In a cohort of 1824 middle-aged men followed for 25 years, intake of dietary cholesterol was associated with risk of death from ischaemic heart disease, from other cardiovascular diseases combined, from all cardiovascular diseases combined, and from all causes combined. The relative hazard of death from all cardiovascular diseases combined, associated with the difference between the mean of the first and fifth quintiles of cholesterol intake (a difference of 184 mg cholesterol/1000 kcal intake) was 1·46 (95% confidence interval 1·10-1·94) after adjustment for age, intake of other dietary lipids, and other coronary risk factors (including serum cholesterol). When stratified into three groups according to serum cholesterol (less than 220 mg/dl, 220-259 mg/dl, and 260 mg/dl or above), the corresponding relative hazards were 1·58, 1·50, and 1·41, respectively. These results are further evidence for the concepts that dietary cholesterol is atherogenic in man, and that the effect is partly independent of total serum cholesterol. They reinforce the recommendation that intake of dietary cholesterol should be low in people without overt hyperlipidaemia as well as those with raised serum cholesterol.
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