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Dyslipoproteinemias and manifestations of coronary heart disease. The Lipid Research Clinics Program Prevalence Study
Insights
Dyslipoproteinemia (DLP) is linked to coronary heart disease (CHD) in older men. Lower high-density lipoprotein cholesterol (HDL-C) and specific DLP types increase CHD odds, while hyperHDL may offer protection.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Preventive Cardiology
Background:
- Dyslipoproteinemia (DLP) is a significant risk factor for cardiovascular diseases.
- Understanding the association between various DLP phenotypes and coronary heart disease (CHD) is crucial for risk stratification.
- Noninvasive methods allow for the assessment of CHD in large, asymptomatic populations.
Purpose of the Study:
- To evaluate the association between different types of dyslipoproteinemia (DLP) and coronary heart disease (CHD).
- To compare the odds of CHD in individuals with DLP versus those without DLP in a general population.
- To assess these associations using noninvasive diagnostic tools.
Main Methods:
- Utilized data from the Lipid Research Clinics Prevalence Study.
- Employed noninvasive evaluations including the Rose questionnaire for angina, resting electrocardiogram, and graded treadmill exercise test.
- Applied multiple linear and logistic regression analyses, adjusting for age, body mass, blood pressure, alcohol, and smoking.
Main Results:
- No consistent associations were found in women or younger men (30-49 years).
- In older men (50-69 years), lower high-density lipoprotein cholesterol (HDL-C) and HDL-C/cholesterol ratio were observed in definite CHD and angina groups.
- Higher odds ratios for CHD were noted for types IIa, IV, and hypoHDL DLPs; a significantly lower odds ratio was observed for hyperHDL DLP.
Conclusions:
- The study confirmed a relationship between elevated low-density lipoprotein cholesterol, decreased HDL-C, and noninvasively determined CHD in older men.
- Specific DLP types (IIa, IV, hypoHDL) are associated with increased CHD risk, while hyperHDL may be protective.
- Noninvasive CHD assessment in asymptomatic populations highlights the importance of lipid profiles in cardiovascular risk.
Abstract:
The Lipid Research Clinics Prevalence Study population underwent a noninvasive evaluation to assess the odds of coronary heart disease (CHD) among individuals with various types of dyslipoproteinemia (DLP) relative to the odds for individuals free of DLP in a nonselected population. The noninvasive evaluation included the Rose questionnaire for angina, a resting electrocardiogram, and a graded treadmill exercise test. The presence of manifestations of CHD was assessed by a combination of these findings. Multiple linear regression and multiple logistic regression analyses were used to evaluate associations between CHD and DLP, with adjustments for the following covariates: age, body mass, systolic blood pressure, alcohol consumption, and cigarette use. There were no consistent associations in women or in men 30 to 49 years old. In men 50 to 69 years old, the mean high-density lipoprotein cholesterol (HDL-C) values and HDL-C/cholesterol ratio were significantly lower in the definite CHD and angina categories, compared with the negative (no evidence of CHD) group. Higher odds ratios for CHD were present in those classified as having type IIa, type IV, and hypoHDL DLPs, relative to those classified as normal by the phenotyping algorithm. These associations were consistent across the several categories of CHD manifestations, but did not reach statistical significance after adjustment for multiple testing. A statistically significant lower odds ratio for CHD was observed in men 50 to 69 classified as having hyperHDL when compared with those without DLPs. The associations between CHD and the various forms of DLP were consistent with those observed between CHD and the plasma lipid and lipoprotein-cholesterol concentrations. The Lipid Research Clinics Prevalence Study confirmed the relationship between elevated low-density lipoprotein cholesterol, decreased HDL-C, and noninvasively determined CHD in a free-living asymptomatic population of older men.