0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Ideas and Opinions |

Cholesterol and Violence: Is There a Connection?

Beatrice A. Golomb, MD, PhD
[+] Article and Author Information

From the University of California, Los Angeles, Los Angeles, California. For the current author address, see end of text. Disclaimer: The views expressed here are solely those of the author and do not necessarily reflect those of the funding agencies. Acknowledgments: The author thanks Drs. Robert Brook, Michael Criqui, Naihua Duan, Arlene Fink, Hal Morgenstern, Sally Morton, Terrence Sejnowski, and Paul Shekelle for methodologic advice and assistance and Shannon Bush for help with references. Grant Support: By grants from the Robert Wood Johnson Clinical Scholars Program and the Harry Frank Guggenheim Foundation. Requests for Reprints: Beatrice A. Golomb, MD, PhD, Department of Medicine, University of California San Diego/San Diego Veterans Affairs Medical Center, 3350 La Jolla Village Drive 111N-1, La Jolla, CA 92161.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;128(6):478-487. doi:10.7326/0003-4819-128-6-199803150-00009
Text Size: A A A

Purpose: To determine whether the seeming relation between low or lowered cholesterol levels and violence is consistent with causality according to Hill's criteria and whether construct validity is supported by convergence of findings across different types of studies.

Data Sources: Search of the MEDLINE database for English-language articles published between 1965 and 1995 was supplemented by searches of the PsycINFO and Current Contents databases and bibliographies of relevant articles.

Study Selection: Peer-reviewed observational and experimental articles and meta-analyses that presented original research; related cholesterol levels to behaviorally defined violence; and if experimental, had single-factor (lipid-only) intervention.

Data Extraction: Studies were grouped according to type. Data on the relation of violence to cholesterol levels from each study were recorded.

Data Synthesis: Observational studies (including cohort, case–control, and cross-sectional studies) consistently showed increased violent death and violent behaviors in persons with low cholesterol levels. Some meta-analyses of randomized trials found excess violent deaths in men without heart disease who were randomly assigned to receive cholesterol-lowering therapy. Experimental studies showed increased violent behaviors in monkeys assigned to low-cholesterol diets. Human and animal research indicates that low or lowered cholesterol levels may reduce central serotonin activity, which in turn is causally linked to violent behaviors. Many trials support a significant relation between low or lowered cholesterol levels and violence (P < 0.001).

Conclusions: A significant association between low or lowered cholesterol levels and violence is found across many types of studies. Data on this association conform to Hill's criteria for a causal association. Concerns about increased risk for violent outcomes should figure in risk–benefit analyses for cholesterol screening and treatment.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)