Hypocholesterolemia

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With the increased use of medication to suppress cholesterol, some have expressed concern that lowering cholesterol levels excessively will itself cause disease.{{cn|date=November 2024}}

Demographic studies suggest that cholesterol levels form a U-shape curve when plotted against mortality; this suggests that low cholesterol is associated with increased mortality, mainly due to depression, cancer, hemorrhagic stroke, aortic dissection and respiratory diseases.{{cite journal |vauthors=Jacobs D, Blackburn H, Higgins M, etal |title=Report of the Conference on Low Blood Cholesterol: Mortality Associations |journal=Circulation |volume=86 |issue=3 |pages=1046–60 |year=1992 |pmid=1355411 |doi=10.1161/01.cir.86.3.1046|doi-access=free }} It is possible that whatever causes the low cholesterol level also causes mortality, and that the low cholesterol is simply a marker of poor health.

Links with depression have been supported by studies.{{cite journal |author=Suarez EC |title=Relations of trait depression and anxiety to low lipid and lipoprotein concentrations in healthy young adult women |journal=Psychosom Med |volume=61 |issue=3 |pages=273–9 |date=1 May 1999|pmid=10367605 |url=http://www.psychosomaticmedicine.org/cgi/content/full/61/3/273 |doi=10.1097/00006842-199905000-00004 |url-access=subscription }} In contrast, no evidence was found for a link with hemorrhagic stroke (although higher cholesterol levels conferred a relative protection), and neither did statin drugs worsen the risk.{{cite journal |vauthors=Woo D, Kissela BM, Khoury JC, etal |title=Hypercholesterolemia, HMG-CoA reductase inhibitors, and risk of intracerebral hemorrhage: a case-control study |journal=Stroke |volume=35 |issue=6 |pages=1360–4 |year=2004 |pmid=15087556 |doi=10.1161/01.STR.0000127786.16612.A4 |doi-access=free }}

The Heart Protection Study found no increase in either respiratory disease or neuropsychiatric illness in a large trial population taking a statin drug.{{cite journal |title=MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial |journal=Lancet |volume=360 |issue=9326 |pages=7–22 |year=2002 |pmid=12114036|doi=10.1016/S0140-6736(02)09327-3 |author1= Heart Protection Study Collaborative Group|s2cid=35836642 }}

In the elderly, low cholesterol may confer a health risk that may not be offset by the beneficial effects of cholesterol lowering.{{cite journal |vauthors=Schatz IJ, Masaki K, Yano K, Chen R, Rodriguez BL, Curb JD |title=Cholesterol and all-cause mortality in elderly people from the Honolulu Heart Program: a cohort study |journal=Lancet |volume=358 |issue=9279 |pages=351–5 |year=2001 |pmid=11502313 |doi=10.1016/S0140-6736(01)05553-2|s2cid=36970728 }} Similarly, for elderly patients admitted to hospital, low cholesterol may predict short-term mortality.{{cite journal |vauthors=Onder G, Landi F, Volpato S, etal |title=Serum cholesterol levels and in-hospital mortality in the elderly |journal=Am. J. Med. |volume=115 |issue=4 |pages=265–71 |year=2003 |pmid=12967690 |doi=10.1016/S0002-9343(03)00354-1}} The prevalence of hypocholesterolemia in the elderly ranges between 2% and 36%, depending on specific cutoff levels and age range investigated.{{Cite journal|last1=Tsabar|first1=Nir|last2=Press|first2=Yan|last3=Rotman|first3=Johanna|last4=Klein|first4=Bracha|last5=Grossman|first5=Yonatan|last6=Vainshtein-Tal|first6=Maya|last7=Eilat-Tsanani|first7=Sophia|date=2018-01-05|title=The low indexes of metabolism intervention trial (LIMIT): design and baseline data of a randomized controlled clinical trial to evaluate how alerting primary care teams to low metabolic values, could affect the health of patients aged 75 or older|journal=BMC Health Services Research|volume=18|issue=1|pages=4|doi=10.1186/s12913-017-2812-0|pmid=29301522|pmc=5755463|issn=1472-6963 |doi-access=free }} Alerting physicians to hypocholesterolemia may benefit some of their patients who take cholesterol-lowering drugs and decrease the rate of their emergency room visits.{{Cite journal|last1=Tsabar|first1=Nir|last2=Press|first2=Yan|last3=Rotman|first3=Johanna|last4=Klein|first4=Bracha|last5=Grossman|first5=Yonatan|last6=Vainshtein-Tal|first6=Maya|last7=Eilat-Tsanani|first7=Sophia|date=2019-10-12|title=A Randomized Trial of Alerting to Hypocholesterolemia Results of the Low Indexes of Metabolism Intervention Trial-C (LIMIT-C)|url=https://www.jamda.com/article/S1525-8610(19)30634-6/abstract|journal=Journal of the American Medical Directors Association|volume=21|issue=3|pages=410–414|language=English|doi=10.1016/j.jamda.2019.08.018|issn=1525-8610|pmid=31610995|s2cid=204702775|url-access=subscription}}

In the setting of critical illness, low cholesterol levels are predictive of clinical deterioration, and are correlated with altered cytokine levels.{{cite journal |vauthors=Gordon BR, Parker TS, Levine DM, etal |title=Relationship of hypolipidemia to cytokine concentrations and outcomes in critically ill surgical patients |journal=Crit. Care Med. |volume=29 |issue=8 |pages=1563–8 |year=2001 |pmid=11505128 |doi=10.1097/00003246-200108000-00011|s2cid=8199266 }}

Possible causes of low cholesterol are:{{Citation needed|date=November 2007}}

• statins
• hyperthyroidism, or an overactive thyroid gland
• adrenal insufficiency
• liver disease
• malabsorption (inadequate absorption of nutrients from the intestines), such as in celiac disease
• malnutrition
• abetalipoproteinemia - a rare genetic disease that causes cholesterol readings below 50 mg/dL. It is found mostly in Jewish populations.{{cite journal|year=2011|last1=Moutzouri|first1=E|last2=Elisaf|first2=M|last3=Liberopoulos|first3=EN|title=Hypocholesterolemia|volume=9|issue=2|pages=200–12|journal=Current Vascular Pharmacology|pmid=20626336|doi=10.2174/157016111794519354}}
• hypobetalipoproteinemia - a genetic disease that causes cholesterol readings below 50 mg/dL
• manganese deficiency
• Smith–Lemli–Opitz syndrome
• Marfan syndrome
• leukemias and other hematological diseases{{cite journal |vauthors=Marini A, Carulli G, Azzarà A, Grassi B, Ambrogi F |title=Serum cholesterol and triglycerides in hematological malignancies |journal=Acta Haematol. |volume=81 |issue=2 |pages=75–9 |year=1989 |pmid=2496554 |doi=10.1159/000205530}}

According to the American Heart Association in 1994, only total cholesterol levels below 160 mg/dL or 4.1 mmol/L are to be classified as "hypocholesterolemia".Criqui MH. (1994). Very Low Cholesterol and Cholesterol Lowering. Leaflet 71-0059. American Heart Association. However, this is not agreed on universally and some put the level lower.{{Citation needed|reason=which "some" put the level lower?|date=August 2023}}

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| ICD9 = {{ICD9|272.5}}

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{{Lipid metabolism disorders}}

Category:Lipid disorders