Coffee, tea, and plasma cholesterol: the Jerusalem Lipid Research Clinic prevalence study

The association of intake of coffee and tea, assessed by 24 hour dietary recall, with plasma cholesterol and its lipoprotein fractions was studied in a sample of 1007 men and 589 women aged 35-64 resident in Jerusalem. These cross sectional data showed a significant linear association (p less than 0.001) between consumption of coffee in men and plasma cholesterol and low density lipoprotein cholesterol concentrations. Men who drank five cups of coffee or more had plasma cholesterol concentrations about 0.5 mmol/l (20 mg/100 ml) higher than non-drinkers after controlling for age, ethnicity, body mass, education, season of year, smoking, tea drinking, and dietary intake of fat and carbohydrates. In women adjusted mean plasma cholesterol concentration was 0.34 mmol/l (13 mg/100 ml) higher in coffee drinkers grouped together (p less than 0.01). The test for a linear trend was not significant. The association in both sexes was largely with the low density lipoprotein cholesterol fraction. High density lipoprotein cholesterol concentrations were somewhat increased in women who drank coffee (p less than 0.01 for a linear trend) but not in men. Tea drinking was not associated with unadjusted plasma cholesterol concentrations in either sex. Male tea drinkers, but not female, had slightly higher adjusted plasma cholesterol concentrations than non-drinkers (0.15 mmol/l (6 mg/100 ml), p = 0.04). No dose response relation was evident. In this population, characterised by a low intake of saturated fatty acids and relatively low mean plasma cholesterol concentrations, coffee drinking may be a determinant of low density lipoprotein cholesterol concentrations.     

Habitual physical activity and cardiovascular risk factors

The relationships between different levels of participation in physical activity and biological indices of cardiovascular risk were examined in a sample of 6814 male and female adults who took part in a national risk factor prevalence survey. Participation in physical activity was classified as "aerobic" (14.6% of total), "moderate" (53.6%) or "inactive" (31.8%). Bivariate analyses found significant associations between level of exercise participation and diastolic blood pressures in men, but not in women; significant associations were found between reported physical activity and systolic blood pressure, total serum cholesterol, high-density lipoprotein (HDL) cholesterol, HDL/total cholesterol ratio and triglycerides for both men and women. Further analyses were controlled for age, education, and the survey site, which were potential confounders of the association between physical activity and other coronary heart disease risk factors. After adjustment, significant associations remained between levels of exercise participation and HDL cholesterol level, HDL/total cholesterol ratio and serum triglyceride levels for both sexes. In women, there was also a significant relationship between activity level and body mass index. In addition, for men only, there was a significant inverse relationship between physical activity and total cholesterol, and, for older men, between physical activity and systolic blood pressure. It is well recognised that physical activity has an independent effect on reducing the risk of coronary heart disease. The results of this study suggest that there may be small supplementary effects mediated through the relationship between exercise and other biological cardiovascular risk factors.     

Moderate exercise and high-density lipoprotein-cholesterol. Observations during a cardiac rehabilitation program.

The effects of a 13-week moderate exercise program on fasting plasma insulin, lipids, and lipoprotein cholesterol concentrations were studied in 32 sedentary, middle-aged men with coronary artery disease. The preponderant component of the exercise program was walking or slow jogging. There was no significant change in the systolic blood pressure and pulse rate product response to a standard exercise load. The high-density lipoprotein-cholesterol (HDL-C) level increased, and the fasting plasma insulin concentration decreased. There were no significant changes in plasma triglycerides or low-density lipoprotein cholesterol levels. In sedentary subjects with coronary artery disease, a modest increase in activity can result in an increase in the HDL-C level and a decrease in the plasma insulin concentration. These changes occurred in the absence of variations in diet, smoking habits, adiposity, or plasma triglyceride concentrations and did not require a cardiovascular training effect.     

Risk of coronary heart disease in women after menopause

An increase in the incidence of coronary heart disease risk has commonly been reported in postmenopausal women. The study population comprised 263 adult healthy men and 237 women (104 premenopausal and 133 postmenopausal) ranging in age group of 21-70 years who were examined for coronary heart disease risk factors from Nellore district in Andhra Pradesh. Anthropometric measurements, blood pressure and serum lipids were analysed using standard procedures. There were no significant differences for anthropometric variables between postmenopausal and premenopausal women. Postmenopausal women had significantly higher levels of blood pressure, pulse rate, serum total cholesterol, triglycerides, low-density lipoprotein cholesterol and ratios of total cholesterol:high-density lipoprotein cholesterol and low-density lipoprotein cholesterol:high-density lipoprotein cholesterol as atherogenic indices than premenopausal women and the corresponding age group of male counterparts. However, the variation of high-density lipoprotein cholesterol levels between these groups were not statistically significant. The prevalence of hypertension, hypercholesterolaemia, hypertriglyceridaemia and atherogenic indices was significantly greater in postmenopausal women than in premenopausal women. This study confirms a higher prevalence of risk factors for coronary heart disease among women in older age group and suggests that when oestrogen production ceases in menopausal women, the risk of coronary heart disease increases.     

早发冠心病的临床危险因素分析与护理对策

目的 探讨早发冠心病的危险致病因素,为其临床防治和护理提供参考。 方法 选择杭州师范大学附属医院2014年6月-2015年9月间收治的48例早发冠心病患者为早发组,并选取同期该院心血管内科收治的48例非早发冠心病患者为晚发组。制作危险因素调查表,对2组年龄、体重指数、文化程度、吸烟史、饮酒史、高血压史、糖尿病史、早发冠心病家族史、甘油三酯、总胆固醇、极低密度脂蛋白、糖化血红蛋白、血尿酸、超敏C-反应蛋白等情况进行统计,并采用单因素和多因素分析确定早发冠心病的危险因素。资料采集前对参与人员进行统一培训,以确保调查的严谨性、科学性和技术性。 结果 单因素和多因素Logistic回归分析结果显示:年龄、吸烟史、饮酒史、高血压史、糖尿病史、早发冠心病家族史、甘油三酯、总胆固醇、极低密度脂蛋白、糖化血红蛋白、血尿酸、超敏C-反应蛋白是早发冠心病的危险因素(P<0.05)。 结论 早发冠心病临床由多因素共同引起,其中年龄、吸烟史、饮酒史、高血压史、糖尿病史、早发冠心病家族史、甘油三酯、总胆固醇、极低密度脂蛋白、糖化血红蛋白、血尿酸、超敏C-反应蛋白是早发冠心病的危险因素,临床上应该高度重视早发冠心病的危险因素,及早预防和治疗,降低早发冠心病的发病率。      

高血压病患者的冠心病危险因素分析

目的　探讨高血压患者发生冠心病的危险因素。方法　 15 9例中男 89例 ,女 70例 ,平均年龄 (5 9.6± 9.2 3)岁 ,有典型心绞痛或不典型胸痛的高血压病患者以性别、年龄、体重指数 (BMI)、坐位舒张压、空腹血糖、总胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白 (HDL C)、低密度脂蛋白 (LDL C)、纤维蛋白原、吸烟量、冠心病家族史等多种危险因素及冠状动脉狭窄程度评分 (冠脉评分 )进行多变量分析 ,患者均行冠脉造影 ,84例冠状动脉造影狭窄≥ 5 0 % ,诊断为冠心病。结果　多元逐步回归及多元lo gistic回归分析显示 :纤维蛋白原、空腹血糖、舒张压、吸烟等级与冠心病独立相关 ,冠心病的相对危险率(OR)分别为 :纤维蛋白原 >5g L为≤ 5g L的 4 .36 2倍 ;空腹血糖 >6 .1mmol L为≤ 6 .1mmol L 7.6 5 4倍 ;舒张压≥ 90mmHg为 <90mmHg的 2 .6 77倍 ;吸烟级别 =3级为 <3级的 6 .5 0 2倍。回归分析结果显示纤维蛋白原、空腹血糖、舒张压、吸烟等级与冠心病独立相关 ,纤维蛋白原、总胆固醇与冠脉狭窄评分独立相关。结论　高血压病患者的纤维蛋白原、空腹血糖、吸烟等级、舒张压与冠心病独立相关 ,纤维蛋白原、总胆固醇与冠脉病变程度有关     

Plasma lipids and lipoproteins and the prevalence of risk for coronary heart disease in Canadian adults. Canadian Heart Health Surveys Research Group.

OBJECTIVE: To report population reference values for blood lipids, to determine the prevalence of lipid risk factors and to assess their association with other risk factors. DESIGN: Population-based cross-sectional surveys. Survey participants were interviewed at home and provided a blood sample at a clinic. All blood lipid analyses were done in the Lipid Research Laboratory, University of Toronto. The laboratory is standardized in the National Heart, Lung Blood Institute-Centres for Disease Control Standardization Program. SETTING: Nine Canadian provinces, from 1986 to 1990. PARTICIPANTS: A probability sample of 26,293 men and women aged 18 to 74 was selected from the health insurance registers for each province. Blood samples were obtained from 16,924 participants who had fasted 8 hours or more. OUTCOME MEASURES: Concentration of total plasma cholesterol, triglycerides and high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol in blood samples from fasting participants. MAIN RESULTS: Of the study population, 46% had total plasma cholesterol levels above 5.2 mmol/L, 15% had LDL-cholesterol levels above 4.1 mmol/L, 15% had triglyceride levels above 2.3 mmol/L and 8% had HDL-cholesterol levels below 0.9 mmol/L. Total plasma cholesterol, LDL-cholesterol and triglyceride levels rose with age in men to a maximum in the 45-54 age group; in women there was little change with age up to ages 45 to 54, at which time the level of each of these lipids increased appreciably. The age-standardized prevalence of obesity was positively associated with elevation of total plasma cholesterol. CONCLUSION: The results suggest the need for a multifactorial approach in health promotion efforts to lower blood cholesterol levels and reduce other risk factors in the population. A considerable number of adults were found to be at risk at all ages in both sexes. In the short term, men aged 34 and older and women aged 45 and older might benefit most from prevention programs.     

Total and high density lipoprotein cholesterol in the serum and risk of mortality: evidence of a threshold effect

The association of serum total and high density lipoprotein cholesterol values with 15 year mortality was examined in a cohort of 10 059 Israeli male civil servants and municipal employees aged 40 and above. In 618 of 1664 deaths in the cohort (37%) coronary heart disease was documented as the cause of death. Risk of mortality was analysed by quintiles. Neither total mortality nor coronary heart disease mortality rose with serum cholesterol concentrations up to 5.6 mmol/1 (216 mg/100 ml), representing 60% of the sample. Rates rose appreciably only in the highest quintile (cholesterol concentration greater than 6.2 mmol/1; greater than 241 mg/100 ml). High density lipoprotein cholesterol was similarly, although inversely, associated with total mortality when expressed as a percentage of total cholesterol. The inverse association of high density lipoprotein cholesterol with coronary heart disease mortality was, in contrast, continuous. These data support the hypothesis that over most of the range of cholesterol values coronary mortality risk and total mortality risk are nearly independent of total cholesterol and most probably independent of low density lipoprotein cholesterol values. In multivariate analysis a low concentration of high density lipoprotein cholesterol appeared to be more predictive of mortality than a high concentration of total cholesterol. The latter was very weakly related to mortality from all causes after multivariate adjustment. It is concluded that the findings of this and other major epidemiological studies support the notion of a "threshold effect." Success in reducing mortality through the pharmacological reduction of serum cholesterol in hypercholesterolaemic patients does not warrant a similar approach in people with average or slightly above average values. These findings appear to provide support for a "high risk strategy" in reducing the risk of coronary heart disease.     

A relation between high-density-lipoprotein cholesterol and bile cholesterol saturation

The association of cholesterol gall stones with coronary artery disease is controversial. To investigate this possible relation at the biochemical level, bile cholesterol saturation and the plasma concentrations of triglycerides, total cholesterol, and high-density-lipoprotein cholesterol (HDL cholesterol) were measured in 25 healthy, middle-aged women. Bile cholesterol saturation index was negatively correlated with HDL cholesterol. It was positively correlated with plasma triglycerides and with total cholesterol minus HDL cholesterol. These findings provide a biochemical basis for a positive association in women between cholesterol gall stones and coronary artery disease.     

吸烟与冠状动脉粥样硬化的相关性分析

目的探讨吸烟与冠状动脉粥样硬化的关系。方法选择96例行冠状动脉造影的男性住院病人,分为吸烟组（51例）和非吸烟组（45例）。对其冠状动脉病变、血脂、血清高敏C反应蛋白（hs-CRP）进行统计分析。结果吸烟组冠状动脉造影显示冠状动脉病变显著高于非吸烟组（P〈0.01）,吸烟组总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）显著高于非吸烟组（P〈0.01）,高密度脂蛋白胆固醇（HDL-C）显著低于非吸烟组（P〈0.01）,血清高敏C反应蛋白显著高于非吸烟组（P〈0.05）。结论吸烟能升高TC、LDL-C、hs-CRP,降低HDL-C,加重冠状动脉粥样硬化,吸烟是冠状动脉粥样硬化的重要危险因素。     

重庆市社区老年人血脂异常的现状调查

目的　调查重庆市老年人群高脂血症患病情况及影响因素。方法　采用随机整群抽样 ,抽取重庆市社区 6 0岁以上人口 4 915人进行调查。血脂分析抽取静脉血 2ml,相关影响因素采用问卷调查 ,查体确定伴发疾病。结果　 4 915名受试者中 ,4 31(8 77% )人为高胆固醇血症 ,70 3(14 30 % )人为高低密度脂蛋白血症 ,772 (15 71% )人为高甘油三脂血症。血清总胆固醇(TC)、甘油三脂 (TG)和低密度脂蛋白 (LDL C)随年龄增长而增高 ,而高密度脂蛋白 (HDL C)则随年龄增长而降低。体重超重者以及有吸烟、饮酒史者的高脂血症患病也显著增高。结论　重庆市社区老年人高胆固醇血症、高甘油三脂血症和高低密度脂蛋白血症的患病率分别为 8 77%、15 71%和 14 30 %。年龄、男性、超重和吸烟、饮酒是高脂血症的危险因素     

Serum lipoproteins and apolipoproteins in young normocholesterolaemic, non-diabetic Indian men with myocardial infarction

Serum total cholesterol, triglycerides, high density lipoprotein cholesterol, low density lipoprotein cholesterol, apolipoprotein A-I and apolipoprotein B were evaluated as potential indicators of the risk of coronary artery disease in young (less than 46 years) normocholesterolaemic, non-diabetic men who had previously sustained a myocardial infarction (n = 50) and in healthy age and sex matched controls (n = 122) with a similar socioeconomic background. Significant differences were observed between patients and controls in the mean concentrations of serum total cholesterol, triglycerides, low density lipoprotein cholesterol, high density lipoprotein cholesterol and apolipoprotein B, as well as in the ratios of total cholesterol to high density lipoprotein cholesterol and apolipoprotein A-I to apolipoprotein B. No significant difference was demonstrated in the concentration of apolipoprotein A-I between the two groups. Stepwise discriminant analysis indicated that apolipoprotein B was the best discriminant between patients and controls. The percentage of exact classification was 74% in patients and 66% in controls. When the patients were compared to a subset of controls (n = 50) matched for age and total cholesterol, significant differences were demonstrated only in the mean concentrations of apolipoprotein B. Discriminant analysis confirmed that the best single discriminating variable was apolipoprotein B. The results therefore indicate that in young normocholesterolaemic, non-diabetic Indian men with myocardial infarction, apolipoprotein B is superior to other lipid parameters studied, as a marker for coronary artery disease.     

Prevention of coronary heart disease: the role of high density lipoproteins.

There is now strong evidence that the risk of developing clinical coronary heart disease (CHD) in apparently healthy middle-aged men is inversely related to the plasma high density lipoprotein (HDL) cholesterol concentration. This reflects an underlying relationship between HDL cholesterol concentration and the severity of coronary atherosclerosis. This new information represents a significant development in atherosclerosis research. In the author''s opinion, however, it is not yet justifiable, or indeed possible, to utilize this knowledge in CHD prevention programmes for 3 reasons. Firstly, there is still little prospective information on HDL and CHD in women, in younger subjects and in patients with existing clinical disease. Secondly, although there are at least 2 working hypotheses, a causal relationship between HDL metabolism and atherogenesis has not yet been established. Thirdly, there is still a relative paucity of information on the environmental determinants of HDL concentration and metabolism. Thus, premature attempts at intervention in an uncontrolled manner, and particularly the use of drugs for an HDL-raising effect, might only confuse the issue. While further research is being undertaken, attention should continue to be directed towards other reversible coronary risk factors (including hypercholesterolaemia, hypertension, and cigarette smoking) in CHD prevention programmes.     

Is elevated serum cholesterol level a risk factor for coronary heart disease in the elderly?

Since serum cholesterol is a major component in the causal pathway of atherosclerosis, a pathological process that usually progresses with age, we have evaluated reported findings of a diminished association between serum cholesterol level and coronary heart disease in the elderly. In the Honolulu (Hawaii) Heart Program, 1480 men aged 65 years and older and free of coronary heart disease were followed up for an average of 12 years. Incidence rates of coronary heart disease increased progressively from the lowest to the highest quartile of serum cholesterol level. The independent role of serum cholesterol level as a predictor of coronary heart disease risk was evaluated with other major risk factors using a Cox multivariate regression model. The upper-lower quartile relative risk for serum cholesterol level was 1.64 (95% confidence interval, 1.14 to 2.36). The relative risk for middle-aged men was also 1.64. The results suggest that serum cholesterol level is an independent predictor of coronary heart disease, even among men older than 65 years. Thus, an elevated serum cholesterol level in the elderly should be regarded, as in middle-aged men, to be an indicator for further evaluation of lipoprotein levels and possible intervention.     

Lipids in women: screening and treatment

Hyperlipidemia is a risk factor for coronary heart disease (CHD) in both men and women, although the association between total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and CHD risk differs in men and women. Although several clinical trials of lipid lowering for both primary and secondary prevention of CHD have been conducted, women have not always been included, have been included in small numbers, or have not had their results analyzed separately. CHD risk assessment is an important component of decision making about screening and treatment of hyperlipidemia. This article presents guidelines for screening and treatment of hyperlipidemia in women with CHD, in healthy women, and in women at risk for CHD.     

Cardiac risk factor management. Experience of an outpatient hypertension clinic

OBJECTIVE: To describe the outcome of the management of cardiovascular risk factors in the hypertension clinic of a teaching hospital over a five-year period. DESIGN: Retrospective analysis of risk factor data (blood pressure, plasma cholesterol level, body weight, smoking and drinking habits) obtained from computerised hypertension clinic progress report forms. SETTING: Public teaching hospital. PATIENTS: One hundred and thirty-one patients referred to the clinic from both general practice and from within the hospital who attended the clinic regularly during the five-year study period. INTERVENTION: Long term management of hypertension and coexisting coronary risk factors by dietary, medical and lifestyle intervention. RESULTS: There was a significant improvement in diastolic blood pressure control in 1990 versus 1986 in both men and women, while systolic blood pressure improved in women only. The number of patients controlled with monotherapy increased from 38% in 1986 to 45% in 1990. Eighty-nine per cent of the men and 85% of women remained above their maximum desirable weight. Reported levels of alcohol consumption were low and the proportion of smokers was below that of the general population. A significant decline in plasma total cholesterol levels was observed in the women. Despite dietary advice and a limited use of lipid lowering drugs, 53.2% of the men and 66.1% of the women continued to have total plasma cholesterol levels above 5.5 mmol/L in 1990. High density lipoprotein levels increased significantly in the women only. CONCLUSION: A high proportion of our clinic patients have well controlled hypertension, but the clinic program produced little evidence of improvement in risk factors in men stabilised by long term therapy. More intensive methods of achieving lifestyle modification and a wider use of lipid lowering drugs may be needed if we are to achieve satisfactory body weights and lipid profiles in hypertensive patients.     

女性早发冠心病病人危险因素的研究

目的研究女性早发冠心病病人发病的危险因素和冠脉病变特点。方法选取2015年6月至2018年6月住院治疗并经冠脉造影确诊的女性早发冠心病病人66例（发病年龄≤65岁）作为早发组,选取年龄与病例组匹配的健康女性42名作为健康对照组,选取同时期确诊的女性晚发冠心病病人70例作为晚发对照组（发病年龄 > 65岁）。对各组间一般资料、疾病史、生化指标等进行对比。结果早发组冠心病病人的吸烟史（21.2%）和高血压病史（45.5%）比例均高于健康对照组（4.8%,9.5%）和晚发对照组（11.4%,35.7%）（P < 0.05~P < 0.01）;早发组病人尿素氮、总胆固醇、低密度脂蛋白、脂蛋白、三酰甘油、乳酸脱氢酶、肌酸激酶水平与健康对照组比较明显升高（P < 0.05~P < 0.01）。与晚发对照组比较,早发组肌酐水平较低（P < 0.01）,而尿素氮、脂蛋白、低密度脂蛋白、乳酸脱氢酶、肌酸激酶水平较高（P < 0.05~P < 0.01）。结论吸烟、高血压病史、尿素氮、脂蛋白、低密度脂蛋白、乳酸脱氢酶、肌酸激酶等生化指标异常升高可能是女性冠心病发病提前的危险因素,此外总胆固醇、三酰甘油水平异常升高还可能是中青年女性冠心病发生的危险因素。     

MODIFIED CLASSIC RISK FACTORS FOR CORONARY ARTERY DISEASE IN CHINESE HAN POPULATION

To investigate the levels of cardiovascular disease risk factors and their relations to clinical phenotype associated with coronary artery disease (CAD).Methods The subjects were recruited from five independent cardiovascular centers. Coronary angiography was employed to define the CAD with stenosis in each major vessel ≥70% and control with stenosis ＜ 10% in every lesion.The classic risk factors including family history, body mass index, smoking habits, hypertension, diabetes mellitus, and serum lipid levels were surveyed according to established criteria. Associations between risk levels and clinical phenotypes were assessed by case control and correlation analysis.Results A total of 762 individuals were collected, including 481 men and 281 women, aged from 17 to 81 (mean 60 ± 10) years. The patients with CAD accounted for 55.5% of all participants, and controls 44. 5%, respectively. Compared with the pattern in published data, our study showed that mean serum high density lipoprotein cholesterol (HDL-C)level was significantly lower (P ＜0. 001 ) and triglycerides was significantly higher (P ＜0. 001 ), while total cholesterol (TC) and low density lipoprotein cholesterol levels were comparative ( both P ＞ 0. 05 ). The prevalence of low HDL-C ( ＜40 g/L) and hypertriglyceridemia ( ＞ 150 g/L) were 27. 2% and 41.4%, respectively. Mean serum levels of HDL-C and apolipoprotein A1 were significantly higher in female subjects than in male ( P ＜ 0. 001 ). Lower HDL-C functioned as an independent risk factor for CAD only in men (RR = 2. 8, 95% CI: 1.5-4. 2, P ＜ 0. 001 ), yet increased non-HDL cholesterol combined with diabetes mellitus and obesity seemed to play a key role in the development of CAD in women. Similarity in risk association with CAD was found for hypertension and TC/HDL ratio in male and female subjects, while family history had no relationship with the presence of CAD.Conclusion It is remarkable that emphasis of intervention in future should be given on the prevalent low serum HDL-C and its strong risk correlation with the presence of CAD in male subjects of Chinese Han population.     

Lp(a) lipoprotein as a risk factor for myocardial infarction

The Lp(a) lipoprotein is structurally related to low-density lipoprotein but is found in lower plasma concentration. It has been associated with coronary disease in several white populations. To test the generalizability of this association, we measured serum Lp(a) by quantitative immunoelectrophoresis in 303 Hawaiian men of Japanese ancestry with a prior myocardial infarction (MI) and in 408 population-based controls. Mean values were 17.1 and 13.7 mg/dL (0.171 and 0.137 g/L), respectively. Increased risk for MI was shown mainly for men in the upper quartile of the Lp(a) lipoprotein distribution (greater than or equal to 20.1 mg/dL [greater than or equal to 0.201 g/L]). Odds ratios at younger than 60, 60 to 69, and 70 years of age or older were 2.5, 1.6, and 1.2 times those for men in the lower three quartiles, respectively. In a multiple logistic model the association with MI remained significant and was not explained by differences in total cholesterol levels, high-density lipoprotein or low-density lipoprotein cholesterol levels, subscapular skin fold, systolic blood pressure, history of smoking, alcohol consumption, or age. We conclude that Lp(a) is an important attribute that should often be considered when coronary heart disease risk is assessed.     

Plasma lipids and lipoprotein cholesterol concentrations in people with different diets in Britain

Concentrations of total cholesterol and cholesterol in the various lipoprotein fractions were measured in vegans, vegetarians, fish eaters (who did not eat meat), and meat eaters. Total and low density lipoprotein cholesterol concentrations were higher in meat eaters than vegans, with vegetarians and fish eaters having intermediate and similar values. High density lipoprotein cholesterol concentration was highest in the fish eaters but did not differ among the other groups. There were striking trends with age in total and low density lipoprotein cholesterol concentrations, which differed between men and women: women showed a steady increase in concentration with age, whereas concentrations in men did not increase appreciably after the age of 40, which may partly explain sex differences in the prevalence of coronary heart disease. The differences in total cholesterol concentration suggest that the incidence of coronary heart disease may be 24% lower in lifelong British vegetarians and 57% lower in lifelong vegans than in meat eaters.