Association of Elevated Serum Triglycerides with Colorectal Cancer Risk: Findings from a Large-scale Prospective Cohort of Korean Adults.

Abstract

Colorectal cancer incidence is increasing in Korea, emphasizing the need to identify its risk factors. Serum lipids may influence colorectal cancer risk, but evidence is conflicting. We examined the associations between serum lipids and colorectal cancer risk in Koreans. Using data from the Korean Genome and Epidemiology Study's Health Examinees cohort, we assessed serum low-density lipoproteins, high-density lipoproteins, triglycerides (TG), and total cholesterol among those who did not use lipid-lowering drugs. Dyslipidemia and its subcategories were defined using established clinical thresholds. Cancer cases were identified via the national cancer registry. Associations between lipids and cancers were evaluated using Cox regression. Subgroup analyses were conducted by sex, age, diabetes, and prior screening experience, along with sensitivity analyses based on follow-up duration. During a median follow-up of 9.1 years, 821 new colorectal cancer cases occurred among 111,330 participants of 40 to 69 years of age (38,455 men and 72,875 women). For colorectal cancer, elevated TG [Q4 vs. Q1: HR = 1.32; 95% confidence interval (CI), 1.07-1.62; P-trend = 0.02] and total cholesterol (Q4 vs. Q1: HR = 1.22; 95% CI, 1.00-1.51) increased the risk. For colon cancer, high TG increased the risk (Q4 vs. Q1: HR = 1.42; 95% CI, 1.08-1.86; P-trend = 0.01). Those with hypertriglyceridemia, compared with those without, showed increased risk (HR = 1.42; 95% CI, 1.07-1.87) for rectal cancer, whereas other lipids showed no significant associations. Similar but attenuated results were found in the subgroup analyses among participants ≥50 years of age. TG was associated with colorectal, colon, and rectal cancers in Koreans. Findings suggest that lipid levels may be relevant to colorectal cancer prevention strategies.

Prevention relevance: Our findings highlight serum lipids as potential modifiable risk factors for colorectal cancer in Koreans. These results support lipid management as a preventive strategy, informing public health efforts. Targeted lipid control programs may reduce colorectal cancer risk, particularly among high-risk individuals, warranting further evaluation of lipid-lowering therapies for prevention.