Lipoprotein profile--its value in prediction

The currently popular view that a high concentration of high density (alpha) lipoprotein (HDL) in the blood plasma protects against coronary heart disease is based on publications which compare persons with and without the disease and persons who develop the disease within a few years after the analysis of the plasma. Very little attention has been paid to mortality and the follow-up period has been short. A recent report on civil servants in Israel claims an important inverse relationship between HDL cholesterol and mortality. The HDL values reported, however, differ greatly from all other published values, and the period of follow-up was less than 5 years. In addition, the statistics showing the protective effect of HDL cholesterol depend largely on the ratio of HDL to total cholesterol which really shows that, as is well known, the total cholesterol concentration is a positive risk factor for coronary heart disease. A 25-year follow-up of Minnesota business and professional men aged 50 to 60 at entry who were examined annually through 1978 produced no evidence that either total or coronary mortality was significantly related to the concentration of plasma HDL. The material covers 135 deaths, including 55 from coronary heart disease. The data actually suggest that the probability of death from neoplastic disease is directly related to the concentration of HDL cholesterol in the plasma or at least that there may be a trade-off between coronary heart disease and cancer death in respect to HDL cholesterol. The view that the higher the level of HDL cholesterol the better needs reexamination with attention to mortality during long follow-up.