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. 1989 Apr 15;298(6679):998–1002. doi: 10.1136/bmj.298.6679.998

Concentrations of high density lipoprotein cholesterol, triglycerides, and total cholesterol in ischaemic heart disease.

S J Pocock 1, A G Shaper 1, A N Phillips 1
PMCID: PMC1836343  PMID: 2499392

Abstract

OBJECTIVE--To assess the roles of serum concentrations of total cholesterol, high density lipoprotein cholesterol, and triglycerides in predicting major ischaemic heart disease. DESIGN--Men recruited for the British regional heart study followed up for a mean of 7.5 years. SETTING--General practices in 24 British towns. PATIENTS--7735 Middle aged men. END POINT--Predictive value of serum concentrations of lipids. MEASUREMENTS AND MAIN RESULTS--At initial screening serum concentrations of total cholesterol, high density lipoprotein cholesterol, and triglycerides were determined from non-fasting blood samples. Altogether 443 major ischaemic heart disease events (fatal and non-fatal) occurred during the study. Men in the highest fifth of the distribution of total cholesterol concentration (greater than or equal to 7.2 mmol/l) had 3.5 times the risk of ischaemic heart disease than did men in the lowest fifth (less than 5.5 mmol/l) after adjustment for high density lipoprotein cholesterol concentration and other risk factors. Men in the lowest fifth of high density lipoprotein cholesterol concentration (less than 0.93 mmol/l) had 2.0 times the risk of men in the highest fifth (greater than or equal to 1.33 mmol/l) after adjustment for total cholesterol concentration and other risk factors. Men in the highest fifth of triglyceride concentration (greater than or equal to 2.8 mmol/l) had only 1.3 times the risk of those in the lowest fifth (less than 1.08 mmol/l) after adjustment for total cholesterol concentration and other risk factors; additional adjustment for high density lipoprotein cholesterol concentration made the association with ischaemic heart disease disappear. CONCLUSIONS--Serum concentration of total cholesterol is the most important single blood lipid risk factor for ischaemic heart disease in men. High density lipoprotein cholesterol concentration is less important, and triglyceride concentrations do not have predictive importance once other risk factors have been taken into account.

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Selected References

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  1. Brunner D., Weisbort J., Meshulam N., Schwartz S., Gross J., Saltz-Rennert H., Altman S., Loebl K. Relation of serum total cholesterol and high-density lipoprotein cholesterol percentage to the incidence of definite coronary events: twenty-year follow-up of the Donolo-Tel Aviv Prospective Coronary Artery Disease Study. Am J Cardiol. 1987 Jun 1;59(15):1271–1276. doi: 10.1016/0002-9149(87)90903-9. [DOI] [PubMed] [Google Scholar]
  2. Cambien F., Jacqueson A., Richard J. L., Warnet J. M., Ducimetiere P., Claude J. R. Is the level of serum triglyceride a significant predictor of coronary death in "normocholesterolemic" subjects? The Paris Prospective Study. Am J Epidemiol. 1986 Oct;124(4):624–632. doi: 10.1093/oxfordjournals.aje.a114435. [DOI] [PubMed] [Google Scholar]
  3. Carlson L. A., Böttiger L. E., Ahfeldt P. E. Risk factors for myocardial infarction in the Stockholm prospective study. A 14-year follow-up focussing on the role of plasma triglycerides and cholesterol. Acta Med Scand. 1979;206(5):351–360. [PubMed] [Google Scholar]
  4. Castelli W. P. The triglyceride issue: a view from Framingham. Am Heart J. 1986 Aug;112(2):432–437. doi: 10.1016/0002-8703(86)90296-6. [DOI] [PubMed] [Google Scholar]
  5. Enger S. C., Hjermann I., Foss O. P., Helgeland A., Holme I., Leren P., Norum K. R. High density lipoprotein cholesterol and myocardial infarction or sudden coronary death: a prospective case-control study in middle-aged men of the Oslo study. Artery. 1979 Feb;5(2):170–181. [PubMed] [Google Scholar]
  6. Fox M. H., Gruchow H. W., Barboriak J. J., Anderson A. J., Hoffmann R. G., Flemma R. J., King J. F. Risk factors among patients undergoing repeat aorta-coronary bypass procedures. J Thorac Cardiovasc Surg. 1987 Jan;93(1):56–61. [PubMed] [Google Scholar]
  7. Goldbourt U., Cohen L., Neufeld H. N. High density lipoprotein cholesterol: prognosis after myocardial infarction. The Israeli Ischemic Heart Disease Study. Int J Epidemiol. 1986 Mar;15(1):51–55. doi: 10.1093/ije/15.1.51. [DOI] [PubMed] [Google Scholar]
  8. Gordon D. J., Probstfield J. L., Garrison R. J., Neaton J. D., Castelli W. P., Knoke J. D., Jacobs D. R., Jr, Bangdiwala S., Tyroler H. A. High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Circulation. 1989 Jan;79(1):8–15. doi: 10.1161/01.cir.79.1.8. [DOI] [PubMed] [Google Scholar]
  9. Gordon T., Castelli W. P., Hjortland M. C., Kannel W. B., Dawber T. R. High density lipoprotein as a protective factor against coronary heart disease. The Framingham Study. Am J Med. 1977 May;62(5):707–714. doi: 10.1016/0002-9343(77)90874-9. [DOI] [PubMed] [Google Scholar]
  10. Heyden S., Heiss G., Hames C. G., Bartel A. G. Fasting triglycerides as predictors of total and CHD mortality in Evans County, Georgia. J Chronic Dis. 1980;33(5):275–282. doi: 10.1016/0021-9681(80)90022-3. [DOI] [PubMed] [Google Scholar]
  11. Hulley S. B., Rosenman R. H., Bawol R. D., Brand R. J. Epidemiology as a guide to clinical decisions. The association between triglyceride and coronary heart disease. N Engl J Med. 1980 Jun 19;302(25):1383–1389. doi: 10.1056/NEJM198006193022503. [DOI] [PubMed] [Google Scholar]
  12. Kannel W. B., Castelli W. P., Gordon T. Cholesterol in the prediction of atherosclerotic disease. New perspectives based on the Framingham study. Ann Intern Med. 1979 Jan;90(1):85–91. doi: 10.7326/0003-4819-90-1-85. [DOI] [PubMed] [Google Scholar]
  13. Lee J. Covariance adjustment of rates based on the multiple logistic regression model. J Chronic Dis. 1981;34(8):415–426. doi: 10.1016/0021-9681(81)90040-0. [DOI] [PubMed] [Google Scholar]
  14. Mann J. I., Lewis B., Shepherd J., Winder A. F., Fenster S., Rose L., Morgan B. Blood lipid concentrations and other cardiovascular risk factors: distribution, prevalence, and detection in Britain. Br Med J (Clin Res Ed) 1988 Jun 18;296(6638):1702–1706. doi: 10.1136/bmj.296.6638.1702. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Petersson B., Trell E., Hood B. Premature death and associated risk factors in urban middle-aged men. Am J Med. 1984 Sep;77(3):418–426. doi: 10.1016/0002-9343(84)90096-2. [DOI] [PubMed] [Google Scholar]
  16. Phillips A. N., Shaper A. G., Pocock S. J., Walker M., Macfarlane P. W. The role of risk factors in heart attacks occurring in men with pre-existing ischaemic heart disease. Br Heart J. 1988 Nov;60(5):404–410. doi: 10.1136/hrt.60.5.404. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Pocock S. J., Shaper A. G., Phillips A. N., Walker M., Whitehead T. P. High density lipoprotein cholesterol is not a major risk factor for ischaemic heart disease in British men. Br Med J (Clin Res Ed) 1986 Feb 22;292(6519):515–519. doi: 10.1136/bmj.292.6519.515. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Regression of atheroma. Br Med J. 1977 Jul 2;2(6078):1–2. [PMC free article] [PubMed] [Google Scholar]
  19. Robertson T. L., Kato H., Gordon T., Kagan A., Rhoads G. G., Land C. E., Worth R. M., Belsky J. L., Dock D. S., Miyanishi M. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California. Coronary heart disease risk factors in Japan and Hawaii. Am J Cardiol. 1977 Feb;39(2):244–249. doi: 10.1016/s0002-9149(77)80198-7. [DOI] [PubMed] [Google Scholar]
  20. Rosenman R. H., Brand R. J., Sholtz R. I., Friedman M. Multivariate prediction of coronary heart disease during 8.5 year follow-up in the Western Collaborative Group Study. Am J Cardiol. 1976 May;37(6):903–910. doi: 10.1016/0002-9149(76)90117-x. [DOI] [PubMed] [Google Scholar]
  21. Shaper A. G., Pocock S. J., Walker M., Cohen N. M., Wale C. J., Thomson A. G. British Regional Heart Study: cardiovascular risk factors in middle-aged men in 24 towns. Br Med J (Clin Res Ed) 1981 Jul 18;283(6285):179–186. doi: 10.1136/bmj.283.6285.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Shaper A. G., Pocock S. J., Walker M., Phillips A. N., Whitehead T. P., Macfarlane P. W. Risk factors for ischaemic heart disease: the prospective phase of the British Regional Heart Study. J Epidemiol Community Health. 1985 Sep;39(3):197–209. doi: 10.1136/jech.39.3.197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Thelle D. S., Shaper A. G., Whitehead T. P., Bullock D. G., Ashby D., Patel I. Blood lipids in middle-aged British men. Br Heart J. 1983 Mar;49(3):205–213. doi: 10.1136/hrt.49.3.205. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Walker M., Shaper A. G. Follow-up of subjects in prospective studies based in general practice. J R Coll Gen Pract. 1984 Jul;34(264):365–370. [PMC free article] [PubMed] [Google Scholar]
  25. Yano K., Reed D. M., McGee D. L. Ten-year incidence of coronary heart disease in the Honolulu Heart Program. Relationship to biologic and lifestyle characteristics. Am J Epidemiol. 1984 May;119(5):653–666. doi: 10.1093/oxfordjournals.aje.a113787. [DOI] [PubMed] [Google Scholar]

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