the same range were included in the study. Depressive symptoms were assessed by using the Beck Depression Inventory; anger, by questionnaires based on the Spielberger Anger Expression Scale and State-Trait Anger Scale; hostility, by the Buss-Durkee Hostility Inventory; and impulsivity, by the Eysenck and Eysenck Impulsivity Questionnaire.
Men with chronically low cholesterol levels showed a consistently higher risk of having depressive symptoms (Beck Depression Inventory score ≥15 or ≥17) than the reference group, even after adjusting for age, energy intake, alcohol use, and presence of chronic diseases. No differences in anger, hostility, and impulsivity were observed between the two groups.
Men with a lower cholesterol level (≤4.5 mmol/liter) have a higher prevalence of depressive symptoms than those with a cholesterol level between 6 and 7 mmol/liter. These data may be important in the ongoing debate on the putative association between low cholesterol levels and violent death.
From the Departments of Epidemiology and Biostatistics (P.H.A.S., A.W.H., A.A.A.B., D.E.G.) and General Practice (P.H.A.S., A.W.H., E.V.), Erasmus University Medical School, Rotterdam; and the Julius Center for Patient-Oriented Research (A.W.H., A.A.A.B., D.E.G.), Academic Hospital/Utrecht University, Utrecht, The Netherlands.
Received for publication July 21, 1998;
revision received August 24, 1999.
Address reprint requests to: Professor Diederick E. Grobbee, Julius Center for Patient-Oriented Research, University Medical Center Utrecht, P.O. Box 80035, 3508 TA Utrecht, The Netherlands. Email: D.E.GROBBEE@jc.azu.NL