Could Low Hdl-Cholesterol Levels Be an Unvalued Predictor of Cancer Risk?: A Retrospective Case Study


Background: The relationship between serum lipid profile levels and cancer risk remained uncertain. Recently, it had been reported a significant inverse association between high-density lipoprotein cholesterol (HDL) and the risk of incident cancer that was independent of low-density lipoprotein cholesterol (LDL), age or sex. Objective: The aim of our study was to evaluate the behavior of HDL in cancer patients and in healthy population. Methods: We created a retrospectively search strategy in the laboratory information system (LIS). We filtered and searched those patients with CEA within 5 - 20 ng/ml and any value of HDL and corroborated the presence of cancer (Group 1 (G1)) or not (Group 2 (G2)). Moreover, we searched a control group (patients in outpatient oncology clinic) to observe the values of HDL. Comparisons and statistical logistic regression models were applied to link the levels of this biomarkers and cancer risk. Results: We examined 852 valid patients, median age 62 (50 - 73) years. Within the search strategy group, G2 showed highest levels of HDL (54 (43 - 67) mg/dl) and lowest CEA levels (6.7 (5.7 - 8.4) ng/ml) comparing with G1: HDL (47 (37 - 60) mg/dl) and the CEA (7.9 (6.2 - 10.9) ng/ml); p < 0.001. The values in control group were: the lowest HDL levels (41 (29 - 54) mg/dl) and CEA (25.2 (6.1 - 124.5) ng/ml); p < 0.001, between oncologic patients and the search strategy group. On logistic regression multivariate analysis, we obtained: r2: 0.092; p < 0.001; HDL [OR: 0.983 (0.974 - 0.993), (p = 0.001)] and CEA [OR: 1.115 (1.060 - 1.174), (p < 0.001)] and they were confirmed as independent predictors of cancer. Conclusion: Our findings confirmed the inverse association of HDL levels between healthy populations and were diagnosed with cancer. Moreover, in a random population, patients with cancer presented lower HDL values compared to those without cancer. Therefore, it could demonstrate the possible positive predictive value of low HDL related to cancer risk.

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Vílchez, J. , Sancho-Rodríguez, N. , Martínez-Ruiz, A. , Martínez-Sánchez, E. , Ruiz-Espejo, F. , Tovar-Zapata, I. and Noguera-Velasco, J. (2015) Could Low Hdl-Cholesterol Levels Be an Unvalued Predictor of Cancer Risk?: A Retrospective Case Study. International Journal of Clinical Medicine, 6, 984-992. doi: 10.4236/ijcm.2015.612129.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Furberg, A.S., Veierod, M.B., Wilsgaard, T., Bernstein, L. and Thune, I. (2004) Serum High-Density Lipoprotein Cholesterol, Metabolic Profile, and Breast Cancer Risk. Journal of the National Cancer Institute, 96, 1152-1160.
[2] Kucharska-Newton, A.M., Rosamond, W.D., Mink, P.J., Alberg, A.J., Shahar, E. and Folsom, A.R. (2008) HDL-Cholesterol and Incidence of Breast Cancer in the ARIC Cohort Study. Annals of Epidemiology, 18, 671-677.
[3] Qadir, M.I. and Malik, S.A. (2008) Plasma Lipid Profile in Gynecologic Cancers. European Journal of Gynaecological Oncology, 29, 158-161.
[4] Wulaningsih, W., Garmo, H., Holmberg, L., Hammar, N., Jungner, I., Walldius, G. and Van, H.M. (2012) Serum Lipids and the Risk of Gastrointestinal Malignancies in the Swedish AMORIS Study. Journal of Cancer Epidemiology, 2012, Article ID: 792034.
[5] Mondul, A.M., Weinstein, S.J., Virtamo, J. and Albanes, D. (2011) Serum Total and HDL Cholesterol and Risk of Prostate Cancer. Cancer Causes & Control, 22, 1545-1552.
[6] Ahn, J., Lim, U., Weinstein, S.J., Schatzkin, A., Hayes, R.B., Virtamo, J. and Albanes, D. (2009) Prediagnostic Total and High-Density Lipoprotein Cholesterol and Risk of Cancer. Cancer Epidemiology, Biomarkers & Prevention, 18, 2814-2821.
[7] Seth, D., Garmo, H., Wigertz, A., Holmberg, L., Hammar, N., Jungner, I., Lambe, M., Walldius, G. and Van, H.M. (2012) Lipid Profiles and the Risk of Endometrial Cancer in the Swedish AMORIS Study. International Journal of Molecular Epidemiology and Genetics, 3, 122-133.
[8] Lindemann, K., Vatten, L.J., Ellstrom-Engh, M. and Eskild, A. (2009) Serum Lipids and Endometrial Cancer Risk: Results from the HUNT-II Study. International Journal of Cancer, 124, 2938-2941.
[9] Michalaki, V., Koutroulis, G., Syrigos, K., Piperi, C. and Kalofoutis, A. (2005) Evaluation of Serum Lipids and High-Density Lipoprotein Subfractions (HDL2, HDL3) in Postmenopausal Patients with Breast Cancer. Molecular and Cellular Biochemistry, 268, 19-24.
[10] Melvin, J.C., Seth, D., Holmberg, L., Garmo, H., Hammar, N., Jungner, I., Walldius, G., Lambe, M., Wigertz, A. and Van, H.M. (2012) Lipid Profiles and Risk of Breast and Ovarian Cancer in the Swedish AMORIS Study. Cancer Epidemiology, Biomarkers & Prevention, 21, 1381-1384.
[11] Lim, U., Gayles, T., Katki, H.A., Stolzenberg-Solomon, R., Weinstein, S.J., Pietinen, P., Taylor, P.R., Virtamo, J. and Albanes, D. (2007) Serum High-Density Lipoprotein Cholesterol and Risk of Non-Hodgkin Lymphoma. Cancer Research, 67, 5569-5574.
[12] Kim, Y., Park, S.K., Han, W., Kim, D.H., Hong, Y.C., Ha, E.H., Ahn, S.H., Noh, D.Y., Kang, D. and Yoo, K.Y. (2009) Serum High-Density Lipoprotein Cholesterol and Breast Cancer Risk by Menopausal Status, Body Mass Index, and Hormonal Receptor in Korea. Cancer Epidemiology Biomarkers and Prevention, 18, 508-515.
[13] Cust, A.E., Kaaks, R., Friedenreich, C., Bonnet, F., Laville, M., Tjonneland, A., Olsen, A., Overvad, K., Jakobsen, M.U., Chajes, V., Clavel-Chapelon, F., Boutron-Ruault, M.C., Linseisen, J., Lukanova, A., Boeing, H., Pischon, T., Trichopoulou, A., Christina, B., Trichopoulos, D., Palli, D., Berrino, F., Panico, S., Tumino, R., Sacerdote, C., Gram, I.T., Lund, E., Quiros, J.R., Travier, N., Martinez-Garcia, C., Larranaga, N., Chirlaque, M.D., Ardanaz, E., Berglund, G., Lundin, E., Bueno-de-Mesquita, H.B., van Duijnhoven, F.J., Peeters, P.H., Bingham, S., Khaw, K.T., Allen, N., Key, T., Ferrari, P., Rinaldi, S., Slimani, N. and Riboli, E. (2007) Metabolic Syndrome, Plasma Lipid, Lipoprotein and Glucose Levels, and Endometrial Cancer Risk in the European Prospective Investigation into Cancer and Nutrition (EPIC). Endocrine-Related Cancer, 14, 755-767.
[14] Andreotti, G., Chen, J., Gao, Y.T., Rashid, A., Chang, S.C., Shen, M.C., Wang, B.S., Han, T.Q., Zhang, B.H., Danforth, K.N., Althuis, M.D. and Hsing, A.W. (2008) Serum Lipid Levels and the Risk of Bilary Tract Cancers and Biliary Stones: A Population-Based Study in China. International Journal of Cancer, 122, 2322-2329.
[15] Jafri, H., Alsheikh-Ali, A.A. and Karas, R.H. (2010) Baseline and On-Treatment High-Density Lipoprotein Cholesterol and the Risk of Cancer in Randomized Controlled Trials of Lipid-Altering Therapy. Journal of the American College of Cardiology, 55, 2846-2854.
[16] Melvin, J.C., Holmberg, L., Rohrmann, S., Loda, M. and Van, H.M. (2013) Serum Lipid Profiles and Cancer Risk in the Context of Obesity: Four Meta-Analyses. Journal of Cancer Epidemiology, 2013, Article ID: 823849.
[17] Vilchez, J., Martinez-Ruiz, A., Sancho-Rodriguez, N., Martinez-Hernandez, P. and Noguera-Velasco, J. (2013) The Real Role of Prediagnostic Hdl Cholesterol and the Cancer Risk: A Concise Review. European Journal of Clinical Investigation, 44, 103-114.
[18] Inamdar, P. and Mehta, G. (2011) Correlation between Obesity and High Density Lipoprotein Cholesterol (HDL-C) in Breast Cancer Patients of Southern Rajasthan. Indian Journal of Surgical Oncology, 2, 118-121.
[19] Kim, K.I., Oh, S.W., Ahn, S., Heo, N.J., Kim, S., Chin, H.J., Na, K.Y., Chae, D.W., Kim, C.H. and Kim, S. (2012) CRP Level and HDL Cholesterol Concentration Jointly Predict Mortality in a Korean Population. American Journal of Medicine, 125, 787-795.
[20] Kucharska-Newton, A.M., Rosamond, W.D., Schroeder, J.C., McNeill, A.M., Coresh, J. and Folsom, A.R. (2008) HDL-Cholesterol and the Incidence of Lung Cancer in the Atherosclerosis Risk in Communities (ARIC) Study. Lung Cancer, 61, 292-300.
[21] Yadav, N.K., Poudel, B., Thanpari, C. and Chandra, K.B. (2012) Assessment of Biochemical Profiles in Premenopausal and Postmenopausal Women with Breast Cancer. Asian Pacific Organization for Cancer Prevention, 13, 3385-3388.
[22] Yang, X., So, W.Y., Ma, R.C., Kong, A.P., Lee, H.M., Yu, L.W., Chow, C.C., Ozaki, R., Ko, G.T. and Chan, J.C. (2011) Low HDL Cholesterol, Metformin Use, and Cancer Risk in Type 2 Diabetes: The Hong Kong Diabetes Registry. Diabetes Care, 34, 375-380.
[23] Grunnet, M. and Sorensen, J.B. (2012) Carcinoembryonic Antigen (CEA) as Tumor Marker in Lung Cancer. Lung Cancer, 76, 138-143.
[24] Molina, R., Filella, X., Auge, J.M., Fuentes, R., Bover, I., Rifa, J., Moreno, V., Canals, E., Vinolas, N., Marquez, A., Barreiro, E., Borras, J. and Viladiu, P. (2003) Tumor Markers (CEA, CA 125, CYFRA 21-1, SCC and NSE) in Patients with Non-Small Cell Lung Cancer as an Aid in Histological Diagnosis and Prognosis: Comparison with the Main Clinical and Pathological Prognostic Factors. Tumor Biology, 24, 209-218.
[25] Molina, R., Auge, J.M., Farrus, B., Zanon, G., Pahisa, J., Munoz, M., Torne, A., Filella, X., Escudero, J.M., Fernandez, P. and Velasco, M. (2010) Prospective Evaluation of Carcinoembryonic Antigen (CEA) and Carbohydrate Antigen 15.3 (CA 15.3) in Patients with Primary Locoregional Breast Cancer. Clinical Chemistry, 56, 1148-1157.
[26] Molina, R., Filella, X., Lejarcegui, J.A., Pahisa, J., Torne, A., Rovirosa, A., Mellado, B., Ordi, J., Puig-Tintore, L.M., Alicarte, J., Biete, A. and Iglesias, J. (2003) Prospective Evaluation of Squamous Cell Carcinoma and Carcinoembryonic Antigen as Prognostic Factors in Patients with Cervical Cancer. Tumor Biology, 24, 156-164.
[27] Chevinsky, A.H. (1991) CEA in Tumors of Other than Colorectal Origin. Seminars in Surgical Oncology, 7, 162-166.
[28] Reiner, Z., Catapano, A.L., De, B.G., Graham, I., Taskinen, M.R., Wiklund, O., Agewall, S., Alegria, E., Chapman, M.J., Durrington, P., Erdine, S., Halcox, J., Hobbs, R.H., Kjekshus, J.K., Perrone, F.P., Riccardi, G., Storey, R.F. and David, W. (2011) ESC/EAS Guidelines for the Management of Dyslipidaemias. Revista Española de Cardiología, 64, 1168.e1-1168.e60.
[29] Molina, R. (2003) Filella X: Marcadores tumorales: Estado actual y perspectivas de futuro II Jano. Roche Diagnostics.
[30] Mainous III, A.G., Wells, B.J., Koopman, R.J., Everett, C.J. and Gill, J.M. (2005) Iron, Lipids, and Risk of Cancer in the Framingham Offspring Cohort. American Journal of Epidemiology, 161, 1115-1122.
[31] Furberg, A.S., Jasienska, G., Bjurstam, N., Torjesen, P.A., Emaus, A., Lipson, S.F. and Ellison, P.T. (2005) Thune I: Metabolic and Hormonal Profiles—HDL Cholesterol as a Plausible Biomarker of Breast Cancer Risk. The Norwegian EBBA Study. Cancer Epidemiology, Biomarkers & Prevention, 14, 33-40.
[32] Moorman, P.G., Hulka, B.S., Hiatt, R.A., Krieger, N., Newman, B., Vogelman, J.H. and Orentreich, N. (1998) Association between High-Density Lipoprotein Cholesterol and Breast Cancer Varies by Menopausal Status. Cancer Epidemiology, Biomarkers & Prevention, 7, 483-488.
[33] LeRoith, D., Novosyadlyy, R., Gallagher, E.J., Lann, D., Vijayakumar, A. and Yakar, S. (2008) Obesity and Type 2 Diabetes Are Associated with an Increased Risk of Developing Cancer and a Worse Prognosis; Epidemiological and Mechanistic Evidence. Experimental and Clinical Endocrinology & Diabetes, 116, S4-S6.
[34] Su, F., Kozak, K.R., Imaizumi, S., Gao, F., Amneus, M.W., Grijalva, V., Ng, C., Wagner, A., Hough, G., Farias-Eisner, G., Anantharamaiah, G.M., Van Lenten, B.J., Navab, M., Fogelman, A.M., Reddy, S.T. and Farias-Eisner, R. (2010) Apolipoprotein A-I (apoA-I) and apoA-I Mimetic Peptides Inhibit Tumor Development in a Mouse Model of Ovarian Cancer. Proceedings of the National Academy of Sciences of the United States of America, 107, 19997-20002.
[35] Llaverias, G., Escolà-Gil, J.C., Lerma, E., Julve, J., Pons, C. and Blanco-Vaca, F. (2012) Phytosterols Inhibit the Tumor Growth and Lipoprotein Oxidizability Induced by a 3 High-Fat Diet in Mice with Inherited Breast Cancer. Journal of Nutritional Biochemistry, 24, 39-48.
[36] Gao, F., Chattopadhyay, A., Navab, M., Grijalva, V., Su, F., Fogelman, A.M., Reddy, S.T. and Farias-Eisner, R. (2012) Apolipoprotein A-I Mimetic Peptides Inhibit Expression and Activity of Hypoxia-Inducible Factor-1Alpha in Human Ovarian Cancer Cell Lines and a Mouse Ovarian Cancer Model. Journal of Pharmacology and Experimental Therapeutics, 342, 255-262.

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