Serum lipoproteins as risk factors: recent epidemiologic studies in individuals with and without prevalent cardiovascular disease.

Contrary to most prospective epidemiologic studies, an earlier report from the British Regional Heart Study (BRHS) suggested that high density lipoprotein (HDL)-cholesterol in men aged 40-59 years was not a significant, independent, predictive risk factor for coronary heart disease (CHD), controlling for the composite of low density lipoprotein (LDL)--plus very low density lipoprotein--cholesterol (i.e. non-HDL-cholesterol) and for other risk factors. In response to that report, a systematic re-examination of the Framingham Heart Study, the Lipid Research Clinics Prevalence Mortality Follow-up Study, the Lipid Research Clinics-Coronary Primary Prevention Trial, and the Multiple Risk Factor Intervention Trial was undertaken to compare the results of these four studies with those of the BRHS. In white men and women aged 30-69 years and free of clinical symptoms of CHD at baseline, the incidence of CHD in all four studies was generally highest in those with a low HDL-cholesterol and lowest in those with a high HDL-cholesterol. A later report from the BRHS, with longer follow-up and increased number of CHD events, controlling for other risk factors but without controlling for combined non-HDL-cholesterol, disclosed a statistically significant, independent prediction of CHD, albeit of modest magnitude, by HDL-cholesterol. Data from the USSR Lipid Research Clinics Follow-up Study differed from the American and the British studies. Despite higher HDL-cholesterol levels, CHD mortality rates were as high (or higher) in the USSR than in the US Lipid Research Clinics.(ABSTRACT TRUNCATED AT 250 WORDS)