Clinical study| Volume 62, ISSUE 5, P707-714, May 1977

High density lipoprotein as a protective factor against coronary heart disease

The Framingham study
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      Lipid and lipoproiein values, including fasting triglycerides and high density lipoproteins (HDL), low density llpoproteins (LDL) and total cholesterol levels, were obtained on 2,815 men and women aged 49 to 82 years chiefly between 1969 and 1971 at Framingham. In the approximately four years following the characterization of lipids, coronary heart disease developed in 79 of the 1,025 men and 63 of the 1,445 women free of coronary heart diseases. At these older ages the major potent lipid risk factor was HDL cholesterol, which had an inverse association with the incidence of coronary heart disease (p < 0.001) in either men or women. This lipid was associated with each major manifestation of coronary heart disease. These associations were equally significant even when other lipids and other standard risk factors for coronary heart disease were taken into consideration. A weaker association with the incidence of coronary heart disease (p < 0.05) was observed for LDL cholesterol. Triglycerides were associated with the incidence of coronary heart disease only in women and then only when the level of other lipids was not taken into account. At these ages total cholesterol was not associated with the risk of coronary heart disease.
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        • Gofman JW
        • Young W
        • Tandy R
        Ischemic heart disease, atherosclerosis and longevity.
        Circulation. 1966; 34: 679
        • Kannel WB
        • Castelli WP
        • Gordon T
        • et al.
        Serum cholesterol lipoproteins, and risk of coronary heart diseases. The Framingham Study.
        Ann Intern Med. 1971; 24: 1
        • Albrink MJ
        • Meigs JW
        • Man EB
        Serum lipids, hypertension and coronary artery disease.
        Am J Med. 1961; 31: 4
        • Carlson LA
        • Böttiger LE
        Ischemic heart disease in relation to fasting values of plasma triglycerides and cholesterol.
        Lancet. 1972; 1: 865
        • Gordon T
        • Kannel WB
        Introduction and general background in the Framingham Study. The Framingham Study.
        National Heart and Lung Institute, Bethesda1968 (Sections 1 and 2)
        • Shurtleff D
        Some characteristics related to the incidence of cardiovascular disease and death. Framingham Study: 18-year follow-up.
        in: The Framingham Study. DHEW Publication (NIH) No. 74-599. U.S. Government Printing Office, Washington, D.C1974 (Section 30)
        • Fredrickson DS
        • Levy RI
        • Lees RS
        Fat transport and lipoproteins—an integrated approach to mechanisms and disorders.
        N Engl J Med. 1967; 276: 32
        • Fredrickson DS
        • Levy RI
        • Lees RS
        Fat transport and lipoproteins—an integrated approach to mechanisms and disorders.
        N Engl J Med. 1967; 276: 94
        • Fredrickson DS
        • Levy RI
        • Lees RS
        Fat transport and lipoproteins—an integrated approach to mechanisms and disorders.
        N Engl J Med. 1967; 276: 148
        • Fredrickson DS
        • Levy RI
        • Lees RS
        Fat transport and lipoproteins—an integrated approach to mechanisms and disorders.
        N Engl J Med. 1967; 276: 215
        • Fredrickson DS
        • Levy RI
        • Lees RS
        Fat transport and lipoproteins—an integrated approach to mechanisms and disorders.
        N Engl J Med. 1967; 276: 273
      1. Castelli WP, Cooper GR, Doyle JT, et al.: Distribution of triglyceride and total, LDL and HDL cholesterol in several populations: a cooperative lipoprotein phenotyping study. J Chronic Dis (in press).

        • Burstein M
        • Samaille J
        Sur un dosage rapide du cholesterol lie' aux α- et aux β-lipoproteins du serum.
        Clin Chim Acta. 1960; 5: 609
        • Abell LL
        • Levy BB
        • Brodie BB
        • et al.
        A simplified method for the estimation of total cholesterol in serum and demonstration of its specificity.
        J Biol Chem. 1952; 195: 357
        • Kessler G
        • Lederer H
        Fluorometric measurements of triglycerides.
        in: Skeggs Jr, LT Technicon Symposia Automation in Analytical Chemistry. Medicad Inc, New York1965: 341
        • Walker SH
        • Duncan DB
        Estimation of the probability of an event as a function of several independent variables.
        Biometrika. 1967; 54: 167
        • Carlson LA
        • Ericsson M
        Quantitative and qualitative serum lipoprotein analysis. 2. Studies in male survivors of myocardial infarction.
        Atherosclerosis. 1975; 21: 435
      2. Goldbourt Uri, Medalie JH: Cholesterol in alpha lipoprotein and clinical myocardial infarction. Submitted for publication.

        • Wood PD
        • Klein H
        • Lewis S
        • et al.
        Plasma lipoprotein concentration in middle aged runners.
        Circulation. 1974; 50: 111
        • Lopez-S A
        • Vial R
        • Balart L
        • et al.
        Effect of exercise and physical fitness on serum lipids and lipoproteins.
        Atherosclerosis. 1974; 20: 1
        • Rhoads GG
        • Gulbrandsen CL
        • Kagan A
        Serum lipoproteins and coronary heart disease in a population study of Hawaii Japanese men.
        N Engl J Med. 1976; 294: 293
        • Wilson DE
        • Lees RS
        Metabolic relationships among plasma lipoproteins, reciprocal changes in the concentrations of very low and low density lipoprotein in men.
        J Clin Invest. 1972; 51: 1051
        • Castelli WP
        • Doyle JT
        • Gordon T
        • et al.
        HDL cholesterol levels (HDLC) in coronary heart disease. A Cooperative Lipoprotein Phenotyping Study.
        Circulation. 1975; 52: II-97
        • Glueck CJ
        • Fallat RW
        • Spadafora M
        • et al.
        Longevity syndromes.
        Circulation. 1975; 52: II-272
        • Barr DP
        • Russ EM
        • Eder HA
        Protein-lipid relationships in human plasma.
        Am J Med. 1951; 11: 480
        • Nikkila E
        Studies on the lipid-protein relationship in normal and pathologic sera and the effect of heparin or serum lipoproteins.
        Scand J Clin Lab Invest. 1953; 5 (suppl): 8
        • Barr DP
        Some chemical factors in the pathogenesis of atherosclerosis.
        Circulation. 1953; 8: 641
        • Oliver MF
        • Boyd GS
        Serum lipoprotein pattern in coronary sclerosis and associated conditions.
        Br Heart J. 1955; 17: 299
        • Jencks WP
        • Hyatt MR
        • et al.
        A study of serum lipoproteins in normal and atherosclerotic patients by paper electropharetic techniques.
        J Clin Invest. 1956; 9: 980
        • Brunner D
        • Altman S
        • Löbl K
        • et al.
        α-cholesterol percentages in coronary patients with and without increased total serum cholesterol levels and in healthy controls.
        J Atheroscler Res. 1962; 2: 424
        • Dodds C
        • Mills GL
        Influence of myocardial infarction on plasma lipoprotein concentration.
        Lancet. 1953; 1: 1160
        • Keys A
        • Fidanza F
        Serum cholesterol and relative body weight of coronary patients in different populations.
        Circulation. 1960; 22: 1031
        • Rosenman RH
        • Friedman M
        • Jenkins CD
        • et al.
        Recurring and fatal myocardial infarction in the Western Collaboration Group Study.
        Am J Cardiol. 1967; 19: 771
        • Miller GJ
        • Miller NE
        Plasma-high-density-lipoprotein concentration and development of ischemic heart disease.
        Lancet. 1975; 1: 16
        • Nestel PJ
        Cholesterol turnover in men.
        Adv Lipid Res. 1970; 8: 1
        • Glomset JA
        Physiological role of lecithin-cholesterol acyltransferase.
        Am J Clin Nutr. 1970; 23: 1129
        • Bailey JM
        Lipid metabolism in cultured cells. 4. Serum alpha-globulin and cellular cholesterol exchange.
        Exp Cell Res. 1965; 37: 175
        • Burns CH
        • Rothblat GH
        Cholesterol excretion by tissue culture cells. Effect of serum lipids.
        Biochim Biophys Acta. 1969; 176: 616
        • Bondjers G
        • Bjorkerud S
        HDL dependent elimination of cholesterol from human arterial tissue.
        in: 3rd ed. Proc Eur Soc Clin Invest. 9. 1975: 51
        • Fredrickson DS
        • Gotto AM
        • Levy RI
        Familial lipoprotein deficiency (Tangier disease).
        in: Stanbury JS Wyngaarten JB Fredrickson DS The metabolic basis of inherited disease. 3rd ed. McGraw-Hill, New York1972: 513
        • Kaschinsky T
        • Carew TE
        • Steinberg D
        Effects of high density lipoprotein (HDL) on low density lipoprotein (LDL) metabolism by pig smooth muscle cells (SMC).
        Circulation. 1975; 52: II-273