Tracking of serum lipids and lipoproteins from childhood to adulthood. The Bogalusa Heart Study

Serum lipids (total cholesterol and triglycerides) and lipoprotein cholesterol fractions (low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol, and high density lipoprotein (HDL) cholesterol) have been measured approximately every 3 years on children and young adults since 1973-1974 in Bogalusa, Louisiana, a community of approximately 22,000 individuals, one-third of whom are black and two-thirds of whom are white. A total of 1,586 children were examined both at baseline (1973-1974) and at the most recent survey (1984-1986), providing 12 years of follow-up. The decreases in levels noted during puberty for total cholesterol and LDL cholesterol, primarily for boys, were followed by a rise until age 26 years. HDL cholesterol levels, particularly for white boys, continued to drop after age 14 years, yielding increasingly high LDL cholesterol/HDL cholesterol ratios. Tracking, as measured by both correlation coefficients and persistence at extreme quartiles, was evident for all of the lipids and lipoproteins. The 12-year correlation coefficients were greatest for LDL cholesterol and no trend in the magnitude of the correlation coefficients with age was noted. Tracking for HDL cholesterol was better after age 9 years, particularly for white males. Approximately 50% of those children who had total cholesterol levels or LDL cholesterol levels above the 75th percentile at baseline remained elevated 12 years later. For HDL cholesterol, a trend with age was noted for white boys: 42% of those aged 9-14 years in the lower most quartile persisted in this rank 12 years later. The best predictor of follow-up lipid or lipoprotein level was baseline level. The next best predictor was increase in weight as defined by weight/height, an index of obesity. That serum lipid and lipoprotein levels continue to track from childhood into young adulthood points to the necessity of measurement early in life and, where indicated, the introduction of preventive and interventional programs aimed at developing healthy lifestyles.     

Relationship between lifestyle and serum lipid and lipoprotein levels in middle-aged Japanese men

Cross-sectional associations between lifestyle factors [cigarette smoking, alcohol intake, overall obesity indicated by body mass index (BMI), eating breakfast, snacking between meals, considering nutritional balance, coffee drinking, physical exercise, and hours of work and sleep] and serum lipid and lipoprotein levels were examined in 1580 middle-aged Japanese men in Osaka, Japan. From stepwise regression analyses, significant correlates with low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and Log triglyceride levels were, in the order of relative importance: BMI, alcohol intake (negative), and age for LDL cholesterol level; BMI (negative), cigarette smoking (negative), alcohol intake, considering nutritional balance, and physical exercise for HDL cholesterol level; and BMI, cigarette smoking, working hours (negative), considering nutritional balance (negative), alcohol intake, and coffee drinking (negative) for Log triglyceride level. The cumulative percentages of variation for LDL cholesterol, HDL cholesterol and Log triglyceride levels were 4.2%, 15.4% and 14.7%, respectively. From stepwise regression analyses, excluding BMI as a factor in the model, snacking between meals emerged as a significant factor for LDL cholesterol level and HDL cholesterol level (negative). The cumulative percentage of variation for each serum lipid and lipoprotein level was decreased (1.5% for LDL cholesterol, 6.8% for HDL cholesterol, and 3.1% for Log triglyceride). These results suggest that BMI has the strongest association with serum lipid and lipoprotein levels and that good daily lifestyles may have an anti-atherogenic effect by altering serum lipid and lipoprotein levels in middle-aged Japanese men.     

Association of lifestyle with serum lipid levels: a study of middle-aged Japanese men

Cross-sectional associations between lifestyle and serum lipid levels were examined in 1591 Japanese male office workers aged 35 to 59 years in Osaka, Japan. From multiple linear regression analyses, significant correlates with low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and Log triglyceride levels and the ratio of LDL cholesterol to HDL cholesterol were, in the order of relative importance: BMI, alcohol intake (negative) and age for LDL cholesterol level; BMI (negative), cigarette smoking (negative), alcohol intake, consideration for nutritional balance, hours of brisk walking, hours of walking at an ordinary pace and physical exercise for HDL cholesterol level; BMI, cigarette smoking, consideration for nutritional balance (negative), hours of work (negative), alcohol intake and coffee drinking (negative) for Log triglyceride level; and BMI, alcohol intake (negative), cigarette smoking, consideration for nutritional balance (negative), age, hours of brisk walking (negative) and the frequency of snack intake between meals for the ratio of LDL cholesterol to HDL cholesterol. Our data suggest that obesity, cigarette smoking and snack intake between meals are atherogenic whereas alcohol consumption, consideration for nutritional balance and walking long hours, especially at a brisk pace, are anti-atherogenic in middle-aged Japanese men.     

Twin study of genetic and environmental effects on lipid levels

A study of 106 pairs of monozygotic (MZ) and 94 pairs of dizygotic (DZ) twins tested the hypothesis that part of the previously described genetic influence on blood lipid levels can be ascribed to closer similarities among MZ than among DZ twin pairs in environmental factors that affect lipid levels. Participants were adult twin volunteers (age 17-66; 64 male and 136 female pairs) who were selected from the NH & MRC Twin Registry or were respondents to advertisements. They completed a 4-day weighed food diary from which mean nutrient intake was derived. Information on lifestyle and demographic variables was obtained by questionnaire and a nonfasting blood sample was taken for measures of total, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol and the HDL2 and HDL3 subfractions. Height and weight were measured, and body mass index (BMI) was calculated (kg/m2). Estimates of the heritability of sex-adjusted lipid levels were 0.72 for total cholesterol, 0.79 for HDL cholesterol, 0.69 for HDL2, 0.20 for HDL3, 1.06 for LDL cholesterol, and 0.44 for sex-adjusted BMI. In all cases except for HDL3, genetic variance was statistically significant. After adjusting for the effects of environmental variables in three different ways, the estimates of heritability were somewhat lower for total cholesterol, HDL2, and BMI, and those for HDL cholesterol (borderline) and LDL cholesterol (definitely) remained statistically significant but were decreased. A genetic influence on HDL3 was not found. Adjusted heritability estimates obtained from one method of analysis were 0.35 for total cholesterol, 0.49 for HDL, 0.04 for HDL2, -0.34 for HDL3, 0.66 for LDL, and 0.32 for BMI. These results suggest that the assumptions made in the classical twin study approach are not appropriate when examining genetic effects on lipid levels or BMI, or indeed on any biological variable that may be affected by environmental factors that tend to be more similar in MZ twins than in DZ twins. In these circumstances, more complex models may be needed to differentiate between genetic and environmental influences.     

Effects of obesity and body fat distribution on lipids and lipoproteins in nondiabetic American Indians: The Strong Heart Study

OBJECTIVES: To examine the relationship between obesity and lipoprotein profiles and compare the effects of total obesity and central adiposity on lipids/lipoproteins in American Indians. RESEARCH METHODS AND PROCEDURES: Participants were 773 nondiabetic American Indian women and 739 men aged 45 to 74 years participating in the Strong Heart Study. Total obesity was estimated using body mass index (BMI). Central obesity was measured as waist circumference. Lipoprotein measures included triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein AI (apoAI), and apolipoprotein B (apoB). Partial and canonical correlation analyses were used to examine the associations between obesity and lipids/ lipoproteins. RESULTS: Women were more obese than men in Arizona (median BMI 32.1 vs. 29.2 kg/m2) and South Dakota and North Dakota (28.3 vs. 28.0 kg/m2), but there was no sex difference in waist circumference. Men had higher apoB and lower apoAI levels than did women. In women, when adjusted for center, gender, and age, BMI was significantly related to HDL cholesterol (r = -0.24, p < 0.001). There was a significant but weak relation with apoAI (r = -0.14, p < 0.001). Waist circumference was positively related to triglycerides (r = 0.14, p < 0.001) and negatively related to HDL cholesterol (r = -0.23, p < 0.001) and apoAI (r = -0.13, p < 0.001). In men, BMI was positively correlated with triglycerides (r = 0.30, p < 0.001) and negatively correlated with HDL cholesterol (r = -0.35, p < 0.001) and apoAI (r = -0.23, p < 0.001). Triglycerides increased with waist circumference (r = 0.30, p < 0.001) and HDL cholesterol decreased with waist circumference (r = -0.36, p < 0.001). In both women and men there was an inverted U-shaped relationship between obesity and waist with LDL cholesterol and apoB. In canonical correlation analysis, waist circumference received a greater weight (0.86) than did BMI (0.17) in women. However, the canonical weights were similar for waist (0.46) and BMI (0.56) in men. Only HDL cholesterol (-1.02) carried greater weight in women, whereas in men, triglycerides (0.50), and HDL cholesterol (-0.64) carried a large amount of weight. All the correlation coefficients between BMI, waist circumference, and the first canonical variable of lipids/lipoproteins or between the individual lipid/lipoprotein variables and the first canonical variable of obesity were smaller in women than in men. Triglycerides and HDL cholesterol showed clinically meaningful changes with BMI and waist circumference in men. All lipid/lipoprotein changes in women in relation to BMI and waist circumference were minimal. DISCUSSION: The main lipoprotein abnormality related to obesity in American Indians was decreased HDL cholesterol, especially in men. Central adiposity was more associated with abnormal lipid/lipoprotein profiles than general obesity in women; both were equally important in men.     

Breast feeding and blood lipid concentrations in male Brazilian adolescents

OBJECTIVE: To assess the association between breast feeding and blood lipid levels in adolescence. DESIGN: Population based prospective birth cohort study. SETTING: City of Pelotas, Brazil. SUBJECTS: All hospital births taking place in 1982; 79% of all males (n = 2250) were followed up for 18 years, and 2089 blood samples were available. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Total cholesterol and fractions (very low density lipoprotein cholesterol (VLDL), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL)), LDL/HDL ratio, serum triglycerides. RESULTS: Three breast feeding variables were studied: total duration of breast feeding, duration of exclusive or predominant breast feeding, and ever compared with never breast fed. Adjusted analyses were controlled for family income, household assets index, maternal education, maternal pre-pregnancy body mass index (BMI), skin colour, birth weight, gestational age, maternal smoking during pregnancy, and adolescent BMI, and behavioural variables (fat content of diet, physical activity, smoking, and alcohol drinking). Only one association reached borderline significance (p = 0.05): LDL cholesterol was slightly higher among never (mean 41.0 mg/dl; 95% CI 39.4 to 42.7) than among ever breast fed men (38.6 mg/dl; 95% CI 38.6 to 40.3), in the adjusted analyses. All other associations were not significant (p> or =0.09). There was no evidence of effect modification according to preterm status, intrauterine growth retardation, socioeconomic level, growth velocity in the first two years of life, or nutritional status at 2 years of age. CONCLUSIONS: There was no clear association between breast feeding duration and serum lipid concentrations at the age of 18 years in this sample of Brazilian men.     

Relationship between adipokines and lipid profile in postmenopausal women with different apolipoprotein E genotypes

The aim of the authors of this study was to clarify the relationships among apolipoprotein E (ApoE) genotype, blood pressure, lipid profile, serum leptin, and adiponectin in healthy postmenopausal women. The study was conducted between March 2011 and December 2012 on 266 participants aged 50–65 years from the Institute of Rural Health in Lublin, Poland. Results showed that women had four combinations of genotypes: ?2/?3, ?3/?3, ?3/?4, and ?4/?4. Carriers of different genotypes did not differ in terms of age, body mass index (BMI), blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, and adiponectin levels. Mean low-density lipoprotein (LDL) cholesterol levels were higher in ε4 carriers compared to non-carriers. Fasting serum leptin concentrations were higher in homozygotes ?4/?4. Leptin correlated positively with BMI in all study groups and with LDL in ?2/?3, ?3/?3, and ?3/?4. Adiponectin correlated negatively with triglycerides in ?2/?3, ?3/?3, and ?3/?4 and positively with HDL in ?2/?3 carriers. Adipokines were not associated with blood pressure. Multiple regression analyses demonstrated associations among leptin, ApoE ?4/?4, BMI, and LDL, and among adiponectin, BMI, and triglycerides. In healthy postmenopausal women ?4/?4 genotype was associated with lower leptin levels. Homozygosity ?4/?4 was associated with a more atherogenic lipid profile and possibly dysregulation of leptin and adiponectin signaling in lipid metabolism.     

Are lipid values and BMI related to hospitalizations in the hemodialysis population?

OBJECTIVE: To examine the relationship between lipid values and BMI (body mass index) on hospitalizations in hemodialysis (HD) patients. DESIGN: Retrospective (2-year) study. SETTING: Outpatient dialysis center in a large metropolitan city. PATIENTS: This study used 158 HD patients stratified on the basis of ethnicity (non-Black and Black) and diabetic status (nondiabetic and diabetic). INTERVENTION: Subjects were observed for 2 years. Body weight, BMI, lipid parameters, and hospitalization duration were determined 8 times (3-month intervals). MAIN OUTCOME MEASUREs: Body weight, BMI, lipid parameters (serum triglyceride concentration, serum total cholesterol, high-density lipoprotein [HDL]-, low-density lipoprotein [LDL]-, very low-density lipoprotein [VLDL]- cholesterol concentrations, serum Apo-protein A1 [Apo-A1] concentration, and serum Apo-protein B [Apo-B] concentration), and morbidity data were recorded. RESULTS: Hemodialysis subjects were hospitalized 2.3 +/- 1.6 times over the 2-year experimental period. Length of hospital stay averaged 6.6 +/- 0.5 days/hospitalization. Length of hospital stay was inversely related to HDL concentration (r = -0.21, P <.05, n = 89), but not significantly related to BMI in HD subjects. BMI was positively associated with LDL concentration (r = +0.28, P <.01, n = 97). Cholesterol concentration was directly associated with LDL concentration (r = +0.52, P <.01, n = 138), VLDL concentration (r = +0.47, P <.01, n = 139), and triglyceride concentration (r = +0.54, P <.01, n = 155). Mean concentration of HDL-cholesterol was inversely related serum triglyceride concentration (r = -0.43, P <.01, n = 140). Although Apo-A1 concentration was directly associated with HDL level (r = +0.39, P <.01, n = 139), Apo-B was inversely related to HDL level (r = -0.37, P <.01, n = 138) and directly related to cholesterol concentration (r = +0.71, P <.01, n = 138), VLDL concentration (r = +0.87, P <.01, n = 138), and triglyceride concentration (r = +0.81, P <.01, n = 138). CONCLUSION: Cardiac disease remains the primary cause of morbidity and mortality in HD patients, and results of the present study suggest that dyslipidemias present in the HD population negatively impact cardiovascular profiles which, in turn, influence the frequency/duration of hospitalizations. Among all lipid parameters analyzed in the present study, increased LDL and decreased HDL concentrations were more strongly related to length of hospital stay than was BMI.     

Lipids and pulmonary function in the Third National Health and Nutrition Examination Survey

Studies considering the association between total cholesterol and noncardiovascular mortality, particularly from respiratory disease, yield inconclusive findings. To explore this question, the relation of lipids to pulmonary function, specifically forced expiratory volume in 1 second (FEV(1)), was investigated in the Third National Health and Nutrition Examination Survey. Conducted in the United States in 1988-1994 among adults aged > or =17 years, this survey measured serum lipids, FEV(1), and confounding factors including smoking and antioxidants. Multiple linear regression analysis explored the relation of FEV(1)/height(2) to low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, and their respective apolipoproteins (apo) B and A-I. A standard deviation increase in HDL cholesterol or apo A-I was associated with an FEV(1) increase of 43 ml (95% confidence interval (CI): 30, 56) or 29 ml (95% CI: 11, 47), respectively, for an average-height adult. A standard deviation increase in LDL cholesterol or apo B was associated with an FEV(1) decrease of -24 ml (95% CI: -43, -5) or -53 ml (95% CI: -74, -32), respectively, adjusted for serum antioxidant status. The lipid subfractions were differentially associated with FEV(1) consistent with the possibility that LDL cholesterol contributes to endogenous oxidative burden while HDL cholesterol attenuates inflammatory tissue damage. Whether these associations are causal remains to be determined.     

Cancer mortality and lipid and lipoprotein levels. Lipid Research Clinics Program Mortality Follow-up Study

The associations of serum lipid and lipoprotein levels with the risk of cancer mortality were assessed in 2,753 men and 2,476 women aged 40-79 years at baseline (1972-1976) who participated in the Lipid Research Clinics Program Mortality Follow-up Study through 1984. Seventy-nine cancer deaths occurred in men and 65 occurred in women during an average follow-up time of 8.4 years. Total cholesterol and low-density lipoprotein (LDL) cholesterol were significantly inversely associated with overall cancer mortality in men, but no relation was observed in women. Neither high-density lipoprotein (HDL) cholesterol nor triglycerides were significantly related to total cancer mortality in either sex, although in women. HDL cholesterol was positively associated with risk of death from gynecologic cancers. Compared with men with higher cholesterol levels, the relative risk of death from colon cancer, adjusted for age, body mass, cigarette smoking, and alcohol consumption, was 5.20 (95 percent confidence interval (Cl) 1.61-16.8) in men with total cholesterol levels less than or equal to 187 mg/dl and 4.79 (95 percent CI 1.37-16.8) in those with LDL cholesterol levels less than or equal to 119 mg/dl. Death from smoking-related cancers was inversely related to baseline total cholesterol but not to LDL cholesterol. The absence of an association with HDL cholesterol, which has been shown to be lower in persons with clinically manifest malignancy, and evidence from survival curves suggest that the inverse relation in men is not due to preexisting disease.     

High density lipoprotein cholesterol in relation to food consumption and running distance

The effects of diet and exercise on serum triglycerides (Trig), total cholesterol (TC), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), and the HDL to TC ratio (HDL/TC) were evaluated in 45 men training continuously for a duration of 6 months. Body mass index (BMI), percentage body fat, and serum values for Trig, TC, HDL, and HDL/TC were constant throughout the observation period. Bivariate correlations indicated that Trig, TC, and LDL were linearly related and HDL and HDL/TC were related inversely to age, BMI, and percentage body fat, respectively. Distance run per month was linearly related to age, BMI, percentage body fat, Trig, TC, and LDL and inversely related to HDL and HDL/TC. Multiple regression analysis suggested that BMI was the best predictor of Trig, TC, and LDL, while distance run per month was the best predictor of HDL and HDL/TC and second best predictor of Trig. The weekly intakes of fish, bread, cooked cereal, wine, beer, soft drinks, and vegetables were less significant predictors of lipoprotein levels.     

Lifestyle and the development of dyslipidemia: a 4-year follow-up study of middle-aged Japanese Male Office Workers

To examine the lifestyle factors related to the development of dyslipidemia [low-density lipoprotein (LDL) cholesterol ≥ 150 mg/dL, high-density lipoprotein (HDL) cholesterol < 40 mg/dL, or triglyceride ≥ 250 mg/dL], 979 dyslipidemia-free Japanese male office workers aged 35 to 54 years were followed up for four years. The numbers of new incidence cases during the follow-up period were 216 for high LDL cholesterol level, 109 for low HDL cholesterol level, and 78 for high triglyceride level. From the Cox proportional hazards model, adjusted hazard ratios (HRs) for the incidence of high LDL cholesterol level were 0.62 [95% confidence interval (CI): 0.47-0.82] for consuming alcohol every day, 1.39 (95% CI: 1.10-1.77) for 5-kg/m² increase in body mass index (BMI), 1.45 (95% CI: 1.10-1.91) for snacking between meals every day, and 1.64 (95% CI: 1.18-2.30) for not eating vegetables every day. As for the incidence of low HDL cholesterol level, adjusted HRs for current cigarette smoking, consuming alcohol every day, and 5-kg/m² increase in BMI were 1.74 (95% CI: 1.17-2.59), 0.61 (95% CI: 0.41-0.89), and 1.79 (95% CI: 1.29-2.46), respectively. Adjusted HRs for the incidence of high triglyceride level were 1.73 (95% CI: 1.07-2.77) for current cigarette smoking, 1.74 (95% CI: 1.10-2.77) for 5-kg/m² increase in BMI, and 0.50 (95% CI: 0.27-0.90) for working 10 h per day or more. These results suggest that an increase in BMI, current cigarette smoking, and snacking between meals every day is closely associated with an increased risk of atherogenic lipid profiles. On the other hand, alcohol consumption and eating vegetables every day may have an anti-atherogenic effect on serum lipid profiles.     

Improving the prediction of cardiovascular risk: interaction between LDL and HDL cholesterol

BACKGROUND: The ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol (or the ratio of low-density lipoprotein [LDL] to HDL) is currently advocated to estimate the coronary risk associated with LDL and HDL cholesterol levels. METHODS: We analyzed the relation between LDL and HDL cholesterol levels to predict the risk of future coronary events. Using data from the Lipid Research Clinics Follow-up Cohort, we developed multivariate equations to predict coronary deaths among 4684 men and women followed for approximately 12 years. We used these equations to compare the predictive power of the LDL/HDL ratio with the independent effects of LDL and HDL and an LDL-HDL interaction term. We then used each model to forecast the 10-year risk of coronary death based on various lipid levels after adjustment for conventional risk factors (eg, blood pressure, gender, cigarette smoking). RESULTS: Levels of LDL and HDL and the interaction between them are all independent risk factors for coronary death. The benefits of increasing HDL are strongest among persons with high LDL. Conversely, the benefits of decreasing LDL are greatest among those with low HDL. We confirmed these observations in a published dataset showing the effects of treatment of hyperlipidemia. Predictions of benefits of treatment that were based on interaction of LDL and HDL were more accurate than predictions without interaction. CONCLUSIONS: The LDL/HDL ratio alone may not fully capture the complex interaction between LDL and HDL and the relation of each to coronary risk.     

U.S.S.R. and U.S. nutrient intake, plasma lipids, and lipoproteins in men ages 40-59 sampled from Lipid Research Clinics populations

Correlates of high-density lipoprotein (HDL) cholesterol and other lipids and lipoproteins were studied in white men ages 40-59 who were part of the 15% random sample recalled to Visit 2 of the Lipid Research Clinics Program Prevalence Study. Standardized examinations were conducted by two U.S.S.R. and nine U.S. clinics. Mean plasma lipid and lipoprotein cholesterol levels differed significantly between the two countries, with the U.S.S.R. subpopulations having higher mean total plasma and HDL cholesterol levels and HDL/total cholesterol ratios and lower mean triglyceride levels and low-density lipoprotein (LDL)/HDL cholesterol ratios than the U.S. subpopulations. Small, but statistically significant, differences were found in some dietary components. The U.S.S.R. sample had a significantly higher intake of saturated fatty acids, carbohydrates, complex carbohydrates, and kilocalories/kilogram body weight and a significantly lower intake of total fat, polyunsaturated fatty acids, protein, and polyunsaturated/saturated fat ratio. The multiple regression models tested were not major predictors for total plasma cholesterol or LDL cholesterol. Characteristics associated with higher HDL cholesterol levels in both countries were lean body mass, ethanol consumption, abstinence from cigarette smoking, and lower dietary consumption of carbohydrates.     

膳食脂质对中老年高胆固醇血症患者血清胆固醇的影响

对１６７名中老年高胆固醇血症患者的膳食脂质摄入情况及血清总胆固醇（ＴＣ）、高密度脂蛋白胆固醇（ＨＤＬ－Ｃ）和低密度脂蛋白胆固醇（ＬＤＬ－Ｃ）水平进行分析测定,结果表明：膳食脂质摄入及身体质量指数（ＢＭＩ）对血清胆固醇水平有重要影响;ＢＭＩ、膳食胆固醇和饱和脂肪酸与ＴＣ和ＬＤＬ－Ｃ水平呈正关联,ＨＤＬ－Ｃ及其与ＴＣ的比值与单不饱和脂肪酸呈正关联,而与ＢＭＩ呈负关联,提示减少膳食胆固醇和饱和脂肪摄入、     

Sources of variation in plasma lipid and lipoprotein traits in a sample selected for health

Substantial variation in plasma lipid, lipoprotein, and apolipoprotein B levels was found in a sample of healthy white collar workers aged 23-59 years (144 women, 371 men) devoid of most clinically identifiable manifestations of cardiovascular disease or major biochemical anomalies and for whom data were gathered in Montreal, Canada, in 1987. The nature of this variability was examined for each gender by means of a stepwise linear regression analysis using indices of biologic variation and behavioral traits. In women, age, height, and weight together accounted for approximately 10% and uric acid for another 7-10% of total cholesterol, low density lipoprotein (LDL) cholesterol, and apolipoprotein B level variation. In men, age alone accounted for 13-16% of the total variation in these traits while uric acid contributed only 3%. The additional contribution of behavioral traits was found to be at least double that associated with the indices of biologic variation for measures of very low density lipoprotein (VLDL) and high density lipoprotein (HDL) cholesterol in women and HDL cholesterol in men. After taking all of the above into account, genetic variation determined by the three common apo E alleles explained an additional 6% of LDL cholesterol variation in women and 3.5% in men. These results emphasize the range of variability in lipid, lipoprotein, and apolipoprotein values in healthy individuals as well as important gender differences in the contribution of biologic, behavioral, and genetic factors in this variability.     

Prevention of Heart Disease: Is LDL Reduction the Outcome of Choice? Absolutely Yes

There is only one well-established relationship between blood cholesterol lipid fractions and coronary artery disease (CAD) that meets all the Heiss and Tyroler criteria of causality. While there are a number of blood lipid fractions, only LDL cholesterol satisfies these criteria. We review the effect of reducing low density lipo-protein (LDL) cholesterol levels on CAD in the landmark lipid intervention trials performed since 1972. Lowering of LDL cholesterol consistently and systematically resulted in a reduction of cardiovascular events, irrespective of the therapy applied or the changes in high density lipoprotein (HDL) cholesterol or triglyceride levels. Findings accumulated over many studies and many years provided sufficient evidence to satisfy all the criteria required to establish a causative relationship between LDL cholesterol and CAD. Consistent inter-ventional benefit demonstrated that reduction of LDL cholesterol is currently the treatment of choice in prevention of heart disease.     

Associations between body height, body composition and cholesterol levels in middle-aged men. The coronary risk factor study in southern Sweden (CRISS)

Background: Short body height is associated with increased risk for coronary heart disease; however, mechanisms are not fully explained. In this study, associations between body height and serum cholesterol, non-high-density lipoprotein (non-HDL cholesterol) and high-density lipoprotein (HDL cholesterol) were investigated. Methods: Prospective cohort study of middle-aged men from Helsingborg, Sweden starting 1990. Two birth-year cohorts were invited at 37, 40 and 43 years of age; participation at baseline was 991 (68%). Serum and HDL cholesterol, systolic and diastolic blood pressure, weight, height, waist and hip circumferences were measured. Non-HDL cholesterol, body mass index (BMI) and waist/hip ratio (WHR) were calculated. The participants completed a questionnaire covering lifestyle variables. Results: There were statistically significant inverse correlations between body height and serum cholesterol (–0.11) and non-HDL cholesterol (–0.12). One standard deviation, 6.7 cm, taller body height was associated with a lower serum cholesterol (–0.12 mmol/l) and a lower non-HDL cholesterol (–0.13 mmol/l; p < 0.001). These associations remained when adjusted for BMI and WHR. Men with serum cholesterol equal to or above 6.5 mmol/l were significantly shorter (mean 178.71 cm) than men with serum cholesterol below 6.5 mmol/l (mean 179.71 cm). In addition, BMI and WHR were positively associated with serum and non-HDL cholesterol and inversely associated with HDL cholesterol. The change in cholesterol levels over the six-year follow-up was significantly associated to the change in BMI and WHR. Conclusions: Body height had an independent and inverse relation to serum cholesterol and non-HDL cholesterol in middle-aged men, and the lipid pattern suggests that the underlying mechanism might be different from the traditional association between lipids and the metabolic syndrome. Although the direct clinical implication is limited, our results may help to explain the association between short height and risk of myocardial infarction.     

Effect of Implanon and Norplant subdermal contraceptive implants on serum lipids--a randomized comparative study

The objective of this study was to assess the possible differences in effects of Implanon (etonogestrel 68 mg, single-rod) and Norplant (levonorgestrel 36 mg, six capsules) implants on serum lipids over 2 years of use. In this 2-year open randomized study of 80 implant acceptors, selected serum lipids were tested before implant insertion and at 6, 12 and 24 months after implant insertion. The lipid parameters evaluated were: total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, apolipoprotein A-I and apolipoprotein B. During the 2 years, the serum lipid pattern in the Implanon users was not significantly different from that of the Norplant users. There was slight decrease in HDL-C levels in both the groups but there were no significant changes in the HDL/TC ratio and the HDL/LDL ratio. Although it was statistically significant, the magnitude of decrease in HDL-C from preinsertion levels in Implanon users was only 5.8% at the end of 2 years.     

Low-density lipoprotein subclass distribution pattern and adiposity-associated dyslipidemia in postmenopausal women

OBJECTIVE: A predominance of small, dense low-density lipoprotein (LDL) particles (subclass pattern B) is associated with increased risk for coronary heart disease and is characterized by elevated triglycerides and depressed high-density lipoprotein (HDL) cholesterol concentrations. The present analysis was undertaken to assess the impact of LDL subclass distribution pattern and adiposity on serum lipids in postmenopausal women. METHODS: Anthropometric measurements and fasting lipid data were obtained from 254 postmenopausal women 70 years of age or younger, not receiving sex hormone replacement, who were participating in a clinical trial designed to assess the influence of hormone replacement regimens on coronary heart disease risk markers. RESULTS: The prevalence of LDL subclass pattern B was 32%. Triglyceride levels were higher and HDL cholesterol lower (both p<0.001) in women with pattern B vs. pattern A, but total and LDL cholesterol levels did not differ. LDL subclass pattern contributed independently to the variance in HDL cholesterol (p<0.001) and log(e) triglyceride (p<0.001) concentrations explained by anthropometric variables (waist circumference or body mass index). Compared to women with LDL subclass pattern A and waist circumference below the median value of 83.0 centimeters, those with pattern B and waist > or =83.0 centimeters had markedly lower HDL cholesterol levels [44.0 (41.6-47.4) vs. 57.2 (54.1-60.3) mg/dL, mean (95% CI)] and increased triglyceride concentrations [geometric mean 147.8 (131.6-165.7) vs. 95.4 (88.2-102.5) mg/dL]. CONCLUSIONS: These data suggest that adiposity and LDL subclass distribution pattern are independent determinants of plasma triglyceride and HDL cholesterol concentrations in postmenopausal women.