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To investigate this question, we analyzed all deaths occurring among middle-aged men in the Mu\u0308nster Heart Study (PROCAM), one of the largest prospective epidemiological studies of coronary heart disease risk markers in Europe.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods and Results<\/jats:italic>\n            In the Mu\u0308nster Heart Study, 10 856 men aged 36 to 65 years at study entry (46.8\u00b17.3 years [mean\u00b1SD]) were followed for 4 to 14 years (7.1\u00b12.4 years). During this period, 313 deaths occurred\u221246 from myocardial infarction, 48 from suspected or definite sudden cardiac death, 14 from cerebrovascular disease, and 10 from other diseases of the circulatory system. There were 121 deaths from cancer and 33 deaths from violent causes (injuries in 16, suicide in 14, and homicide in 3 cases). Death in 29 cases occurred from other causes and was unexplained in 12 cases. Total cholesterol, LDL cholesterol, and the LDL\/HDL ratio showed a J-shaped relationship with total mortality. At high total and LDL cholesterol concentrations, increased mortality was due to increased coronary deaths. At low total and LDL cholesterol concentrations, increased mortality was seen in smokers only and was explained by an increase in smoking-related cancer deaths.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            The increase in mortality at low levels of total and LDL cholesterol among middle-aged men in the Mu\u0308nster Heart Study is explained by an increase in smoking-related cancer deaths among smokers.\n          <\/jats:p>","DOI":"10.1161\/01.cir.96.7.2128","type":"journal-article","created":{"date-parts":[[2012,6,12]],"date-time":"2012-06-12T00:41:02Z","timestamp":1339461662000},"page":"2128-2136","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":80,"title":["The Mu\u0308nster Heart Study (PROCAM)"],"prefix":"10.1161","volume":"96","author":[{"given":"Paul","family":"Cullen","sequence":"first","affiliation":[{"name":"From the Institutes of Arteriosclerosis Research (P.C., H.S., G.A.) and Clinical Chemistry and Laboratory Medicine (G.A.), University of Mu\u0308nster (Germany)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helmut","family":"Schulte","sequence":"additional","affiliation":[{"name":"From the Institutes of Arteriosclerosis Research (P.C., H.S., G.A.) and Clinical Chemistry and Laboratory Medicine (G.A.), University of Mu\u0308nster (Germany)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerd","family":"Assmann","sequence":"additional","affiliation":[{"name":"From the Institutes of Arteriosclerosis Research (P.C., H.S., G.A.) and Clinical Chemistry and Laboratory Medicine (G.A.), University of Mu\u0308nster (Germany)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1992.00400190110021"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.308.6925.363"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a116231"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1987.03390160062027"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(92)91381-D"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.ATV.8.6.737"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1981.03310280023021"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a113171"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a113170"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.290.6466.422"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(86)90597-0"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.298.6678.920"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a113157"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1991.00400050113021"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(92)90034-K"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/0021-9681(80)90026-0"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/1047-2797(92)90041-N"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/1047-2797(92)90039-S"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(92)90131-6"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(87)90890-7"},{"key":"e_1_3_2_21_2","first-page":"452","volume":"48","year":"1988","unstructured":"Schatzkin AS, Hoover RN, Taylor PR, Ziegler RG, Carter CL, Albanes D, Larson DB, Licitra LM. 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