(Circulation. 1995;92:1430-1436.)
© 1995 American Heart Association, Inc.
Articles |
Combined Effects of HDL Cholesterol, Triglyceride, and Total Cholesterol Concentrations on 18-Year Risk of Atherosclerotic Disease
Presented in part at the 66th Scientific Sessions of the American Heart Association, November 10, 1993, Atlanta, Ga.
From the Honolulu Epidemiology Research Unit (C.M.B., D.S.S.), Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Honolulu, Hawaii; Division of Endocrinology, Gerontology and Metabolism (A.L.), Department of Medicine, Stanford University School of Medicine, Palo Alto, Calif; Honolulu Heart Program (R.B., D.C., B.L.R., J.D.C.), Kuakini Medical Center, Honolulu, Hawaii; Department of Medicine (B.L.R., J.D.C.), John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, Hawaii; and Department of Medicine (R.J.G.), University of Massachusetts Medical School (Worcester).
Correspondence to Dr Cecil Burchfiel, Honolulu Heart Program, 347 N Kuakini St, Honolulu, HI 96817. E-mail buzz@hhs.cba.hawaii.edu.
Background Whether the combination of a low level of HDL cholesterol (HDL-C) and high level of triglyceride (TG) confers increased risk of cardiovascular disease and whether risk varies across levels of total cholesterol (TC) are not well established. Combined effects of HDL-C, TG, and TC on the incidence of atherosclerotic disease were examined prospectively in Japanese-American men from the Honolulu Heart Program.
Methods and Results Among 1646 men aged 51 to 72 years who were
free of coronary heart disease (CHD), stroke, and cancer and
were not taking lipid-lowering medication, 318 developed
atherosclerotic events (angina, coronary insufficiency, aortic
aneurysm, definite CHD, or thromboembolic stroke) and 170
developed definite CHD between 1970 and 1988. Subjects were stratified
by TC level (desirable, <200 mg/dL; borderline high, 200 to 239 mg/dL;
high, 
240 mg/dL), HDL-C level (<35 and 35 mg/dL), and TG level
(<200 and 200 mg/dL). With Cox regression with high HDL-C and low TG
as reference, age-adjusted relative risks (RR) of atherosclerotic
events were significantly elevated in men with low HDL-C and high TG at
borderline-high (RR, 2.46; 95% CI, 1.48 to 4.09) and high (RR,
2.21; 95% CI, 1.34 to 3.66) TC levels but not in men with desirable TC
levels (RR, 0.89; 95% CI, 0.38 to 2.09). Elevated risks were
independent of blood pressure, obesity, fat distribution, diabetes,
smoking, and alcohol. Results were not materially altered by exclusion
of subjects with angina alone and were similar but somewhat weaker
for CHD.
Conclusions Risk of atherosclerotic disease appears elevated in subjects with low HDL-C and high TG levels when TC is borderline high or high, independent of other cardiovascular risk factors. These findings support recent cholesterol screening recommendations and suggest that joint effects of HDL-C and TG may be important to consider.
Key Words: Asian Americans • cardiovascular diseases • incidence • lipoproteins • longitudinal studies
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