Circulation, Vol 89, 2533-2539, Copyright © 1994 by American Heart Association
A Kitamura, H Iso, Y Naito, M Iida, M Konishi, AR Folsom, S Sato, M Kiyama, M Nakamura and T Sankai
BACKGROUND: The objective of this study was to examine the relation of
high-density lipoprotein cholesterol (HDL-C) to coronary heart disease in
Japanese men whose serum total cholesterol is low by Western standards.
METHODS AND RESULTS: A prospective, observational study based on 7.7 years
of follow-up for incidence of coronary heart disease and stroke was
conducted. The subjects were 6408 middle-aged male workers aged 40 to 59
years at baseline in urban companies in Osaka, Japan, whose mean serum
total cholesterol was 5.10 mmol/L. Mean HDL-C adjusted for age, total
cholesterol, systolic blood pressure, alcohol intake, cigarette smoking,
and body mass index was 1.27 to 1.28 mmol/L for men who developed coronary
heart disease (n = 46) or definite myocardial infarction (n = 21) compared
with 1.46 mmol/L for those free of cardiovascular disease (n = 6256;
difference, P < .01). There was no significant difference in mean HDL-C
between stroke cases (n = 33) and those free of cardiovascular disease. The
incidence rates of coronary heart disease and definite myocardial
infarction, adjusted for the other risk factors, were three to four times
higher in the lowest HDL-C quartile (< 1.24 mmol/L) than the highest
quartile (> or = 1.66 mmol/L), and there was a significant dose response
for definite myocardial infarction. Serum total cholesterol was positively
and significantly associated with coronary heart disease incidence.
Furthermore, the inverse association for HDL-C was apparent among men with
total cholesterol < 5.69 mmol/L (mean total cholesterol, 4.76 mmol/L)
and men with total cholesterol > or = 5.69 mmol/L (mean total
cholesterol, 6.26 mmol/L). CONCLUSIONS: Coronary heart disease incidence is
inversely related to HDL-C in urban Japanese middle-aged men, whose mean
total cholesterol (5.10 mmol/L) is relatively low.
ARTICLES
High-density lipoprotein cholesterol and premature coronary heart disease in urban Japanese men
Department of Epidemiology and Mass Examination, Center for Adult Diseases, Osaka, Japan.
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