HDL CHOLESTEROL AND MORTALITY IN FINNISH MEN WITH SPECIAL REFERENCE TO ALCOHOL INTAKE

Background There is substantial evidence that a low serum level of HDL cholesterol (HDLC) is a risk factor for coronary deaths. However, dat a on older people are scarce, and previous studies have not examined t his association in relation to alcohol intake. Methods and Results Cor onary 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. D uring 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 relat ed to alcohol and violence. HDLC levels were inversely associated with coronary mortality, irrespective of age, whereas high total cholester ol 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 yea rs old. Correction for temporal variation in HDLC measurement indicate d a 43% stronger inverse association between HDLC and coronary mortali ty compared with that based only on a single value. The inverse associ ation of HDLC and coronary mortality was less marked at higher levels of alcohol intake. All-cause and alcohol- and violence-related mortali ty were positively associated with HDLC among the younger men. All-cau se mortality showed a U-shaped dose response among men greater than or equal to 60 years old. Conclusions Previous studies may have underest imated the beneficial effect of high HDLC because of regression-diluti on bias and the confounding effect of heavy alcohol intake. This study supports the view that, particularly among older men, lipoprotein fra ctions may be more appropriate for screening than total cholesterol.