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HDL cholesterol and mortality in Finnish men with special reference to alcohol intake
M Paunio1, O P Heinonen, J Virtamo
1University of Helsinki, Department of Public Health, Finland.
Insights
Low high-density lipoprotein cholesterol (HDLC) is linked to coronary deaths. This study found the association between HDLC and coronary mortality was weaker with higher alcohol intake, especially in older men.
Area of Science:
- Cardiovascular Health
- Epidemiology
- Gerontology
Background:
- Low high-density lipoprotein cholesterol (HDLC) is a known risk factor for coronary heart disease mortality.
- Limited data exist on this association in older populations and its relation to alcohol consumption.
Purpose of the Study:
- To investigate the relationship between serum HDLC levels and mortality in older male smokers.
- To examine the influence of alcohol intake on the association between HDLC and mortality.
Main Methods:
- Analysis of 7052 male smokers aged 50-69 from the ATBC Study placebo group (1984-1988).
- Follow-up for an average of 4.7 years, recording coronary, all-cause, and alcohol/violence-related mortality.
- Statistical analysis accounting for age, total cholesterol, and temporal variations in HDLC measurements.
Main Results:
- HDLC levels were inversely associated with coronary mortality, regardless of age.
- The inverse association between HDLC and coronary mortality was less pronounced with higher alcohol intake.
- Total cholesterol was positively associated with coronary mortality in younger men (50-59) but not older men (60-69).
- All-cause and alcohol/violence-related mortality showed positive associations with HDLC in younger men; a U-shaped response was observed in older men.
Conclusions:
- Previous studies may have underestimated the protective effect of high HDLC due to bias and alcohol's confounding effect.
- Lipoprotein fractions, particularly HDLC, may be more valuable than total cholesterol for risk screening in older men.
- Alcohol intake significantly modifies the relationship between HDLC and coronary mortality.
Background:
There is substantial evidence that a low serum level of HDL cholesterol (HDLC) is a risk factor for coronary deaths. However, data on older people are scarce, and previous studies have not examined this association in relation to alcohol intake.
Methods And Results:
Coronary mortality, all-cause mortality, and mortality due to alcohol and violence were related to HDLC levels among 7052 male smokers 50 to 69 years old in south and west Finland enrolled from 1984 to 1988 in the ATBC (AT, alpha-tocopherol; BC, beta-carotene) Study placebo group. During the average follow-up period of 4.7 years, 620 men died; 222 of these deaths were from coronary heart disease and 82 from causes related alcohol and violence. HDLC levels were inversely associated with coronary mortality, irrespective of age, whereas high total cholesterol was positively associated with coronary mortality among the younger men, 50 to 59 years of age, but not among the older men, 60 to 69 years old. Correction for temporal variation in HDLC measurement indicated a 43% stronger inverse association between HDLC and coronary mortality compared with that based only on a single value. The inverse association of HDLC and coronary mortality was less marked at higher levels of alcohol intake. All-cause and alcohol- and violence-related mortality were positively associated with HDLC among the younger men. All-cause mortality showed a U-shaped dose response among men > or = 60 years old.
Conclusions:
Previous studies may have underestimated the beneficial effect of high HDLC because of regression-dilution bias and the confounding effect of heavy alcohol intake. This study supports the view that, particularly among older men, lipoprotein fractions may be more appropriate for screening than total cholesterol.