Monday March 16  6:19 PM EST

Low Cholesterol Linked To Violence
     By E.J. Mundell

NEW YORK (Reuters) -- Lowering cholesterol could trigger
changes in brain chemistry that encourage violent behavior,
according to a report. But leading cardiovascular experts
believe that evidence of such a link remains inconclusive, and
they say the medical benefits of cholesterol-lowering
medications still outweigh any theoretical risks.

Dr. Beatrice Golomb, of the Department of Medicine at the
University of California San Diego, says her review of dozens of
studies supports a connection between low or lowered
cholesterol levels and adverse violent outcomes in certain
populations.  Golomb's analysis appears in the current issue of
the Annals of Internal Medicine.

She explains that cholesterol levels directly affect the
activity of serotonin, a brain neurotransmitter  implicated in
the control of violent behaviors.  She believes it is
possible that lowered cholesterol levels may lead to lowered
brain serotonin activity; this may, in turn, lead to increased
violence.

Golomb says many studies seem to support the existence of a
cholesterol-violence relationship. One 1992 analysis, published
in the journal Circulation, looked at 18 different study groups
and found 50% more violent deaths in men with cholesterol
levels less than 160 milligrams per deciliter (mg/dL) than in
the group with the highest cholesterol levels,  Golomb said.
She says a 1996 French study of nearly 6,400 men, published in
the British Medical Journal, also found that a low average
cholesterol was linked to subsequent death by suicide.

Studies in monkeys may support such a relationship. Two
separate studies conducted in the early 1990s revealed that
monkeys assigned to diets low in fat or cholesterol showed
significantly lower brain serotonin activity.

Finally, the California researcher says three separate
neurological studies (in 1989, 1990, and 1994) agreed that in
humans, low brain serotonin is linked to increased impulsive
violence, including homicide, arson, and suicide.

In her opinion, the evidence favor(s) a conservative
approach to cholesterol management  among patients who are
otherwise at relatively low risk for heart disease.

But the American Heart Association (AHA) does not agree.
"In no way should physicians abandon cholesterol-lowering
strategies for patients with high cholesterol levels", said Dr.
Sidney Smith, a past AHA president. "There is far more good
than harm accomplished through cholesterol lowering".
Cardiovascular expert Dr. James Cleeman, coordinator of the
National Cholesterol Education Program at the National Heart,
Lung, and Blood Institute in Bethesda, Maryland, agrees.
" Clinical trials show us the benefit (of cholesterol-lowering
therapies) and no harm", Cleeman told Reuters. He points to a 
major review (published last year in The Journal of the American
Medical Association) of clinical trials involving over 29,000 patients
taking cholesterol-lowering medications for periods averaging
over three years. That study's authors concluded that these therapies
conferred a large and significant decrease in cardiovascular
mortality, while having no effect on patient death rates from
other causes.

 Source: Annals of Internal Medicine (1998;128(6):478-487);
 The Journal of the American Medical Association (1997;278:313-321)

S. Zarina 
    szarina@szed.khi.sdnpk.undp.org

    Wed, 18 Mar 1998 03:00:32 +0000

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