Objective: To investigate the association between serum total cholesterol (TC) and suicide using a large general population cohort with long follow-up times. Method: Analyses included 16 341 men and 28 905 women aged 40–69 from the Japan Public Health Center-based Prospective Study followed from 1990 to 2012. TC levels were defined per clinical guidelines: low (<4.66 mmol/l [180 mg/dl]), normal (4.66–5.70 mmol/l [180–220 mg/dl]), and high (≥5.70 mmol/l [220 mg/dl]). Cox proportional hazards regression models were used to determine hazard ratios (HR) and confidence intervals (CI) for suicide according to TC level. Mean follow-up time was 19 years for men and 20 years for women. Results: There were 185 suicides (men: 107; women: 78) during follow-up. Compared to women with normal TC, women with high TC had a significantly increased risk of suicide (HR = 1.90, 95% CI, 1.13–3.19). Incremental increases (0.26 mmol/l [10 mg/dl]) of low-density lipoprotein (HR = 1.11, 95% CI, 1.02–1.21) and non-high-density lipoprotein cholesterol (HR = 1.09, 95% CI, 1.01–1.18) were also associated with increased risk of suicide in women. There was no association between TC levels, or lipid fractions, and suicide in men. Conclusion: High TC levels may be associated with an increased risk of suicide in women.
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