Volume 102, Issue 12 , Pages 1663-1667, 15 December 2008
Change in High-Density Lipoprotein Cholesterol and Incident Coronary Heart Disease in Apparently Healthy Male Physicians
The association between change in high-density lipoprotein (HDL) cholesterol and risk of subsequent coronary heart disease (CHD) is unclear. Change in HDL cholesterol was calculated in a prospective cohort of 4,501 male physicians enrolled in the Physician's Health Study (PHS) I who had HDL cholesterol measured in 1982 and again approximately 14 years later. Subjects were divided into categories of those with a decrease (≥−2.5 mg/dl), no change (change −2.5 to 2.5 mg/dl), a small increase of 2.5 to 12.5 mg/dl, or a large increase of ≥12.5 mg/dl. Cox proportional hazards was used to examine the association between change in HDL cholesterol and incident CHD (confirmed acute myocardial infarction or cardiac death). Hazard ratios (HRs) were adjusted for age, initial HDL cholesterol, diabetes mellitus, hypertension, non-HDL cholesterol, and history of cholesterol medication. Compared with subjects with a decrease in HDL cholesterol, multivariable-adjusted HRs for CHD were 0.66 (95% confidence interval [CI] 0.40 to 1.09) in subjects with no change, 0.56 (95% CI 0.35 to 0.89) for subjects with an increase of 2.5 to 12.5 mg/dl, and 0.43 (95% CI 0.23 to 0.83) for subjects with an HDL cholesterol increase ≥12.5 mg/dl. In conclusion, our findings were consistent with an inverse graded relation between 14-year increase in HDL cholesterol and risk of subsequent CHD.
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This work was supported by the Office of Research and Development, Cooperative Studies Program (CSP), Department of Veterans Affairs. Dr. Djoussé is Principal Investigator on Grant K01 HL-70444 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. The PHS is supported by Grants CA-34944, CA-40360, and CA-097193 from the National Cancer Institute and Grants HL-26490 and HL-34595 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.
The authors had full access to the data and take responsibility for its integrity, and all authors have read and agree to the manuscript as written. Dr. Bowman reports consulting for Veroscience LLC. Dr. Gaziano reports that he currently or in the past 5 years has received investigator-initiated federal funding from the National Institutes of Health (National Cancer Institute, National Heart, Lung, and Blood Institute, NIA, NEI) and the VA (CSP) and nonfederal investigator-initiated funding from McNeil Consumer Products and Pliva; research support in the form of pills and or packaging from BASF, DMS Pharmaceuticals, and Wyeth Pharmaceuticals; and honoria from Bayer and Pfizer for speaking engagements; and has served as a consultant for McNeil Consumer Products and Wyeth Pharmaceuticals; and as expert witness for Merck, Nutraquest, and Glaxo Smith Kline.
PII: S0002-9149(08)01389-1
doi:10.1016/j.amjcard.2008.07.055
Published by Elsevier Inc.
Volume 102, Issue 12 , Pages 1663-1667, 15 December 2008
