Abstract
Background
Raised total cholesterol is a strong risk factor for cardiovascular disease (CVD).
It remains unknown whether sex differences exist in the relationship between total
cholesterol and CVD outcomes.
Methods
PubMed was searched in December 2014 for cohort studies reporting on the relationship
between total cholesterol and coronary heart disease (CHD) and total stroke, separately
in men and women. Random effects meta-analyses with inverse variance weighting were
used to obtain adjusted pooled sex-specific relative risks (RR) and women-to-men ratio
of RRs (RRRs).
Results
Data from 97 cohorts, 1,022,276 individuals, and 20,176 CHD and 13,067 stroke cases
were included. The pooled RR (95% confidence interval) for CHD associated with a 1-mmol/L
increase in total cholesterol was 1.20 (1.16; 1.24) in women and 1.24 (1.20; 1.28)
in men, resulting in a RRR of 0.96 (0.93; 0.99). Corresponding RRs for the risk of
total stroke were 1.01 (0.98; 1.05) in women, and 1.03 (1.00; 1.05) in men, with a
pooled RRR of 0.99 (0.93; 1.04). Pooled RRRs (95% CI) comparing individuals in the
highest TC category to those in the lowest, such as the highest versus lowest third,
were 0.87 (0.79; 0.96) for CHD and 0.86 (0.76; 0.97) for total stroke.
Conclusion
Raised total cholesterol is a strong risk factor for CHD, with evidence of a small,
but significantly stronger, effect in men compared to women. Raised total cholesterol
had little effect on the risk of total stroke in both sexes.
Keywords
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Article info
Publication history
Published online: March 14, 2016
Accepted:
March 12,
2016
Received in revised form:
February 25,
2016
Received:
January 8,
2016
Identification
Copyright
© 2016 Elsevier Ireland Ltd. All rights reserved.
