Circulation, Vol 79, 8-15, Copyright © 1989 by American Heart Association
DJ Gordon, JL Probstfield, RJ Garrison, JD Neaton, WP Castelli, JD Knoke, DR Jacobs Jr, S Bangdiwala and HA Tyroler
The British Regional Heart Study (BRHS) reported in 1986 that much of the
inverse relation of high-density lipoprotein cholesterol (HDLC) and
incidence of coronary heart disease was eliminated by covariance
adjustment. Using the proportional hazards model and adjusting for age,
blood pressure, smoking, body mass index, and low-density lipoprotein
cholesterol, we analyzed this relation separately in the Framingham Heart
Study (FHS), Lipid Research Clinics Prevalence Mortality Follow- up Study
(LRCF) and Coronary Primary Prevention Trial (CPPT), and Multiple Risk
Factor Intervention Trial (MRFIT). In CPPT and MRFIT (both randomized
trials in middle-age high-risk men), only the control groups were analyzed.
A 1-mg/dl (0.026 mM) increment in HDLC was associated with a significant
coronary heart disease risk decrement of 2% in men (FHS, CPPT, and MRFIT)
and 3% in women (FHS). In LRCF, where only fatal outcomes were documented,
a 1-mg/dl increment in HDLC was associated with significant 3.7% (men) and
4.7% (women) decrements in cardiovascular disease mortality rates. The 95%
confidence intervals for these decrements in coronary heart and
cardiovascular disease risk in the four studies overlapped considerably,
and all contained the range 1.9-2.9%. HDLC levels were essentially
unrelated to non- cardiovascular disease mortality. When differences in
analytic methodology were eliminated, a consistent inverse relation of HDLC
levels and coronary heart disease event rates was apparent in BRHS as well
as in the four American studies.
ARTICLES
High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies
Lipid Metabolism-Atherogenesis Branch, National Institutes of Health, Bethesda, Maryland, MD 20892.
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