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Int J Mol Epidemiol Genet 2012;3(2):122-133
Original Article
Lipid profiles and the risk of endometrial cancer in the Swedish AMORIS study
Divya Seth, Hans Garmo, Annette Wigertz, Lars Holmberg, Niklas Hammar, Ingmar Jungner, Mats Lambe, Göran Walldius,
Mieke Van Hemelrijck
King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Unit, London, UK; Harvard
College, Harvard University, Cambridge, MA; Regional Cancre Centre, Uppsala University Hospital, Uppsala, Sweden;
Department of Epidemiology, Insitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; AstraZeneca
Sverige, Södertalje, Sweden; Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet and CALAB
Research, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Medical
Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Received March 14, 2012; accepted April 24, 2012; Epub May 15, 2012; Published May 30, 2012
Abstract: Background: While the association between obesity and endometrial cancer (EC) is well established, the underlying
mechanisms require further study. We assessed possible links between lipid profiles and EC risk, while also taking into
account BMI, parity, and menopausal status at baseline. Methods: Using the information available from the Swedish
Apolipoprotein MOrtality RISk (AMORIS) study we created a cohort of 225,432 women with baseline values for glucose,
triglycerides (TG), and total cholesterol (TC). Two subgroups of 31,792 and 26,317 had, in addition, baseline measurements of
HDL, LDL, apolipoprotein A-I and apoB and BMI, respectively. We used Multivariate Cox proportional hazards models to analyze
quartiles and dichotomized values of these lipid components for a link to EC risk. Results: During mean follow-up of 12 years
(SD: 4.15), 1,144 persons developed endometrial cancer. A statistically significant association was found between TG and EC
risk when using both quartiles and a clinical cut-off (Hazard Ratio (HR): 1.10 (95%CI: 0.88-1.37), 1.34 (1.09-1.63), and 1.57
(1.28-1.92)) for the 2nd, 3rd, and 4th quartile, compared to the 1st, with P-value for trend: <0.001). The association remained
after exclusion of the first three years of follow-up. Also total cholesterol and TG/HDL ratio were positively associated with EC
risk, but no link was found for the other lipid components studied. Conclusion: This detailed analysis of lipid components
showed a consistent relation between TG levels and EC risk. Future research should continue to analyze the metabolic
pathway and its relation to EC risk, as a pathway to further understand the relation of obesity and disease. (IJMEG1203002).
Keywords: Lipid profiles, risk factor, endometrial cancer, Swedish AMORIS study
Address all correspondence to:
Dr. Mieke Van Hemelrijck
King’s College London, School of Medicine
Division of Cancer Studies, Cancer Epidemiology Unit
Research Oncology, 3rd Floor, Bermondsey Wing
Guy’s Hospital, London SE1 9RT, UK.
Tel: +44(0)20 7188 7904
E-mail: mieke.vanhemelrijck@kcl.ac.uk
Original Article
Lipid profiles and the risk of endometrial cancer in the Swedish AMORIS study
Divya Seth, Hans Garmo, Annette Wigertz, Lars Holmberg, Niklas Hammar, Ingmar Jungner, Mats Lambe, Göran Walldius,
Mieke Van Hemelrijck
King’s College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Unit, London, UK; Harvard
College, Harvard University, Cambridge, MA; Regional Cancre Centre, Uppsala University Hospital, Uppsala, Sweden;
Department of Epidemiology, Insitute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; AstraZeneca
Sverige, Södertalje, Sweden; Department of Medicine, Clinical Epidemiological Unit, Karolinska Institutet and CALAB
Research, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Medical
Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
Received March 14, 2012; accepted April 24, 2012; Epub May 15, 2012; Published May 30, 2012
Abstract: Background: While the association between obesity and endometrial cancer (EC) is well established, the underlying
mechanisms require further study. We assessed possible links between lipid profiles and EC risk, while also taking into
account BMI, parity, and menopausal status at baseline. Methods: Using the information available from the Swedish
Apolipoprotein MOrtality RISk (AMORIS) study we created a cohort of 225,432 women with baseline values for glucose,
triglycerides (TG), and total cholesterol (TC). Two subgroups of 31,792 and 26,317 had, in addition, baseline measurements of
HDL, LDL, apolipoprotein A-I and apoB and BMI, respectively. We used Multivariate Cox proportional hazards models to analyze
quartiles and dichotomized values of these lipid components for a link to EC risk. Results: During mean follow-up of 12 years
(SD: 4.15), 1,144 persons developed endometrial cancer. A statistically significant association was found between TG and EC
risk when using both quartiles and a clinical cut-off (Hazard Ratio (HR): 1.10 (95%CI: 0.88-1.37), 1.34 (1.09-1.63), and 1.57
(1.28-1.92)) for the 2nd, 3rd, and 4th quartile, compared to the 1st, with P-value for trend: <0.001). The association remained
after exclusion of the first three years of follow-up. Also total cholesterol and TG/HDL ratio were positively associated with EC
risk, but no link was found for the other lipid components studied. Conclusion: This detailed analysis of lipid components
showed a consistent relation between TG levels and EC risk. Future research should continue to analyze the metabolic
pathway and its relation to EC risk, as a pathway to further understand the relation of obesity and disease. (IJMEG1203002).
Keywords: Lipid profiles, risk factor, endometrial cancer, Swedish AMORIS study
Address all correspondence to:
Dr. Mieke Van Hemelrijck
King’s College London, School of Medicine
Division of Cancer Studies, Cancer Epidemiology Unit
Research Oncology, 3rd Floor, Bermondsey Wing
Guy’s Hospital, London SE1 9RT, UK.
Tel: +44(0)20 7188 7904
E-mail: mieke.vanhemelrijck@kcl.ac.uk
