Advertisement

Prevalence of risk factors in men with premature coronary artery disease

  • Jacques J. Genest
    Affiliations
    Lipid Metabolism Laboratory, the United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA

    Cardiology Division, Department of Medicine, New England Medical Center Hospital, Boston, Massachusetts, USA
    Search for articles by this author
  • Judith R. McNamara
    Affiliations
    Lipid Metabolism Laboratory, the United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA

    Cardiology Division, Department of Medicine, New England Medical Center Hospital, Boston, Massachusetts, USA
    Search for articles by this author
  • Deeb N. Salem
    Affiliations
    Lipid Metabolism Laboratory, the United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA

    Cardiology Division, Department of Medicine, New England Medical Center Hospital, Boston, Massachusetts, USA
    Search for articles by this author
  • Ernst J. Schaefer
    Correspondence
    Address for reprints: Ernst Schaefer, MD, Lipid Metabolism Laboratory, the United States Department of Agriculture, 711 Washington Street, Boston, Massachusetts 02111.
    Affiliations
    Lipid Metabolism Laboratory, the United States Department of Agriculture Human Nutrition Research Center on Aging at Tufts University, Boston, Massachusetts, USA

    Cardiology Division, Department of Medicine, New England Medical Center Hospital, Boston, Massachusetts, USA
    Search for articles by this author
      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      The prevalence of modifiable cardiovascular risk factors (systemic hypertension, diabetes mellitus, cigarette smoking, low-density lipoprotein [LDL] cholesterol ≥ 160 mg/dl and high-density lipoprotein [HDL] cholesterol <35 mg/dl) was determined in 321 men <60 years of age (mean ± standard deviation 50± 7) with premature coronary artery disease (CAD) documented at coronary angiography. The prevalence of these risk factors was markedly different than in the Framingham Offspring Study population, used here as a comparison group. In the patients with CAD, only 3% had no risk factor (other than male sex), compared with 31% in the Framingham Offspring Study subjects. Most patients with CAD (97%) had ≥ 1 additional risk factor. When the patients with CAD were divided by age groups (40 to 49 years [n = 109], 50 to 59 [n = 191]), no significant differences were observed in the prevalence of risk factors between the young and older patients. The prevalence of systemic hypertension (41 vs 19%, p <0.001), diabetes mellitus (12 vs 1.1%, p <0.001), cigarette smoking (67 vs 28%, p <0.001) and HDL cholesterol <35 mg/dl (63 vs 19%, p <0.001) was markedly higher in the patients with CAD than in Framingham Offspring Study subjects, whereas the prevalence of LDL cholesterol ≥ 160 mg/dl was not significantly different between patients with CAD and Framingham Offspring Study sub jects (26 vs 26%). The use of β-adrenergic blockers was associated with a decreased prevalence of elevated LDL cholesterol and an increased prevalence of low HDL cholesterol, compared with patients not receiving this class of medication. When applying the guidelines of the National Cholesterol Education Program to patients with established CAD, only 52% had total cholesterol levels ⩾200 mg/dl and thus nearly half (48%) would not undergo further screening for lipoprotein abnormalities. In the group of patients with a total cholesterol <200 mg/dl, 75% had a low HDL cholesterol (<35 mg/dl). It is recommended that in men with established CAD, and in those with ≥ 1 additional risk factor, fasting triglyceride and HDL cholesterol levels be determined in addition to total cholesterol.
      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Dawber T.R.
        The Framingham Study. Lipids and atherosclerotic disease.
        in: The Epidemiology of Atherosclerotic Disease. Harvard University Press, Cambridge, Massachusetts1980: 121-141
        • Stamler J.
        • Wentworth D.
        • Neaton J.D.
        Is the relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT).
        JAMA. 1986; 256: 2823-2828
        • Martin M.J.
        • Hulley S.B.
        • Browner W.S.
        • Kuller L.H.
        • Wentworth D.
        Serum cholesterol, blood pressure, and mortality: implications from a cohort of 361,662 men.
        Lancet. 1986; 2: 933-936
        • The Coronary Drug Project Research Group
        Clofibrate and niacin in coronary heart disease.
        JAMA. 1975; 231: 360-381
      1. JAMA. 1984; 251: 351-364
      2. JAMA. 1984; 251: 365-374
        • Frick M.H.
        • Elo O.
        • Haapa K.
        • Heinonen O.P.
        • Heinsalmi P.
        • Helo P.
        • Huttunen J.K.
        • Kaitaniemi P.
        • Koskinen P.
        • Manninen V.
        • Maenpaa H.
        • Malkonen M.
        • Manttari M.
        • Norola S.
        • Pasternak A.
        • Pikkarainen J.
        • Romo M.
        • Sjoblom T.
        • Nikkila E.A.
        Helsinki Heart Study: primary prevention trial with gemfibrozil in middle-aged men with dyslipidemia.
        N Engl J Med. 1987; 317: 1237-1245
      3. Arch Intern Med. 1988; 148: 36-69
      4. Can Med Assoc J. 1988; 138 (suppl): 1-8
        • European Atherosclerosis Society
        • Study Group
        Strategies for the prevention of coronary heart disease: a policy statement of the European Atherosclerosis Society.
        Eur Heart J. 1987; 8: 77-88
        • Canner P.L.
        • Berge K.G.
        • Wenger N.K.
        • Stamler J.
        • Friedman L.
        • Prineas R.J.
        • Friedewald W.
        Fifteen-year mortality in coronary drug project patients: longterm benefit with niacin.
        J Am Coll Cardiol. 1986; 8: 1245-1255
        • Carlson A.A.
        • Rosenhamer G.
        Reduction of mortality in the Stockholm ischaemic heart disease secondary prevention study by combined treatment with clofibrate and nicotinic acid.
        Acta Med Scand. 1988; 223: 405-418
        • Grundy S.M.
        • Vega G.L.
        Fibric acids: effect on lipids and lipoprotein metabolism.
        Am J Med. 1987; 83: 9-20
        • Grundy S.M.
        HMG-CoA reductase inhibitors for treatment of hypercholesterolemia.
        N Engl J Med. 1988; 319: 24-33
        • Sempos C.
        • Fulwood R.
        • Haines C.
        • Carroll M.
        • Anda R.
        • Williamson D.F.
        • Remington P.
        • Cleeman J.
        The prevalence of high blood cholesterol levels among adults in the United States.
        JAMA. 1989; 262: 45-52
        • Wilson P.W.
        • Christiansen J.C.
        • Anderson K.M.
        • Kannel W.B.
        Impact of national guidelines for cholesterol risk factor screening. The Framingham Offspring Study.
        JAMA. 1989; 262: 41-44
        • Gordon D.J.
        • Rifkind B.M.
        High-density lipoproteins-the clinical implications of recent studies.
        N Engl J Med. 1989; 321: 1311-1316
        • McNamara J.R.
        • Schaefer E.J.
        Automated enzymatic standardized lipid analyses for plasma and lipoprotein fractions.
        Clin Chim Acta. 1987; 166: 1-8
        • Warnick G.R.
        • Benderson J.
        • Albers J.J.
        Dextran sulfate-Mg2+ precipitation procedure for quantitation of high-density lipoprotein cholesterol.
        Clin Chem. 1982; 79: 93-98
        • Friedewald W.T.
        • Levy R.I.
        • Fredrickson D.S.
        Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge.
        Clin Chem. 1972; 18: 499-502
        • Genest J.J.
        • Corbett H.M.
        • McNamara J.R.
        • Schaefer M.M.
        • Salem D.N.
        • Schaefer E.J.
        Effect of hospitalization on high-density lipoprotein cholesterol in patients undergoing elective coronary angiography.
        Am J Cardiol. 1988; 61: 998-1000
        • Genest J.J.
        • McNamara J.R.
        • Ordovas J.M.
        • Martin-Munley S.
        • Jenner J.L.
        • Millar J.
        • Salem D.N.
        • Schaefer E.J.
        Effect of hospitalization on plasma lipoprotein cholesterol and apolipoproteins A–I, B and Lp(a).
        Am J Cardiol. 1990; 65: 677-679
        • Willett W.C.
        • Reynolds R.D.
        • Cotrelle-Hoener S.
        • Sampson L.
        • Browne M.L.
        Validation of a semi-quantitative food-frequency questionnaire comparison with a 1 year diet.
        J Am Diet Assoc. 1987; 87: 43-47
        • Hegsted D.M.
        • McGandy R.B.
        • Myers M.L.
        • Stare F.J.
        Quantitative effect of dietary fat on serum cholesterol in man.
        Am J Clin Nutr. 1965; 17: 281-287
        • Wolinsky H.
        The effect of beta-adrenergic blocking agents on blood lipid levels.
        Clin Cardiol. 1987; 10: 561-566
        • MRFIT Research Group
        Multiple Risk Factor Intervention Trial, risk factor changes and mortality results.
        JAMA. 1982; 248: 1465-1477
        • Frishman W.H.
        • Furberg C.H.
        • Friedewald W.T.
        Beta-adrenergic blockade for survivors of acute myocardial infarction.
        N Engl J Med. 1984; 310: 830-836
        • Abbott R.D.
        • Wilson P.W.
        • Kannel W.B.
        • Castelli W.P.
        High density lipoprotein cholesterol, total cholesterol screening, and myocardial infarction. The Framingham Study.
        Arteriosclerosis. 1988; 8: 207-211
        • Miller M.
        • Mead L.A.
        • Kwiterovich P.O.
        • Pearson T.A.
        Dyslipidemias with desirable plasma total cholesterol levels and angiographically demonstrated coronary artery disease.
        Am J Cardiol. 1990; 65: 1-5
        • Manninen V.
        • Elo M.O.
        • Frick M.H.
        • Haapa K.
        • Heinonen O.P.
        • Heinsalmi P.
        • Helo P.
        • Huttunen J.K.
        • Kaitaniemi P.
        • Koskinen P.
        • et al.
        Lipid alterations and decline in the incidence of coronary heart disease in the Helsinki Heart Study.
        JAMA. 1988; 260: 641-651