Serum cholesterol and coronary heart disease risk in female and older hypertensives. The experience under usual community care in the Hypertension Detection and Follow-up Program.

The coronary heart disease (CHD) risk function associated with baseline serum cholesterol levels among women and older hypertensives was determined for the 5455 participants who were randomized in the Hypertension Detection and Follow-up Program (HDFP), referred to usual care in 14 US communities, and followed for the years 1974 through 1979. The risk of fatal CHD in relation to serum cholesterol for those under age 65 appeared as strong in women as in men in age- and race-adjusted analyses stratified by serum cholesterol levels; however, there was no association of serum cholesterol levels with combined fatal plus nonfatal incident coronary events for these women, adjusting for other major risk factors and covariables. There was no association of serum cholesterol with fatal or combined fatal plus nonfatal CHD events in either adjusted or unadjusted analyses for older hypertensive women. In contrast to the findings for women, serum cholesterol levels were strongly predictive of fatal plus nonfatal CHD in both younger and older hypertensive men, controlling for the effects of other factors such as age, antecedent history of antihypertensive medication, and presence of comorbidity. This study, based on the experience of the usual care group within the HDFP, was observational in nature. Clinical trials of specific regimens of serum cholesterol lowering in hypertensives are required definitively to determine their efficacy and safety for these high-risk patients; however, the experience within the HDFP indicates the desirability of detection and prudent management of hypercholesterolemia in older as well as younger male hypertensives.