Circulation, Vol 85, 22-29, Copyright © 1992 by American Heart Association
JE Buring, GT O'Connor, SZ Goldhaber, B Rosner, PN Herbert, CB Blum, JL Breslow and CH Hennekens
BACKGROUND. A large and consistent body of evidence supports the judgment
that elevation of total plasma blood cholesterol is a cause of myocardial
infarction (MI) and that high levels of low density lipoprotein (LDL)
cholesterol have a positive relation and high levels of high density
lipoprotein (HDL) cholesterol an inverse relation with MI. At present,
however, the roles, if any, of the major subfractions of HDL, namely, HDL2
and HDL3, have not been clarified. In addition, the relation of plasma
apolipoprotein concentrations to MI and whether they provide predictive
information over and above their lipoprotein cholesterol associations is
unknown. METHODS AND RESULTS. We evaluated these questions in a
case-control study of patients hospitalized with a first MI and
neighborhood controls of the same age and sex. Cases had significantly
lower levels of total HDL (p less than 0.0001) as well as HDL2 (p less than
0.0001) and HDL3 (p less than 0.0001) cholesterol. These differences
persisted after controlling for a large number of demographic, medical
history, and behavioral risk factors and levels of other lipids. There were
significant (p less than 0.0001) inverse dose- response relations with odds
ratios for those in the highest quartile relative to those in the lowest of
0.15 for total HDL, 0.17 for HDL2, and 0.29 for HDL3 cholesterol levels.
Levels of LDL and very low density lipoprotein cholesterol and
triglycerides were also higher among cases than controls, but only for
triglycerides was the difference statistically significant after adjustment
for coronary risk factors and other lipids (p = 0.044). Apolipoproteins A-I
and A-II were both significantly (p less than 0.0001) lower in cases, and
differences remained even after adjustment for coronary risk factors and
lipids. There were significant dose-response relations for both
apolipoprotein A-I (p = 0.026) and A-II (p = 0.002). Neither apolipoprotein
B nor E was significantly related to MI after adjustment for lipids and
other coronary risk factors. When all four apolipoproteins were taken
together, there was an increased level of prediction of MI over the
information provided by the lipids and other coronary risk factors (p =
0.003), but this appeared present only for the individual apolipoproteins
A-I (p = 0.027) and A-II (p = 0.011). CONCLUSIONS. These data indicate that
both HDL2 and HDL3 cholesterol levels are significantly associated with MI.
They also raise the possibility that apolipoprotein levels, especially A-I
and A-II, may add importantly relevant information to determination of risk
of MI.
ARTICLES
Decreased HDL2 and HDL3 cholesterol, Apo A-I and Apo A-II, and increased risk of myocardial infarction
Channing Laboratory, Department of Medicine, Harvard Medical School, Boston, MA.
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