High-density lipoprotein cholesterol in blacks and whites: potential ramifications for coronary heart disease.

Black male and female juveniles and adult black males have higher levels of high-density lipoprotein (HDL) cholesterol than do whites, differences that potentially "protect" them against augmented coronary heart disease morbidity and mortality, given an excess of certain coronary heart disease risk factors among blacks, particularly hypertension. The loss of the "protective" HDL cholesterol difference in adult black females appears most likely to be due to their pandemic obesity. Inasmuch as blacks smoke more, are more likely to have diabetes, and are more often treated with antihypertensives, these factors would tend to reduce black-white differences in HDL cholesterol. Black-white differences in alcohol intake and habitual and leisure-time physical activity would not be likely, in the aggregate, to affect black-white differences in HDL cholesterol. It thus seems likely that, whereas environment has a substantial effect on HDL cholesterol for blacks and whites, there may be a "genetic" vector accounting for higher levels of HDL cholesterol in blacks.