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Background: No study to date provides evidence suggesting that lower cholesterol is associated with excess death in non-cardiovascular disease (NCVD). This study aimed to determine the association between low cholesterol level and NCVD mortality. Methods: A nine-year cohort study was conducted on 3,079 male and 26,005 female Italians aged 20-69 years old. The Cox proportional hazard models implied a hazard ratio with 95% confidence interval for association. Results: Among males, there were significant inverse associations between the lowest cholesterol decile (&lt; 160mg/dl) hazard ratio and all-cause deaths and non-cardiovascular deaths, 1.50 (1.19-1.89) and 2.06 (1.54-2.74), respectively. Among females, there was a significant inverse association of lowest and fourth cholesterol deciles, 1.53 (1.01-2.34); 1.52 (1.06-2.18) hazard ratio for all-cause deaths and risk for non-cardiovascular deaths in the same deciles 1.52 (0.91-2.50); 1.78 (1.16-2.71), respectively. Remarkably, in depth analysis for NCVD, found significant inverse associations hazard of cholesterol &lt;160 mg/dl for cancer, non-cancer liver dysfunction (NCLD), other non-cancer-non- CVD in males and only NCLD death was significant in females. Conclusion: Among males, there were significant inverse hazard associations between the lowest cholesterol decile and all-cause and non-CVD deaths . Among females, there were significant inverse hazard associations of lowest and fourth cholesterol decile for all-cause and also risk first and fourth deciles for non-CVD mortality.

The Association Between Low Serum Cholesterol and Non-Cardiovascular Mortality among Italian Males and Females: A Nine- Year Prospective Cohort Ctudy