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(Circulation. 1996;94:2381-2388.)
© 1996 American Heart Association, Inc.

Articles

Serum Lipids and Incidence of Coronary Heart Disease

Findings From the Systolic Hypertension in the Elderly Program (SHEP)

Philip H. Frost, MD; Barry R. Davis, MD, PhD; Alfredo J. Burlando, MD; J. David Curb, MD; Gordon P. Guthrie, Jr, MD; Jonathan L. Isaacsohn, MD; Sylvia Wassertheil-Smoller, PhD; Alan C. Wilson, PhD; Jeremiah Stamler, MD; for the Systolic Hypertension in the Elderly Research Group

the Cardiovascular Research Institute, University of California, San Francisco (P.H.F.); University of Texas School of Public Health, Houston (B.R.D.); Kaiser Permanente Medical Center, Sacramento, Calif (A.J.B.); University of Hawaii School of Medicine, Honolulu (J.D.C.); University of Kentucky College of Medicine, Lexington (G.P.G.); Christ Hospital, Cincinnati, Ohio (J.L.I.); Albert Einstein College of Medicine, Bronx, NY (S.W.-S.); Robert Wood Johnson Medical School, New Brunswick, NJ (A.C.W.); and Northwestern University Medical School, Chicago, Ill (J.S.).

Correspondence to Philip H. Frost, MD, University of California, San Francisco, 400 Parnassus Ave, #585, San Francisco, CA 94143-0326. E-mail phf@itsa.ucsf.edu.

Background The association of serum lipids with coronary heart disease has been studied extensively in middle-aged men and, to a lesser extent, in similar women. Less well defined are lipid variables predictive of CHD in individuals of age 60 years.

Methods and Results The Systolic Hypertension in the Elderly Program recruited 4736 persons (mean age, 72 years; 14% were black; and 43% were men). Mean systolic and diastolic blood pressures were 170 and 77 mm Hg, respectively. Baseline mean total cholesterol was 6.11 mmol/L (236 mg/dL); HDL cholesterol, 1.39 mmol/L (54 mg/dL); and non-HDL cholesterol, 4.72 mmol/L (182 mg/dL). Triglyceride levels were 1.62 mmol/L (144 mg/dL) for fasting participants and 1.78 mmol/L for the total group. LDL cholesterol, estimated in fasting samples with triglycerides of <4.52 mmol/L, averaged 3.98 mmol/L (154 mg/dL). Mean follow-up was 4.5 years. In multivariate Cox regression analyses, baseline total, non-HDL, and LDL cholesterol levels and the ratios of total, non-HDL, and LDL to HDL cholesterol were significantly related to CHD incidence. HDL cholesterol and triglycerides were not significant in these analyses. In fasting participants with triglyceride levels of <4.52 mmol/L, a 1.03 mmol/L (40 mg/dL) higher baseline total, non-HDL, or LDL cholesterol was associated with a 30% to 35% higher CHD event rate.

Conclusions The results of this study support the concept that serum lipids are CHD risk factors in older Americans.

Key Words: cholesterol • coronary disease • risk factors • lipids • lipoproteins

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