Copyright © 1990 by the European Society of Cardiology.
© 1990 The European Society of Cardiology
Serum lipoproteins as risk factors: recent epidemiologic studies in individuals with and without prevalent cardiovascular disease
University of North Carolina, Chapel Hill North Carolina, U.S.A.
Address for correspondence: Herman A. Tyroler, MD, Department of Epidemiology. School of Public Health, University of North Carolina, McGavran-GreenbergHall, Chapel Hifl, NC27599, U.S.A.
Contrary to most prospective epidemiologic studies, an earlier report from the British Regional Heart Study (BRHS) suggested that high density lipoprotein (HDL)-cholesterol in men aged 40–59 years was not a significant, independent, predictive risk factor for coronary heart disease (CHD). controlling for the composite of low density lipoprotein (LDL) —plus very low density lipoprotein —cholesterol (i.e. non-HDL-cholesterol) and for other risk factors. In response to that report, a systematic re-examination of the Framingham Heart Study, the Lipid Research Clinics Prevalence Mortality Follow-up Study, the Lipid Research Clinics-Coronary Primary Prevention Trial, and the Multiple Risk Factor Intervention Trial was undertaken to compare the results of these four studies with those of the BRHS. In white men and women aged 30–69 years and free of clinical symptoms of CHD at baseline, the incidence of CHD in all four studies was generally highest in those with a low HDL-cholesterol and lowest in those with a high HDL-cholesterol. A later report from the BRHS, with longer follow-up and increased number of CHD events, controlling for other risk factors but without controlling for combined non-HDL-cholesterol, disclosed a statistically significant, independent prediction of CHD, albeit of modest magnitude, by HDL-cholesterol. Data from the USSR Lipid Research Clinics Follow-up Study differed from the American and the British studies. Despite higher HDL-cholesterol levels, CHD mortality rates were as high (or higher) in the USSR than in the US Lipid Research Clinics. HDL-cholesterol was not predictive of CHD mortality in the USSR Lipid Research Clinics, but was positively associated with all-cause mortality and all non-cardiovascular deaths. In the United States Lipid Research Clinics Follow-up Study, HDL-cholesterol was also a predictor of CHD in individuals with clinical manifestations of CHD. Men with a history of myocardial infarction, apositive graded exercise test, or either angina, arrhythmias, or other evidence of CHD showed an inverse association of HDL-cholesterol and a direct association of total cholesterol with cardiovascular mortality. In age-adjusted survival analysis, total-, LDL-. and HDL-cholesterol were all significantly (P <0·01) strong predictors of cardiovascular mortality in men with or without any manifestations of prevalent heart disease. The risk of subsequent mortality from cardiovascular disease among hypercholesterolaemic men with no clinical evidence of CHD was as great or greater than it was among patients with a positive graded exercise test and low total cholesterol or high HDL cholesterol levels.
Key Words: High density lipoproteins • very low density lipproteins • coronary haert disease • epidemiology
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