Plasma Cholesterol Concentration and Mortality:  The Whitehall Study

George Davey Smith, MD; Martin J. Shipley, MSc; Michael G. Marmot, FFPHM; Geoffrey Rose, DM
JAMA. 1992;267(1):70-76. doi:10.1001/jama.1992.03480010078028.
Text Size: A A A
Published online

Objective.  —To examine the relationship between plasma cholesterol concentration and mortality from major causes of death.

Design.  —Cohort study.

Setting.  —Civil service offices in London, England.

Participants.  —There were 17718 male civil servants aged 40 through 64 years at the time of study entry between 1967 and 1969.

Main Outcome Measure.  —Mortality from major cause groups.

Results.  —There were 4022 deaths in the cohort over the 18 years of follow-up. Total mortality increased with cholesterol level, although mortality in the small group with very low cholesterol levels (5% of study population) was nonsignificantly higher (P>.5) than that of the remainder of the lowest quintile cholesterol group. Coronary heart disease mortality increased with increasing cholesterol concentration from the lowest levels (P<.001 for trend). The cancer mortality rate in the group below the fifth centile of the cholesterol distribution was higher than in the remainder of the cohort for lung (P<.001), pancreas (P=.05), liver (P=.09), and all smoking-related cancers (P=.02). Only for lung cancer was there a consistent inverse trend with cholesterol level (P<.01). Rates of mortality due to non-neoplastic respiratory disease were inversely related to cholesterol level (P<.001). Health state at the time of examination and socioeconomic position were related to cholesterol concentration—subjects in lower employment grades, with disease at baseline, with a history of recent unexplained weight loss, or who had been widowed had lower initial cholesterol levels. These associations largely accounted for the relationships between cholesterol level and noncardiovascular mortality.

Conclusions.  —The inverse associations between plasma cholesterol concentration and mortality from certain causes of death seen in cohort studies could be because the participants with low cholesterol levels possess other characteristics that place them at an elevated risk of death.(JAMA. 1992;267:70-76)


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
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).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.