Determinants of high-density lipoprotein cholesterol in blacks and whites: the second National Health and Nutrition Examination Survey.

In 19,521 subjects (8259 and 8561 white males and females; 1299 and 1402 black males and females) in the second National Health and Nutrition Examination Survey (NHANES II), we assessed black-white differences as major determinants of high-density lipoprotein (HDL) cholesterol to determine whether, and to what degree, higher levels of HDL cholesterol in blacks can be accounted for by black-white differences in nutrient intake, relative ponderosity, alcohol intake, cigarette smoking, leisure-time and habitual physical activity, hypertension, and diabetes. Lower intake of carbohydrate in blacks would be congruent with their higher levels of HDL cholesterol and lower triglyceride levels. In male and female youths and in adult males, there were no substantial black-white differences in Quetelet index; much higher Quetelet indices in black adolescent and adult females compared with whites would be consistent with the narrowing of black-white HDL cholesterol and triglyceride differences in females. There were no substantial differences between blacks and whites in frequency of alcoholic beverage intake, and it seems unlikely that differences in HDL cholesterol levels can be attributed to higher alcohol intake in blacks. Overall, blacks were more likely to have diabetes, were more often hypertensive, and were more often treated with antihypertensive agents; these factors would tend to reduce black-white differences in HDL cholesterol. Heavier smoking rates in whites might augment black-white differences in HDL cholesterol levels. There were no consistent black-white differences in leisure-time activity, although habitual physical activity was at a higher level in blacks. It seems unlikely, overall, that physical activity could account for black-white differences in HDL cholesterol. We speculate that whereas environment has a substantial effect on HDL cholesterol in both blacks and whites, there must be a substantial "genetic" vector accounting for higher levels of HDL cholesterol in blacks.