HDL cholesterol and other lipids in coronary heart disease. The cooperative lipoprotein phenotyping study.
Level 4 - case-series / case-control
Multi-center case-control study assessing lipid levels and coronary heart disease prevalence.
PubMed 191215 · doi:10.1161/01.cir.55.5.767
What was done
A case-control study examined the association between fasting lipid levels and coronary heart disease (CHD) prevalence across five populations (Albany, Framingham, Evans County, Honolulu, and San Francisco). The sample included 6,859 men and women aged 40 years and older of Black, Japanese, and White ancestry.
What was found
Mean high-density lipoprotein (HDL) cholesterol levels were statistically significantly lower in individuals with CHD compared to those without CHD, with an average difference of 3 to 4 mg/dl across major study groups. This inverse association persisted in most age-, race-, and sex-specific subgroups and was not appreciably diminished after adjusting for low-density lipoprotein (LDL) cholesterol and triglyceride levels. Total cholesterol, LDL cholesterol, and triglycerides were directly related to CHD prevalence, but these associations were less consistently present across study groups than the inverse HDL association.
Why it matters
This study provided key epidemiological evidence establishing lower HDL cholesterol as an independent, consistent marker associated with coronary heart disease across racially and geographically diverse cohorts.
Limits
The case-control design evaluates prevalence rather than incidence, precluding causal inference or determination of whether low HDL preceded disease. Exact risk estimates, p-values, confidence intervals, and confounding variables such as medication use or smoking were not reported in the abstract.
Cited by
- supports Low HDL cholesterol is a stronger overall statistical predictor of heart disease risk than high LDL cholesterol.