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.     

Effects of similarities in lifestyle habits on familial aggregation of high density lipoprotein and low density lipoprotein cholesterol: the NHLBI Family Heart Study.

It is generally assumed that familial aggregation of lipids relates to both genetic and shared environmental factors. To determine the degree to which familial similarities in lifestyle habits explain familial aggregation of high density lipoprotein (HDL) and low density lipoprotein (LDL) cholesterol, the authors analyzed 1994-1996 data from 2,284 US adult participants in the National Heart, Lung, and Blood Institute Family Heart Study. For men and women, respectively, HDL cholesterol correlated with alcohol consumption (r = 0.27, p < 0.001; r = 0.21, p < 0.001), exercise (r = 0.06, p = 0.05; r = 0.10, p = 0.002), and smoking (r = -0.09, p = 0.005; r = -0.13, p < 0.001). There was strong familial aggregation of HDL cholesterol (parent-child, r = 0.32; sibling-sibling, r = 0.29), but less than 10% was explained by lifestyle habits. For LDL cholesterol, weak correlations were found for intake of total fat (r = 0.06, p = 0.07) and fruits/vegetables (r = -0.09, p = 0.005) among men and for smoking (r = 0.10, p = 0.002) among women. LDL cholesterol correlated strongly among family members (parent-child, r = 0.24; sibling-sibling, r = 0.31), but essentially none of this aggregation related to the lifestyle factors studied. This study suggests that lifestyle factors have little effect on the familial aggregation of HDL and LDL cholesterol.     

Adverse influences of alcohol, tobacco, and oral contraceptive use on cardiovascular risk factors during transition to adulthood

Risk factors for cardiovascular disease were measured in 990 young adults, aged 17-24 years, in a 1982-1983 survey of the biracial (black-white) community of Bogalusa, Louisiana. Even after controlling for age and obesity, several lifestyle factors (cigarette smoking, alcohol consumption, and oral contraceptive use) were independently related (p less than 0.05) to levels of serum lipids, lipoprotein cholesterol fractions, and blood pressure. Oral contraceptive use was associated with increased levels of both serum triglycerides (20 mg/dl, blacks; 25 mg/dl, whites) and low density lipoprotein (LDL) cholesterol (19 mg/dl, whites), and decreased levels of high density lipoprotein (HDL) cholesterol (-6 mg/dl, whites). Linear regression analyses also showed that cigarette smoking was associated with elevated levels of serum triglycerides (ranging from 15 to 26 mg/dl) and decreased levels of HDL cholesterol (ranging from -9 to -11 mg/dl) in white males and females. Although persons who smoked cigarettes were also likely to consume alcohol, alcohol intake in nonsmokers was positively associated with levels of serum triglycerides, LDL cholesterol, and very low density lipoprotein cholesterol in white males, and with blood pressure levels in black males. A statistically significant association between alcohol intake and HDL cholesterol levels (r = 0.24) was observed only in white females who did not smoke. These adverse influences of lifestyle factors on cardiovascular disease risk may provide a rational basis for intervention during adolescence and early adulthood.     

Life-style correlates of risk factor change in young adults: an eight-year study of coronary heart disease risk factors in the Framingham offspring

This paper describes the life-style and behavioral correlates of change in coronary heart disease risk factors measured eight years apart in the young adult offspring of the Framingham Heart Study cohort. Changes in total cholesterol, lipoprotein cholesterols (high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, very low density lipoprotein (VLDL) cholesterol), and blood pressure were observed longitudinally in 397 men and 497 women who were aged 20-29 years at entry into the study. Stepwise multiple linear regression procedures were used to identify characteristics and their changes that were significantly associated with risk factor changes in each sex. The attribute most strongly and consistently related to lipoprotein and blood pressure changes in both sexes was change in body mass index (p less than or equal to 0.01 or p less than or equal to 0.001). In addition to weight gain, increases in alcohol consumption in men (p less than or equal to 0.001) and beginning oral contraceptive use in women (p less than or equal to 0.01) were associated with increases in blood pressure over the study period. Weight loss, stopping or decreasing cigarette consumption (p less than or equal to 0.01), increasing alcohol intake (p less than or equal to 0.01), and, in women, discontinuing oral contraceptive use (p less than or equal to 0.01) also were independently related to improvements in lipoprotein profiles during follow-up. After adjustment for all life-style correlates of risk factor change, simple self-assessments of physical activity or activity change were negatively associated with changes in VLDL cholesterol (p less than or equal to 0.01) and the total cholesterol/HDL cholesterol ratio (p less than or equal to 0.05) in men and positively associated with changes in HDL cholesterol (p less than or equal to 0.05) in women. Sociodemographic and behavioral characteristics that made a further independent contribution to increases in the total cholesterol/HDL cholesterol ratio in men were blue-collar occupation and trait Type A behavior pattern (p less than or equal to 0.05). Unexplained, but provocative, results of this study included the associations of interim vasectomy with increases in total cholesterol in men (p less than or equal to 0.05) and of number of livebirths with decreases in total cholesterol and HDL cholesterol in women (p less than or equal to 0.01). These findings are among the first to offer prospective evidence which suggests that habits and behaviors during young adulthood have a substantial effect on lipid and lipoprotein profiles in men and women.(ABSTRACT TRUNCATED AT 400 WORDS)     

Lipid responses to a dietary docosahexaenoic acid supplement in men and women with below average levels of high density lipoprotein cholesterol

OBJECTIVE: To assess fasting lipid responses to a docosahexaenoic acid (DHA) supplement in men and women with below-average levels of high-density lipoprotein (HDL) cholesterol. METHODS: This randomized, double-blind, controlled clinical trial included 57 subjects, 21-80 years of age, with fasting HDL cholesterol concentrations < or =44 mg/dL (men) and < or =54 mg/dL (women), but > or =35 mg/dL. Subjects were randomly assigned to receive either 1.52 g/day DHA from capsules containing DHA-rich algal triglycerides or olive oil (control) for six weeks. RESULTS: There were no significant differences between groups in baseline lipid values. The DHA supplemented group showed significant changes [-43 (DHA) vs. -14 (controls) mg/dL, p = 0.015] and percent changes [-21% (DHA) vs. -7% (controls), p = 0.009] in triglycerides, total (12 vs. 3 mg/dL; p = 0.021 and 6% vs. 2%; p = 0.018) and low-density lipoprotein (17 vs. 3 mg/dL; p = 0.001 and 12% vs. 3%; p = 0.001) cholesterol concentrations, and in the triglyceride to HDL cholesterol ratio (-1.33 vs. -0.50, p = 0.010), compared with controls. In addition, there was a significant reduction in the percentage of LDL cholesterol carried by small, dense particles in the DHA supplemented group (changes = -10% vs. -3%, p = 0.025). CONCLUSIONS: Supplementation with 1.52 g/d of DHA in men and women with below-average HDL cholesterol concentrations raised the LDL cholesterol level, but had favorable effects on triglycerides, the triglyceride/HDL cholesterol ratio and the fraction of LDL cholesterol carried by small, dense particles. Further research is warranted to evaluate the net impact of these alterations on cardiovascular risk.     

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.     

The effects of gender and age on associations between blood lipid levels and obesity in Danish men and women aged 35-65 years.

The purpose of the study was to assess the influence of gender and age on the associations between different measures of obesity, and blood lipid levels. Overall obesity (body fat, body fat percentage and body mass index) or abdominal obesity (waist/hip-ratio, waist/thigh-ratio and waist-circumference) and lipid levels [high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), total cholesterol and triglyceride level] were measured in 1987/88 in a random Danish population sample of men and women (N = 2987), aged 35, 45, 55 and 65 yr. All lipid levels were dependent on gender and age. The associations between most measures of obesity and HDL or LDL were independent of gender and age, whereas, with a few exceptions, associations between measures of obesity and total cholesterol, VLDL or triglycerides were dependent on gender and/or age. Compared to levels of HDL, LDL and total cholesterol, abdominal obesity specifically affected levels of VLDL or triglycerides, whereas overall obesity affected HDL, LDL, VLDL, total cholesterol and triglyceride levels more evenly. When men and women were compared, associations between the measures of obesity and blood lipids were stronger in men than in women of the same age, except for the associations between measures of abdominal obesity and VLDL or triglycerides in 45-year-old women. No age trend was found for associations between the measures of obesity and VLDL or triglycerides, whereas young age-groups showed stronger associations between obesity and total cholesterol than older age-groups. Failure to consider age/gender effects induces bias and may lead to misleading conclusions regarding the bivariate association between obesity and lipids, and further may make results from population studies incomparable.     

Reduction of abdominal fat and chronic disease factors by lifestyle change in migrant Asian Indians older than 50 years

The objective of this study was to assess the impact of a group diet and physical activity intervention on body composition, blood lipid profile and insulin resistance in migrant Asian Indian volunteers. Total body and abdominal fat, waist girth, serum glucose, insulin and lipids were measured one month before and immediately prior to an intervention designed to encourage increased physical activity and improved diet. Measurements were repeated after a 5-month period of altered exercise and dietary habits. Over this period monthly group education sessions were held on diet and physical activity and the importance of lifestyle changes to reduce risk factors for chronic disease. Forty one (21M, 20F) volunteers (aged > 50 y) were recruited from Asian Indian community groups in urban Auckland, New Zealand. Body weight, total and percentage body fat, waist girth and abdominal fat decreased in men following the intervention (p < 0.006) while these changes were not statistically significant in women. In both men and women high density lipoprotein (HDL) levels increased and LDL and total cholesterol/HDL ratio decreased (p < 0.002) without changes in serum glucose, insulin and triglycerides. Reduction in systolic and diastolic blood pressure was associated with an increase in HDL cholesterol in women (r = 0.63, p = 0.003, r = 0.48, p = 0.03) but not in men (r = 0.09, p = 0.69, r = 0.04, p = 0.86). Over a five month period, an Asian Indian community group diet and physical activity intervention resulted in significant reductions in total and abdominal body fat and blood lipid risk factors but not in insulin sensitivity or resistance.     

Serum lipid profiles in Japanese women and men during consumption of walnuts

OBJECTIVE: To determine the serum cholesterol, apolipoproteins and LDL oxidizability in young Japanese women and men during walnut consumption and to evaluate its active principle. DESIGN: Experimental study with a randomized design. SUBJECTS: Twenty healthy women and 20 healthy men. INTERVENTIONS: Subjects were randomly assigned to consume each of two mixed natural diets for 4 weeks in a cross-over design. Reference and walnut diets were designed and the walnut diet had 12.5% of the energy derived from walnuts (44-58 g/day). RESULTS: The total cholesterol and serum apolipoprotein B concentrations, and the ratio of LDL cholesterol to HDL cholesterol was significantly lowered in women and men when fed on the walnut diet, than when on the reference diet (P相似文献   

Sex differences in the coronary heart disease risk profile: a possible role for insulin. The Beaver County Study

The mortality rate from coronary heart disease is much higher among men than women except in diabetes mellitus, which appears to reduce this sex difference. It is hypothesized that the female advantage is due, at least partly, to the more efficient insulin mediated glucose homeostasis in females, an advantage lost in the diabetic state. The authors studied 170 young adult men and women aged 20-24 years from a population-based survey in Beaver County, Pennsylvania, in 1981-1982, in an attempt to further elucidate the sex-specific relationships between fasting serum insulin concentrations and several risk factors. Women who used oral contraceptives and subjects whose fasting serum glucose exceeded 110 mg/dl were excluded. Insulin was related to body mass index in both sexes (r = 0.31; p less than 0.01 for men; r = 0.26, p less than 0.01 for women) and to systolic blood pressure (r = 0.27, p less than 0.01 for men; r = 0.36, p less than 0.001 for women). Insulin was related to diastolic blood pressure in men only (r = 0.31, p less than 0.05). Multivariate analysis revealed fasting serum insulin to be an independent predictor of systolic blood pressure in both sexes and of diastolic blood pressure in men only. Insulin was inversely related to high density lipoprotein cholesterol only among men and this relationship appeared to be largely independent of body mass index and triglycerides. Results indicate that insulin concentration is associated with an adverse coronary heart disease risk factor profile especially among men, consistent with their excess risk of cardiovascular disease.     

Serum lipid and apolipoprotein distributions in Hong Kong Chinese.

STUDY OBJECTIVE--The aim was to describe the distribution of lipids and apolipoproteins in the Chinese population in Hong Kong. DESIGN--This was a prospective, cross sectional, population based survey. SETTINGS--The study was conducted in a single, self referred, out patient screening centre. PARTICIPANTS--Altogether 825 Chinese adults aged > or = 20 years were screened. One hundred subjects who had previously had lipid measurement and 29 who were taking lipid modifying drugs were excluded but 289 men and 407 women remained for further analysis. MAIN RESULTS--Age standardised mean (SEM) lipids concentrations for Hong Kong Chinese were total cholesterol: men, 5.48 (0.05) mmol/l and women, 5.46 (0.06) mmol/l; triglycerides: men, 1.22 (1.03) mmol/l and women, 1.00 (1.03) mmol/l; high density lipoprotein (HDL) cholesterol: men, 1.25 (0.02) mmol/l and women, 1.42 (0.02) mmol/l; low density lipoprotein (LDL) cholesterol: men, 3.56 (0.05) mmol/l and women, 3.50 (0.06) mmol/l; apolipoprotein A-I (apo A-I): men, 1.34 (0.01) g/l and women, 1.46 (0.01) g/l; and apolipoprotein B (apo B): men, 1.15 (0.02) g/l and women, 1.06 (0.02) g/l. The total to HDL cholesterol ratios were men, 4.62 (0.07) and women, 4.10 (0.08); and apo B to apo A-I ratios (apo B/A) were men, 0.88 (0.02) and women, 0.75 (0.02). While levels of total cholesterol, LDL cholesterol, apo B, triglycerides, total/HDL cholesterol, and apo B/A were positively associated with age in both sexes and were higher in men before the age 50-59 years, they rose steeply thereafter in women to cross over the levels in men. In contrast, HDL cholesterol decreased with age while apo A-I remained constant, and both were consistently higher in women than in men in all age groups. CONCLUSIONS--Hong Kong Chinese have attained lipid profiles similar to those in other developed western populations. Environmental factors seem influential in this regard. Faced with the increasing coronary mortality of recent years, there should be a major effort to reduce the cholesterol concentrations in this population.     

Carbohydrate restriction alters lipoprotein metabolism by modifying VLDL, LDL, and HDL subfraction distribution and size in overweight men

To determine the effects of carbohydrate restriction (CR) with and without soluble fiber on lipoprotein metabolism, 29 men participated in a 12-wk weight loss intervention. Subjects were matched by age and BMI and randomly assigned to consume 3 g/d of either a soluble fiber supplement (n=14) or placebo (n=15) with a macronutrient energy distribution of approximately 10% carbohydrate, approximately 65% fat, and approximately 25% protein. Because the groups did not differ in any of the variables measured, all data were pooled and comparisons were made between baseline and 12 wk. After 12 wk, subjects had a mean weight loss of 7.5 kg (P<0.001), and abdominal fat was reduced by 20% (P<0.001). Plasma LDL cholesterol and triglycerides (TG) were significantly reduced by 8.9 and 38.6%, respectively. Similarly, apolipoproteins C-I (-13.8%), C-III (-21.2%) and E (-12.5%) were significantly lower after the intervention. In contrast plasma HDL-cholesterol concentrations were increased by 12% (P<0.05). Changes in plasma TG were positively correlated with reductions in large (r=0.615, P<0.01) and medium VLDL particles (r=0.432, P<0.05) and negatively correlated with LDL diameter (r=-0.489, P<0.01). Changes in trunk fat were positively correlated with medium VLDL (r=0.474, P<0.0) and small LDL (r=0.405, P<0.05) and negatively correlated with large HDL (r=-0.556, P<0.01). We conclude that weight loss induced by CR favorably alters the secretion and processing of plasma lipoproteins, rendering VLDL, LDL, and HDL particles associated with decreased risk for atherosclerosis and coronary heart disease.     

Sex differences in high-density lipoprotein cholesterol and subfractions among young black adults

The high-density lipoprotein cholesterol and high-density lipoprotein subfraction (HDL2 and HDL3) concentrations were examined in 170 young black adults. The women examined had significantly higher total high-density lipoprotein cholesterol concentrations than the men, i.e., 57.0 mg/dl vs 51.2 mg/dl, P less than 0.002. The increased high-density lipoprotein cholesterol among women represented a significant increase in both HDL2 and HDL3 cholesterol concentrations. The sex differential could not be explained by body mass index, alcohol consumption, or physical activity. The determinants of high-density lipoprotein cholesterol for men appeared to be different than those for women.     

Correlates of high-density lipoprotein cholesterol in a sample of healthy workers

METHODS. Correlates of high-density lipoprotein cholesterol are analyzed in a sample of 797 male workers in southern Italy participating in the Olivetti Heart Study. At the univariate level high-density lipoprotein cholesterol concentrations are positively related to alcohol consumption (r = 0.127; P less than or equal to 0.001) and sport activity (r = 0.074; P less than or equal to 0.05) and inversely related to body mass index (r = -0.160; P less than or equal to 0.001), serum triglycerides (r = -0.349; P less than or equal to 0.001), cigarette smoking (r = -0.227; P less than or equal to 0.001), and coffee consumption (r = -0.153; P less than or equal to 0.001). RESULTS. In the group as a whole, body mass index, alcohol consumption, cigarette smoking, and serum triglycerides remain significantly related to high-density lipoprotein cholesterol in the multivariate model, while the association with coffee intake and sport activity loses statistical significance. A significant negative interaction is reported between physical activity and cigarette smoking, and a positive significant linear trend between high-density lipoprotein cholesterol and sport activity is observed only in nonsmokers. CONCLUSION. These findings suggest that body mass index, alcohol consumption, cigarette smoking, serum triglycerides, and sport activity are important correlates of high-density lipoprotein cholesterol but that the positive significant association between sport activity and high-density lipoprotein cholesterol is absent in smokers.     

Fasting plasma insulin modulates lipid levels and particle sizes in 2- to 3-year-old children

OBJECTIVE: Obesity and hyperinsulinemia are associated with dyslipidemia in adults and older children, but little is known about these relationships in very young children. We examined the relation of fasting insulin to lipid levels and lipid particle size in young healthy children. RESEARCH METHODS AND PROCEDURES: Analyses were performed on data from 491 healthy 2- and 3-year old Hispanic children enrolled in a dietary study conducted in New York City, 1992-1995. Obesity measures included BMI, ponderal index, skinfold thickness, and waist circumference. Low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol particle size were measured by nuclear magnetic resonance. RESULTS: Fasting insulin level was positively correlated with triglyceride levels (r = 0.24 for boys and r = 0.23 for girls; p < 0.001 for both) and inversely correlated with HDL-cholesterol level in boys (r = -0.20; p < 0.01). Higher fasting insulin level was also correlated with smaller mean HDL particle size in both boys (r = -0.21; p < 0.001) and girls (r = -0.14; p < 0.05) and smaller mean LDL particle size in boys (r = -0.13; p < 0.05). The associations of fasting insulin level with triglyceride and HDL-cholesterol levels and HDL and LDL particle size remained significant after multivariate regression adjustment for age, sex, and BMI or ponderal index. DISCUSSION: Fasting insulin level is associated with relative dyslipidemia in healthy 2- and 3-year-old Hispanic children.     

High density lipoprotein cholesterol as a predictor of cardiovascular disease mortality in men and women: the follow-up study of the Lipid Research Clinics Prevalence Study

With data from the Lipid Research Clinics Prevalence Study used as a baseline, an average of 8.4 years of mortality follow-up has been completed for 8,825 male and female participants who were at least 30 years of age at the time of the study. The participants were examined at 10 North American sites during 1972-1976. Univariate findings for high density lipoprotein (HDL) cholesterol in the 7,569 persons initially free of coronary heart disease indicate an inverse relation with cardiovascular disease mortality for men and women. Controlling for age, low density lipoprotein (LDL) cholesterol, triglycerides, body mass index, systolic blood pressure, and smoking, multivariate analysis results indicate inverse relations between HDL cholesterol and cardiovascular disease mortality. In men, the cardiovascular disease mortality rate ratio for HDL cholesterol increments of 10 mg/dl was similar to the cardiovascular disease mortality rate ratio for LDL cholesterol increments of 30 mg/dl. In women, HDL cholesterol is more closely related to cardiovascular disease than is LDL cholesterol. HDL cholesterol is inversely related to both coronary heart disease and other cardiovascular disease mortality in both sexes, though the relation of HDL cholesterol with coronary heart disease mortality in women approached statistical significance only for the combined end point of suspect and definite cases. No relation was observed in either sex group between HDL cholesterol and noncardiovascular disease mortality. This study, only the second large prospective study evaluating the role of HDL cholesterol in women, confirms both the importance and the independence in both men and women of HDL cholesterol in the epidemiology of coronary heart disease and other cardiovascular disease mortality.     

Hyperglycemia and coronary risk factors results from western Austria

We investigated mean levels and prevalences of total cholesterol, HDL cholesterol, triglycerides, fasting blood glucose, systolic blood pressure and body mass index in adults aged 25 to 64 years participating in the WHO Country-wide Integrated Noncommunicable. Diseases Intervention (CINDI) Programme in Vorarlberg, western Austria. According to the Austrian expert panel and based upon the above age standardized risk factors 50.9% of the male and 29.3% of the female population were at high risk for developing coronary heart disease. Risk factor levels were further compared between euglycemic and hyperglycemic participants. After adjusting for age hyperglycemia was associated with higher body mass index in men (p=0.026) and women (p<0.001), higher systolic blood pressure in men (p<0.001) and women (p=0.003), and higher levels of triglycerides in women (p=0.008). No significant differences were observed in total and HDL cholesterol in either sex. When controlling for age and body mass index, fasting blood glucose levels had significant associations only with systolic blood pressure in men (p=0.001). But, with respect to all risk factors, hyperglycemic participants had an age-adjusted adverse coronary risk profile both in men (p=0.002) and in women (p<0.001).     

Cholesterol measures to identify and treat individuals at risk for coronary heart disease

BACKGROUND: Low-density lipoprotein (LDL)-based guidelines are currently used to initiate and monitor cholesterol-lowering therapy. METHODS: Using stratified analyses, data from the Framingham Heart Study and the Coronary Primary Prevention Trial were evaluated to determine whether (1) cholesterol levels (total cholesterol [TC] or LDL [low-density lipoprotein]) better discriminated risk for coronary heart disease (CHD) than cholesterol ratios (LDL/HDL [high-density lipoprotein] or TC/HDL); and (2) whether changes in ratios better predicted risk reduction than changes in levels. RESULTS: Individuals with similar LDL/HDL ratios had similar risks for CHD regardless of whether they had high LDL levels or low LDL levels (23% vs 23% for the CPPT, 13.8% vs 14% for FHS men, and 8.6% vs 10.9% for FHS women). Among men with similar initial LDL/HDL ratios and similar changes in LDL/HDL ratios, risks for CHD did not differ (20.3% compared with 21.0%; p =0.96) between those with the largest and smallest reductions in LDL levels (21.3% compared with 6.5%). Among men with similar initial LDL levels and similar LDL reductions, a 20% reduction in risk for CHD was seen (19.5% compared with 24.5%; p =0.005) between those with the largest and smallest reductions in LDL/HDL ratios (23% compared with 4.6%). TC/HDL had predictive ability similar to LDL/HDL. CONCLUSIONS: Cholesterol levels do not provide incremental predictive value over cholesterol ratios in identifying people at risk for CHD. Changes in ratios are better predictors of successful CHD risk reduction than changes in levels. Future guidelines should consider incorporating ratios in initiating and monitoring successful lipid-lowering therapy.     

Serum plant sterols and their relation to cholesterol absorption

beta-Sitosterol and campesterol were measured in serum lipoproteins of 17 subjects from two families. The serum levels of the two phytosterols were closely correlated with each other (r = 0.974), less consistently with serum cholesterol (r = 0.489), and not at all with serum triglycerides. As compared to cholesterol, serum free and esterified phytosterols tended to be accumulated in HDL where the phytosterol/cholesterol ratios were almost 40% higher than in VLDL and LDL. The serum phytosterol concentrations, the phytosterol/cholesterol ratios, especially in VLDL and LDL, and the fractional absorption of cholesterol were higher in women than in men. The levels of the phytosterols in whole serum and in each lipoprotein were significantly correlated with the percentage absorption of dietary cholesterol but were independent of the amount of dietary cholesterol and plant sterols. Our findings suggest that, in general, serum levels of noncholesterol sterols are effectively determined by the absorption which in turn is proportionate to the fractional absorption of cholesterol.     

Associations of oral contraceptive use with serum lipids and lipoproteins in young women: The Bogalusa Heart Study

PURPOSE: Cross-sectional and longitudinal associations of serum lipids and lipoproteins with oral contraceptive (OC) use were examined among white and black women aged 18–27 years in 1985–1986 and 1988–1991 in the Bogalusa Heart Study, a study of cardiovascular disease in a Southern community.

METHODS: Analyses of covariance.

RESULTS: In 1985–1986, white OC users had significantly (p < 0.05) higher adjusted mean total and low density lipoprotein (LDL) cholesterols, and lower high density lipoprotein (HDL) cholesterol compared with nonusers; black OC users had higher triglycerides and LDL cholesterol, and lower HDL cholesterol. In 1988–1991, white OC users had higher total cholesterol, triglycerides, and LDL cholesterol, while black OC users had higher triglycerides. OC use was unrelated to mean HDL cholesterol levels in 1988–1991; however, a lower percentage of white OC users than nonusers in 1988–1991 had HDL cholesterol levels < 35 mg/dl. Longitudinally, white OC nonusers at baseline who used OCs at follow-up had significant increases from baseline levels in total cholesterol, triglycerides, and very low density lipoprotein (VLDL) and LDL cholesterols; black women showed an increase only in LDL cholesterol. White women who stopped using OCs by follow-up had a decrease in VLDL and LDL cholesterols, and an increase in HDL cholesterol. White OC users at both exams also had a significant increase in HDL cholesterol, whereas women who began using OCs by follow-up did not.

CONCLUSIONS: The unfavorable lipid profile associated with OC use was not apparent upon discontinued use. Lack of an adverse effect of OC use on HDL cholesterol at follow-up may be the result of changing formulations, and requires further examination.