Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You and Your Team.

Learn More →

Inflammation, Cholesterol Levels, and Risk of Mortality Among Patients Receiving Dialysis

Inflammation, Cholesterol Levels, and Risk of Mortality Among Patients Receiving Dialysis Inflammation, Cholesterol Levels, and Risk of Mortality Among Patients Receiving Dialysis To the Editor: Dr Liu and colleagues1 reported that among patients receiving dialysis, cholesterol levels and mortality were inversely associated among patients with chronic inflammation but were positively associated in those without inflammation. The authors concluded that inverse relationships between cholesterol and mortality in previous studies of this population are due to the cholesterol-lowering effect of malnutrition and systemic inflammation, rather than to a protective effect of high cholesterol levels. However, there is considerable epidemiologic, clinical, and laboratory evidence that high cholesterol levels protect against infections, while low cholesterol levels predispose to infections.2 For instance, in a 15-year follow-up study of more than 100 000 healthy individuals, cholesterol levels were inversely associated with the risk of being admitted to the hospital with a diagnosis of infectious disease.3 Evidently, low cholesterol levels analyzed at baseline could not have been caused by a disease these individuals had not yet acquired. Children with Smith-Lemli-Opitz syndrome have extremely low cholesterol levels and experience frequent and severe infections, which can be prevented with supplementary dietary cholesterol.4 Numerous experimental studies have demonstrated an important role of low-density lipoprotein cholesterol (LDL-C) as an effective inhibitor of bacterial toxins. For instance, the survival of rats with experimental hypolipidemia challenged with lipopolysaccharide or gram-negative bacteria is much lower, and the survival of mice with familial hypercholesterolemia challenged similarly is much higher than normal.5 Finally, in at least 7 studies of people aged 60 and older, total mortality was inversely associated with cholesterol levels, or high cholesterol levels were associated with longevity.2 Therefore, if statin treatment should be used in dialysis patients, it may be wise to use the lowest possible dose, if any at all. References 1. Liu Y, Coresh J, Eustace JA. et al. Association between cholesterol level and mortality in dialysis patients: role of inflammation and malnutrition. JAMA.2004;291:451-459.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14747502&dopt=AbstractGoogle Scholar 2. Ravnskov U. High cholesterol may protect against infections and atherosclerosis. QJM.2003;96:927-934.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14631060&dopt=AbstractGoogle Scholar 3. Iribarren C, Jacobs Jr DR, Sidney S, Claxton AJ, Feingold KR. Cohort study of serum total cholesterol and in-hospital incidence of infectious diseases. Epidemiol Infect.1998;121:335-347.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9825784&dopt=AbstractGoogle Scholar 4. Elias ER, Irons MB, Hurley AD, Tint GS, Salen G. Clinical effects of cholesterol supplementation in six patients with the Smith-Lemli-Opitz syndrome (SLOS). Am J Med Genet.1997;68:305-310.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9024564&dopt=AbstractGoogle Scholar 5. Feingold KR, Funk JL, Moser AH, Shigenaga JK, Rapp JH, Grunfeld C. Role for circulating lipoproteins in protection from endotoxin toxicity. Infect Immun.1995;63:2041-2046.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7729918&dopt=AbstractGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Inflammation, Cholesterol Levels, and Risk of Mortality Among Patients Receiving Dialysis

JAMA , Volume 291 (15) – Apr 21, 2004

Loading next page...
 
/lp/american-medical-association/inflammation-cholesterol-levels-and-risk-of-mortality-among-patients-V9HSv4Q1Vl
Publisher
American Medical Association
Copyright
Copyright © 2004 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.291.15.1833
Publisher site
See Article on Publisher Site

Abstract

Inflammation, Cholesterol Levels, and Risk of Mortality Among Patients Receiving Dialysis To the Editor: Dr Liu and colleagues1 reported that among patients receiving dialysis, cholesterol levels and mortality were inversely associated among patients with chronic inflammation but were positively associated in those without inflammation. The authors concluded that inverse relationships between cholesterol and mortality in previous studies of this population are due to the cholesterol-lowering effect of malnutrition and systemic inflammation, rather than to a protective effect of high cholesterol levels. However, there is considerable epidemiologic, clinical, and laboratory evidence that high cholesterol levels protect against infections, while low cholesterol levels predispose to infections.2 For instance, in a 15-year follow-up study of more than 100 000 healthy individuals, cholesterol levels were inversely associated with the risk of being admitted to the hospital with a diagnosis of infectious disease.3 Evidently, low cholesterol levels analyzed at baseline could not have been caused by a disease these individuals had not yet acquired. Children with Smith-Lemli-Opitz syndrome have extremely low cholesterol levels and experience frequent and severe infections, which can be prevented with supplementary dietary cholesterol.4 Numerous experimental studies have demonstrated an important role of low-density lipoprotein cholesterol (LDL-C) as an effective inhibitor of bacterial toxins. For instance, the survival of rats with experimental hypolipidemia challenged with lipopolysaccharide or gram-negative bacteria is much lower, and the survival of mice with familial hypercholesterolemia challenged similarly is much higher than normal.5 Finally, in at least 7 studies of people aged 60 and older, total mortality was inversely associated with cholesterol levels, or high cholesterol levels were associated with longevity.2 Therefore, if statin treatment should be used in dialysis patients, it may be wise to use the lowest possible dose, if any at all. References 1. Liu Y, Coresh J, Eustace JA. et al. Association between cholesterol level and mortality in dialysis patients: role of inflammation and malnutrition. JAMA.2004;291:451-459.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14747502&dopt=AbstractGoogle Scholar 2. Ravnskov U. High cholesterol may protect against infections and atherosclerosis. QJM.2003;96:927-934.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=14631060&dopt=AbstractGoogle Scholar 3. Iribarren C, Jacobs Jr DR, Sidney S, Claxton AJ, Feingold KR. Cohort study of serum total cholesterol and in-hospital incidence of infectious diseases. Epidemiol Infect.1998;121:335-347.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9825784&dopt=AbstractGoogle Scholar 4. Elias ER, Irons MB, Hurley AD, Tint GS, Salen G. Clinical effects of cholesterol supplementation in six patients with the Smith-Lemli-Opitz syndrome (SLOS). Am J Med Genet.1997;68:305-310.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=9024564&dopt=AbstractGoogle Scholar 5. Feingold KR, Funk JL, Moser AH, Shigenaga JK, Rapp JH, Grunfeld C. Role for circulating lipoproteins in protection from endotoxin toxicity. Infect Immun.1995;63:2041-2046.http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7729918&dopt=AbstractGoogle Scholar

Journal

JAMAAmerican Medical Association

Published: Apr 21, 2004

References

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$499/year

Save searches from
Google Scholar,
PubMed

Create folders to
organize your research

Export folders, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month