Advertisement

Change in High-Density Lipoprotein Cholesterol and Incident Coronary Heart Disease in Apparently Healthy Male Physicians

  • Catherine Rahilly-Tierney
    Correspondence
    Corresponding author: Tel: 617-232-9500, ext. 44201; fax: 857-364-4424
    Affiliations
    Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Office of Research and Development, Cooperative Studies Program, Department of Veterans Affairs, Boston, Massachusetts

    Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts
    Search for articles by this author
  • Thomas S. Bowman
    Affiliations
    Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Office of Research and Development, Cooperative Studies Program, Department of Veterans Affairs, Boston, Massachusetts

    Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts
    Search for articles by this author
  • Luc Djoussé
    Affiliations
    Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts

    Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts
    Search for articles by this author
  • Howard D. Sesso
    Affiliations
    Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Office of Research and Development, Cooperative Studies Program, Department of Veterans Affairs, Boston, Massachusetts

    Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts

    Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts
    Search for articles by this author
  • J. Michael Gaziano
    Affiliations
    Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), Office of Research and Development, Cooperative Studies Program, Department of Veterans Affairs, Boston, Massachusetts

    Division of Aging, Brigham and Women's Hospital, Boston, Massachusetts
    Search for articles by this author
      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.
      To read this article in full you will need to make a payment

      References

        • Belanger C.
        • Buring J.E.
        • Cook N.
        • Aberlein K.
        • Goldhaber S.Z.
        • Gordon D.
        • Hennekins C.H.
        • Mayrent S.L.
        • Peto R.
        • Rosner B.
        • et al.
        • Steering Committee of the Physician's Health Study Research Group
        Final report on the aspirin component of the ongoing Physician's Health Study.
        N Engl J Med. 1989; 10: 1425-1505
        • Hennekens C.H.
        • Buring J.E.
        • Manson J.E.
        • Stampfer M.
        • Rosner B.
        • Cook N.R.
        • Belanger C.
        • Lamotte R.
        • Gaziano J.M.
        • Ridker P.M.
        • Willett W.
        • Peto R.
        Lack of effect of long-term supplementation with beta-carotene on incidence of malignant neoplasms and cardiovascular disease.
        N Engl J Med. 1996; 334: 1145-1149
        • Sesso H.D.
        • Gaziano J.M.
        • VanDenBurgh M.
        • Hennekens C.H.
        • Glynn R.J.
        • Buring J.E.
        Comparison of baseline characteristics and mortality experience of participants and non-participants in a randomized clinical trial: the Physician's Health Study.
        Control Clin Trials. 2002; 23: 686-702
        • Scranton R.
        • Sesso H.D.
        • Stampfer M.J.
        • Levenson J.W.
        • Buring J.E.
        • Gaziano J.M.
        Predictors of 14-year changes in the total cholesterol to high-density lipoprotein cholesterol ratio in men.
        Am Heart J. 2004; 147: 1033-1038
        • Wilson P.W.
        • Anderson K.M.
        • Harris T.
        • Kannel W.B.
        • Castelli W.P.
        Determinants of change in total cholesterol and HDL-C with age: the Framingham Study.
        J Gerontol. 1994; 49: M252-M257
        • Ferrara A.
        • Barrett-Connor E.
        • Shan J.
        Total, LDL, HDL cholesterol decrease with age in older men and women.
        Circulation. 1997; 96: 37-43
        • Garry P.J.
        • Hunt W.C.
        • Koehler K.M.
        • VanderJagt D.J.
        • Vellas B.J.
        Longitudinal study of dietary intakes and plasma lipids in healthy elderly men and women.
        Am J Clin Nutr. 1992; 55: 682-688
        • Baigent C.
        • Keech A.
        • Kearney P.M.
        • Blackwell L.
        • Buck G.
        • Pollicino C.
        • Kirby A.
        • Sourjina T.
        • Peto R.
        • Collins R.
        • Simes J.
        • Cholesterol Treatment Trialists' (CTT) Collaborators
        Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90056 participants in 14 randomized trials of statins.
        Lancet. 2005; 366: 1267-1278
        • Cannon C.P.
        • Steinberg B.A.
        • Murphy S.A.
        • Mega J.L.
        • Braunwald E.
        Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy.
        J Am Coll Cardiol. 2006; 48: 438-445
        • Deedwania P.
        • Stone P.H.
        • Merz N.B.
        • Cosin-Aguilar J.
        • Koylan N.
        • Luo D.
        • Ouyan P.
        • Piotrowicz R.
        • Schenck-Gustafsson K.
        • Sellier P.
        • et al.
        Effects of intensive versus moderate lipid-lowering therapy on myocardial ischemia in older patients with coronary heart disease: results of the Study Assessing Goals in the Elderly (SAGE).
        Circulation. 2007; 115: 700-707
        • Gordon T.
        • Castelli W.P.
        • Hjortland M.C.
        • Kannel W.B.
        • Dawber T.R.
        High density lipoprotein as a protective factor against coronary heart disease.
        Am J Med. 1977; 62: 707-714
        • Castelli W.P.
        • Garrison R.J.
        • Wilson P.W.F.
        • Abbott R.D.
        • Kalousdian S.
        • Kannel W.B.
        Incidence of coronary heart disease and lipoprotein cholesterol levels.
        JAMA. 1986; 256: 2835-2838
        • Gordon D.J.
        • Probstfield J.L.
        • Garrison R.J.
        • Neaton J.D.
        • Castelli W.P.
        • Knoke J.D.
        • Jacobs D.R.
        • Bandiwala S.
        • Tyroler H.A.
        High-density lipoprotein cholesterol and cardiovascular disease.
        Circulation. 1989; 79: 8-15
        • Gaziano J.M.
        • Buring J.E.
        • Breslow J.L.
        • Goldhaber S.Z.
        • Rosner B.
        • VanDenBurgh M.
        • Willett W.
        • Hennekens C.H.
        Moderate alcohol intake, increased levels of high-density lipoprotein and its subfractions, and decreased risk of myocardial infarction.
        N Engl J Med. 1993; 329: 1829-1834
        • Stampfer M.J.
        • Sacks F.M.
        • Salvini S.
        • Willett W.C.
        • Hennekens C.H.
        A prospective study of cholesterol, apolipoproteins, and the risk of myocardial infarction.
        N Engl J Med. 1991; 325: 373-381
        • Miller N.E.
        • Thelle D.S.
        • Forde O.H.
        • Mjos O.D.
        The Tromsø Heart-Study: high-density lipoprotein and coronary heart-disease: a prospective case-control study.
        Lancet. 1977; 1: 965-968
        • Perova N.V.
        • Organov R.G.
        • Williams D.H.
        • Irving S.H.
        • Abernathy J.R.
        • Deev A.D.
        • Shestov D.B.
        • Zhukovsky G.S.
        • Davis C.E.
        • Tyroler H.A.
        Association of high-density-lipoprotein cholesterol with mortality and other risk factors for major chronic noncommunicable disease in samples of US and Russian men.
        Ann Epidemiol. 1995; 5: 179-185
        • Jacobs D.R.
        • Mebane I.L.
        • Bangdiwala S.I.
        • Criqui M.H.
        • Tyroler H.A.
        High density lipoprotein cholesterol as a predictor of cardiovascular disease mortality in men and women: the follow-up study of the Lipid Research Clinics Prevalence Study.
        Am J Epidemiol. 1990; 131: 32-47
        • Gordon D.J.
        • Knoke J.
        • Probstfield J.L.
        • Superko R.
        • Tyroler H.A.
        High-density lipoprotein cholesterol and coronary heart disease in hypercholesterolemic men: the Lipid Research Clinics Coronary Primary Prevention Trial.
        Circulation. 1986; 74: 1217-1225
        • Svensvold I.
        • Urdal P.
        • Thürmer H.
        • Tverdal A.
        • Lund-Larsen P.G.
        • Foss O.P.
        High-density lipoprotein cholesterol and coronary, cardiovascular, and all cause mortality among middle-aged Norwegian men and women.
        Eur Heart J. 1992; 13: 1155-1163
        • Enger S.C.
        • Hjermann I.
        • Foss O.P.
        • Helgeland A.
        • Holme I.
        • Leren P.
        • Norum K.R.
        High density lipoprotein cholesterol and myocardial infarction or sudden coronary death: a prospective case-control study in middle-aged men of the Oslo study.
        Artery. 1979; 5: 170-181
        • Shaten B.J.
        • Kuller L.H.
        • Neaton J.D.
        Association between baseline risk factors, cigarette smoking, and CHD mortality after 10.5 years.
        Prev Med. 1991; 20: 655-659
        • Multiple Risk Factor Intervention Trial Research Group
        Relationship between baseline risk factors and coronary heart disease and total mortality in the Multiple Risk Factor Intervention Trial.
        Prev Med. 1986; 15: 254-273
        • Singh I.M.
        • Shishehbor M.H.
        • Ansell B.J.
        High-density lipoprotein as a therapeutic target.
        JAMA. 2007; 298: 786-798
        • Goldenberg I.
        • Goldbourt U.
        • Boyko V.
        • Behar S.
        • Reicher-Reiss H.
        • BIP Study Group
        Relation between on-treatment increments in serum high-density lipoprotein cholesterol levels and cardiac mortality in patients with coronary heart disease (from the Bezafibrate Infarction Prevention Trial).
        Am J Cardiol. 2006; 97: 466-471
        • Weisweiler P.
        Plasma lipoproteins and lipase and lecithin: cholesterol acyltransferase activities in obese subjects before and after weight reduction.
        J Clin Endocrinol Metab. 1987; 65: 969-973
        • Dattilo A.M.
        • Kris-Etherton P.M.
        Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis.
        Am J Clin Nutr. 1992; 56: 320-328
        • Burke V.
        • Beilin L.J.
        • Cutt H.E.
        • Mansour J.
        • Williams A.
        • Mori T.A.
        A lifestyle program for treated hypertensives improved health-related behaviors and cardiovascular risk factors, a randomized controlled trial.
        J Clin Epidemiol. 2007; 60: 133-141
        • Ellison R.C.
        • Zhang Y.
        • Qureshi M.M.
        • Knox S.
        • Arnett D.K.
        • Province M.A.
        • Investigators of the NHLBI Family Heart Study
        Lifestyle determinants of high-density lipoprotein cholesterol: the National Heart, Lung, and Blood Institute Family Heart Study.
        Am Heart J. 2004; 147: 529-535