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Published on: October 12, 2017
Total cholesterol, low density lipoprotein cholesterol, and high density lipoprotein cholesterol and coronary heart
A D Hargreaves1, R L Logan, M Thomson
1Department of Cardiology, University of Edinburgh.
Insights
Over 12 years, Scottish men experienced worsening lipid profiles, with increased low-density lipoprotein (LDL) cholesterol. High LDL and low high-density lipoprotein (HDL) cholesterol, along with smoking, predicted coronary heart disease risk.
Area of Science:
- Cardiovascular epidemiology
- Lipid metabolism
- Public health
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality.
- Understanding long-term changes in cardiovascular risk factors is crucial for prevention.
- Lipid profiles, including total cholesterol, HDL, and LDL, are key indicators.
Purpose of the Study:
- To track changes in cholesterol levels and other CHD risk factors over 12 years in Scottish men.
- To determine the predictive value of these risk factors for developing CHD.
Main Methods:
- A longitudinal study followed 107 men from Edinburgh, initially aged 40 in 1976.
- Follow-up assessments in 1988-9 measured cholesterol, weight, smoking, and alcohol intake.
- Coronary artery disease events were recorded.
Main Results:
- Mean total cholesterol increased, primarily due to a rise in LDL cholesterol, despite a decrease in HDL cholesterol.
- Body weight and weight-to-height index increased; smoking prevalence decreased.
- High LDL and low HDL cholesterol in 1976 predicted CHD, as did smoking; total cholesterol did not.
Conclusions:
- The lipid profile significantly deteriorated over 12 years in this cohort.
- Low HDL, high LDL, and smoking were associated with CHD development in middle-aged men.
- Findings suggest implications for targeted screening programs for cardiovascular risk.
Objective:
To investigate long term changes in total cholesterol, high density lipoprotein cholesterol, and low density lipoprotein cholesterol concentrations and in measures of other risk factors for coronary heart disease and to assess their importance for the development of coronary heart disease in Scottish men.
Design:
Longitudinal study entailing follow up in 1988-9 of men investigated during a study in 1976.
Setting:
Edinburgh, Scotland.
Subjects:
107 men from Edinburgh who had taken part in a comparative study of risk factors for heart disease with Swedish men in 1976 when aged 40.
Intervention:
The men were invited to attend a follow up clinic in 1988-9 for measurement of cholesterol concentrations and other risk factor measurements. Eighty three attended and 24 refused to or could not attend.
Main Outcome Measures:
Changes in total cholesterol, high density lipoprotein cholesterol, and low density lipoprotein cholesterol concentrations, body weight, weight to height index, prevalence of smoking, and alcohol intake; number of coronary artery disease events.
Results:
Mean serum total cholesterol concentration increased over the 12 years mainly due to an increase in the low density lipoprotein cholesterol fraction (from 3.53 (SD 0.09) to 4.56 (0.11) mmol/l) despite a reduction in high density lipoprotein cholesterol concentration. Body weight and weight to height index increased. Fewer men smoked more than 15 cigarettes/day in 1988-9 than in 1976. Blood pressure remained stable and fasting triglyceride concentrations did not change. The frequency of corneal arcus doubled. Alcohol consumption decreased significantly. Eleven men developed clinical coronary heart disease. High low density lipoprotein and low high density lipoprotein cholesterol concentrations in 1976, but not total cholesterol concentration, significantly predicted coronary heart disease (p = 0.05). Almost all of the men who developed coronary heart disease were smokers (91% v 53%, p less than 0.05).
Conclusion:
Over 12 years the lipid profile deteriorated significantly in this healthy cohort of young men. Smoking, a low high density lipoprotein concentration and a raised low density lipoprotein concentration were all associated with coronary heart disease in middle aged Scottish men, whereas there was no association for total cholesterol concentration. The findings have implications for screening programmes.
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