Skip to main content
NCBI home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1980 Aug;56(658):575–578. doi: 10.1136/pgmj.56.658.575

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

N E Miller
PMCID: PMC2425962  PMID: 7465461

Abstract

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.

Full text

PDF
575

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Applebaum-Bowden D., Hazzard W. R., Cain J., Cheung M. C., Kushwaha R. S., Albers J. J. Short-term egg yolk feeding in humans. Increase in apolipoprotein B and low density lipoprotein cholesterol. Atherosclerosis. 1979 Aug;33(4):385–396. doi: 10.1016/0021-9150(79)90031-5. [DOI] [PubMed] [Google Scholar]
  2. Brunzell J. D., Schrott H. G., Motulsky A. G., Bierman E. L. Myocardial infarction in the familial forms of hypertriglyceridemia. Metabolism. 1976 Mar;25(3):313–320. doi: 10.1016/0026-0495(76)90089-5. [DOI] [PubMed] [Google Scholar]
  3. Carew T. E., Koschinsky T., Hayes S. B., Steinberg D. A mechanism by which high-density lipoproteins may slow the atherogenic process. Lancet. 1976 Jun 19;1(7973):1315–1317. doi: 10.1016/s0140-6736(76)92650-7. [DOI] [PubMed] [Google Scholar]
  4. Castelli W. P., Doyle J. T., Gordon T., Hames C. G., Hjortland M. C., Hulley S. B., Kagan A., Zukel W. J. HDL cholesterol and other lipids in coronary heart disease. The cooperative lipoprotein phenotyping study. Circulation. 1977 May;55(5):767–772. doi: 10.1161/01.cir.55.5.767. [DOI] [PubMed] [Google Scholar]
  5. Feinleib M., Garrison R. J., Fabsitz R., Christian J. C., Hrubec Z., Borhani N. O., Kannel W. B., Rosenman R., Schwartz J. T., Wagner J. O. The NHLBI twin study of cardiovascular disease risk factors: methodology and summary of results. Am J Epidemiol. 1977 Oct;106(4):284–285. doi: 10.1093/oxfordjournals.aje.a112464. [DOI] [PubMed] [Google Scholar]
  6. Garrison R. J., Kannel W. B., Feinleib M., Castelli W. P., McNamara P. M., Padgett S. J. Cigarette smoking and HDL cholesterol: the Framingham offspring study. Atherosclerosis. 1978 May;30(1):17–25. doi: 10.1016/0021-9150(78)90149-1. [DOI] [PubMed] [Google Scholar]
  7. Glomset J. A. Physiological role of lecithin-cholesterol acyltransferase. Am J Clin Nutr. 1970 Aug;23(8):1129–1136. doi: 10.1093/ajcn/23.8.1129. [DOI] [PubMed] [Google Scholar]
  8. Goldbourt U., Medalie J. H. High density lipoprotein cholesterol and incidence of coronary heart disease--the Israeli Ischemic Heart Disease Study. Am J Epidemiol. 1979 Mar;109(3):296–308. doi: 10.1093/oxfordjournals.aje.a112683. [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. Hulley S. B., Cohen R., Widdowson G. Plasma high-density lipoprotein cholesterol level. Influence of risk factor intervention. JAMA. 1977 Nov 21;238(21):2269–2271. [PubMed] [Google Scholar]
  11. Jenkins P. J., Harper R. W., Nestel P. J. Severity of coronary atherosclerosis related to lipoprotein concentration. Br Med J. 1978 Aug 5;2(6134):388–391. doi: 10.1136/bmj.2.6134.388. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Miller G. J., Miller N. E. Plasma-high-density-lipoprotein concentration and development of ischaemic heart-disease. Lancet. 1975 Jan 4;1(7897):16–19. doi: 10.1016/s0140-6736(75)92376-4. [DOI] [PubMed] [Google Scholar]
  13. Miller N. E., Nestel P. J., Clifton-Bligh P. Relationships between plasma lipoprotein cholesterol concentrations and the pool size and metabolism of cholesterol in man. Atherosclerosis. 1976 May-Jun;23(3):535–547. doi: 10.1016/0021-9150(76)90013-7. [DOI] [PubMed] [Google Scholar]
  14. Miller N. E., Thelle D. S., Forde O. H., Mjos O. D. The Tromsø heart-study. High-density lipoprotein and coronary heart-disease: a prospective case-control study. Lancet. 1977 May 7;1(8019):965–968. doi: 10.1016/s0140-6736(77)92274-7. [DOI] [PubMed] [Google Scholar]
  15. Moore R. B., Long J. M., Matts J. P., Amplatz K., Varco R. L., Buchwald H. Plasma lipoproteins and coronary arteriography in subjects in the program on the surgical control of the hyperlipidemias. Preliminary report. Atherosclerosis. 1979 Feb;32(2):101–119. doi: 10.1016/0021-9150(79)90076-5. [DOI] [PubMed] [Google Scholar]
  16. Nestel P. J., Miller N. E. Cholesterol kinetics and faecal steroid excretion in subjects with primary hyperalphalipoproteinaemia. Atherosclerosis. 1980 May;36(1):127–134. doi: 10.1016/0021-9150(80)90206-3. [DOI] [PubMed] [Google Scholar]
  17. Pearson T. A., Bulkley B. H., Achuff S. C., Kwiterovich P. O., Gordis L. The association of low levels of HDL cholesterol and arteriographically defined coronary artery disease. Am J Epidemiol. 1979 Mar;109(3):285–295. doi: 10.1093/oxfordjournals.aje.a112682. [DOI] [PubMed] [Google Scholar]
  18. Rhoads G. G., Gulbrandsen C. L., Kagan A. Serum lipoproteins and coronary heart disease in a population study of Hawaii Japanese men. N Engl J Med. 1976 Feb 5;294(6):293–298. doi: 10.1056/NEJM197602052940601. [DOI] [PubMed] [Google Scholar]
  19. Robinson D., Williams P., Day J. High-density-lipoprotein cholesterol in the Maasai of East Africa: a cautionary note. Br Med J. 1979 May 12;1(6173):1249–1249. doi: 10.1136/bmj.1.6173.1249. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Shepherd J., Packard C. J., Patsch J. R., Gotto A. M., Jr, Taunton O. D. Effects of dietary polyunsaturated and saturated fat on the properties of high density lipoproteins and the metabolism of apolipoprotein A-I. J Clin Invest. 1978 Jun;61(6):1582–1592. doi: 10.1172/JCI109078. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Williams P., Robinson D., Bailey A. High-density lipoprotein and coronary risk factors in normal men. Lancet. 1979 Jan;1(8107):72–75. doi: 10.1016/s0140-6736(79)90063-1. [DOI] [PubMed] [Google Scholar]
  22. Wilson D. E., Lees R. S. Metabolic relationships among the plasma lipoproteins. Reciprocal changes in the concentrations of very low and low density lipoproteins in man. J Clin Invest. 1972 May;51(5):1051–1057. doi: 10.1172/JCI106896. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Wood P. D., Haskell W., Klein H., Lewis S., Stern M. P., Farquhar J. W. The distribution of plasma lipoproteins in middle-aged male runners. Metabolism. 1976 Nov;25(11):1249–1257. doi: 10.1016/s0026-0495(76)80008-x. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES