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Interrelations of lipids and lipoproteins with coronary artery disease mortality in 19 countries
Insights
High total serum cholesterol and total cholesterol/HDL cholesterol ratios significantly predict coronary artery disease (CAD) mortality in men internationally. HDL cholesterol levels did not explain CAD mortality differences between populations.
Area of Science:
- Cardiovascular epidemiology
- Public health
- Biochemistry
Background:
- Coronary artery disease (CAD) mortality rates vary significantly between countries.
- Interpopulation differences in CAD mortality are thought to be linked to variations in serum cholesterol levels.
Purpose of the Study:
- To investigate the relationship between serum lipid levels (total cholesterol, HDL cholesterol, triglycerides) and CAD mortality rates across industrialized nations.
- To determine the predictive value of different lipid parameters for interpopulation differences in CAD mortality.
Main Methods:
- Data on age- and sex-specific serum cholesterol, triglyceride, and HDL cholesterol levels were collected from 19 industrialized countries with reliable World Health Organization mortality data.
- Statistical analyses were performed to correlate lipid levels with CAD mortality rates in middle-aged subjects.
Main Results:
- In men, serum cholesterol levels explained 45% of CAD mortality variation, HDL cholesterol 32%, and the total cholesterol/HDL cholesterol ratio 55%.
- Serum triglyceride levels did not correlate with CAD mortality in men.
- In women, only the total cholesterol/HDL cholesterol ratio showed a significant correlation, explaining 31% of CAD mortality variation.
Conclusions:
- Total serum cholesterol and the total cholesterol/HDL cholesterol ratio are significant international predictors of CAD mortality in men.
- While HDL cholesterol may be a risk factor within a population, it does not explain interpopulation differences in CAD mortality.
- Analyses in women were less informative regarding interpopulation CAD mortality risk factors.
Abstract:
Coronary risk factors differ in importance from country to country, but a proportion of interpopulation differences in coronary artery disease (CAD) mortality is probably closely related to interpopulation differences in total serum cholesterol levels. Interpopulation differences in high density lipoprotein (HDL) cholesterol levels supposedly do not explain interpopulation differences in CAD mortality, although HDL cholesterol may be an important negative risk factor within a population. Age- and sex-specific serum cholesterol, triglyceride and HDL cholesterol levels have been sought for 27 industrialized countries for which the World Health Organization has reliable mortality data. At least partially complete information was obtained from 19 countries, derived from national or regional studies in middle-aged subjects, and this has been related to CAD mortality rates. In men, 45% of the interpopulation variation in CAD mortality was explained by variation in serum cholesterol levels; 32% by variation in HDL cholesterol; and 55% by variation in the ratio of total serum cholesterol/HDL cholesterol. CAD mortality in men did not correlate with a population's serum triglyceride levels. In women, the only significant correlate of interpopulation variation in CAD mortality was the ratio of total serum cholesterol/HDL cholesterol, which explained 31% of the variation in CAD mortality. These findings highlight the contributions of total serum cholesterol and the ratio of total serum cholesterol/HDL cholesterol to CAD mortality in men at the international level and have implications for individual members of a population. Similar analyses in women were not particularly informative.