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HDL-cholesterol as a risk factor in coronary heart disease. An update of the Helsinki Heart Study
M H Frick1, V Manninen, J K Huttunen
1First Department of Medicine, University Central Hospital, Helsinki, Finland.
Insights
Elevated high-density lipoprotein (HDL)-cholesterol levels significantly reduce coronary heart disease risk. Low HDL-cholesterol levels increase disease incidence, highlighting HDL’s predictive power.
Area of Science:
- Cardiology
- Preventive Medicine
- Lipid Metabolism
Background:
- Dyslipidemia is a major risk factor for coronary heart disease (CHD).
- High-density lipoprotein (HDL)-cholesterol is inversely associated with cardiovascular risk.
- Low-density lipoprotein (LDL)-cholesterol is a well-established risk factor for CHD.
Purpose of the Study:
- To investigate the impact of increasing HDL-cholesterol and decreasing LDL-cholesterol on CHD incidence.
- To evaluate the predictive value of HDL-cholesterol levels for CHD in dyslipidemic men.
- To assess the relationship between lipid levels and cardiovascular events in primary prevention.
Main Methods:
- The Helsinki Heart Study was a 5-year, placebo-controlled, primary prevention trial.
- 4081 dyslipidemic men aged 40-55 years were enrolled.
- Gemfibrozil was administered to modify lipoprotein levels; placebo group data were analyzed for risk prediction.
Main Results:
- Elevated HDL-cholesterol levels were associated with a reduced incidence of coronary heart disease.
- Low HDL-cholesterol levels correlated with an increased incidence of CHD.
- LDL-cholesterol showed a weaker association with CHD risk; triglycerides had no significant effect.
Conclusions:
- HDL-cholesterol is a strong predictor of coronary heart disease incidence.
- Modulating HDL-cholesterol levels may be a viable strategy for CHD prevention.
- The study underscores the importance of HDL-cholesterol in cardiovascular risk assessment.
Abstract:
The aim of the Helsinki Heart Study, a 5-year primary prevention placebo-controlled study involving 4081 dyslipidaemic men (aged 40 to 55 years), was to investigate if increasing high density lipoprotein (HDL)-cholesterol plasma levels and decreasing low density lipoprotein (LDL)-cholesterol levels would reduce the incidence of coronary heart disease. Gemfibrozil 600mg twice daily was administered to induce these changes in lipoprotein levels. Baseline HDL-cholesterol levels in the study group were similar to those in the general population. Data from patients treated with placebo were analysed to investigate the influence of HDL-cholesterol levels on the incidence of coronary heart disease. Using the number of cardiac end-points per 1000 person-years to indicate the risk of coronary heart disease, it was clear that elevated HDL-cholesterol levels reduced the risk of coronary heart disease while the incidence increased at low HDL-cholesterol levels. This relationship was not altered when the effect of HDL-cholesterol levels was analysed jointly with other coronary risk factors (age, smoking or blood pressure). A weaker association was seen between LDL-cholesterol and risk of coronary heart disease, and triglycerides appeared to have no significant effect on the incidence of the disease. The data clearly suggest that HDL-cholesterol is a strong predictor of the incidence of coronary heart disease in the placebo group of the Helsinki Heart Study.