Objective To examine the association between serum concentrations of total cholesterol, high density lipoprotein cholesterol (HDL), low density lipoprotein cholesterol, triglycerides, apolipoprotein A-I (apoA), apolipoprotein B and the incidence of colorectal cancer (CRC).
Design Nested case–control study.
Setting The study was conducted within the European Prospective Investigation into Cancer and Nutrition (EPIC), a cohort of more than 520 000 participants from 10 western European countries.
Participants 1238 cases of incident CRC, which developed after enrolment into the cohort, were matched with 1238 controls for age, sex, centre, follow-up time, time of blood collection and fasting status.
Main outcome measures Serum concentrations were quantitatively determined by colorimetric and turbidimetric methods. Dietary and lifestyle data were obtained from questionnaires. Conditional logistic regression models were used to estimate incidence rate ratios (RRs) and 95% CIs which were adjusted for height, weight, smoking habits, physical activity, education, consumption of fruit, vegetables, meat, fish, alcohol, fibre and energy.
Results After adjustments, the concentrations of HDL and apoA were inversely associated with the risk of colon cancer (RR for 1 SD increase of 16.6 mg/dl in HDL and 32.0 mg/dl in apoA of 0.78 (95% CI 0.68 to 0.89) and 0.82 (95% CI 0.72 to 0.94), respectively). No association was observed with the risk of rectal cancer. Additional adjustment for biomarkers of systemic inflammation, insulin resistance and oxidative stress or exclusion of the first 2 years of follow-up did not influence the association between HDL and risk of colon cancer.
Conclusions These findings show that high concentrations of serum HDL are associated with a decreased risk of colon cancer. The mechanism behind this association needs further elucidation.
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Funding This work was supported by the European Commission: Public Health and Consumer Protection Directorate 1993-2004; Research Directorate-General 2005-.; Ligue contre le Cancer, Societé 3M, Mutuelle Générale de l'Education Nationale, Institut National de la Santé et de la Recherche Médicale (INSERM) (France); German Cancer Aid, German Cancer Research Center, Federal Ministry of Education and Research (Germany); Danish Cancer Society (Denmark); Health Research Fund (FIS) of the Spanish Ministry of Health, The participating regional governments and institutions (Spain); Cancer Research UK, Medical Research Council (UK); Hellenic Ministry of Health, the Stavros Niarchos Foundation and the Hellenic Health Foundation (Greece); Italian Association for Research on Cancer, National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (the Netherlands); Swedish Cancer Society, Swedish Scientific Council, Regional government of Västerbotten (Sweden); Norwegian Cancer Society (Norway).
Competing interests The institution of FvD has received grants from the Ministry of Public Health, Welfare and Sports for the submitted work. The institution of HBBdM has received grants from the Ministry of Public Health, Welfare and Sports for the submitted work. The institution of TP has received grants from German Cancer Aid, Federal Ministry for Education and Research, European Union for the submitted work. The institution of RT has received support from the European Union and AIRC-ITALY for the submitted work. The institution of DD has received grants from German Cancer Aid, Federal Ministry for Education and Research, European Union for the submitted work. The institution of AT has received grants from Stavros Niarchos Foundation for the submitted work. The institution of PL has received grants from the Hellenic Ministry of Health for the submitted work. The institution of VD has received grants from the Hellenic Health Foundation for the submitted work. The institution of K-TK has received grants from MRC and Cancer Research UK for the submitted work. There are no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; and no other relationships or activities that could appear to have influenced the submitted work.
Ethics approval This study was conducted with the approval of the ethics review boards of the International Agency for Research on Cancer and individual EPIC centres. EPIC participants provided written consent for the use of their blood samples and all data.
Provenance and peer review Not commissioned; externally peer reviewed.
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