LETTER
Cholesterol and Violence: Is There A Connection?
Mark R. Goldstein, MD
15 October 1998 | Volume 129 Issue 8 | Pages 668-669
TO THE EDITOR:
Before breakfast, as I was reading Dr. Golomb's intriguing article [1], I realized which connection between cholesterol and violence actually exists. I was quite angry about the article's conclusions.
The connection between low cholesterol and aggressive behavior may be a connection between hunger and aggressive behavior. In some instances, low cholesterol levels may be a surrogate marker for being chronically underfed. From an evolutionary standpoint, it makes sense. In times of low food supply, primitive humans were hungry, probably had low cholesterol levels, and were aggressive enough to hunt food for survival.
Did you ever watch children in school scurry, push, and shove to the cafeteria to be first in line to eat lunch? Did you ever go shopping for food when hungry and your aggressive tactics resulted in purchasing a huge order? Did anyone ever tell you not to talk to him or bother him until he has had his coffee? What about the "man" of the house coming home for dinner after a hard day's work? He's not so pleasant at first, but after dinner, he's a different person. It's obvious that it is not necessarily low cholesterol levels that lead to aggressive tendencies in these situations.
Several recent trials with statin drugs [2-4] have reported that when blood cholesterol levels were decreased to a much greater extent than in earlier trials [5], violence did not increase. This finding may be explained by the diets of the study participants. In my experience, patients taking statin drugs are less strict with their diets because their cholesterol levels are lowered with these powerful agents, regardless of diet. Therefore, pharmacologically lowering cholesterol levels does not lead to aggressive behavior.
After eating breakfast, I was no longer angry and was able to put the article in proper perspective. It's not good to be hungry.
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Author and Article Information
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Crozer-Keystone HealthPlex; Springfield, PA 19064
1. Golomb BA. Cholesterol and violence: is there a connection? Ann Intern Med. 1998; 128:478-87.
2. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994; 344:1383-9.
3. Shepherd J, Cobbe SM, Ford I, Isles CG, Lorimer AR, MacFarlane PW, et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. N Engl J Med. 1995; 333:1301-7.
4. Sacks FM, Pfeffer MA, Moye LA, Rouleau JL, Rutherford JD, Cole TG, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial Investigators. N Engl J Med. 1996; 335:1001-9.
5. The Lipid Research Clinics Coronary Primary Prevention Trial results. II. The relationship of reduction in incidence of coronary heart disease to cholesterol lowering. JAMA. 1984; 251:365-74.
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