CARDIOVASCULAR RISK-FACTORS AND LIPOPROTEIN PROFILE IN FRENCH-CANADIANS WITH PREMATURE CAD - IMPACT OF THE NATIONAL-CHOLESTEROL-EDUCATION-PROGRAM-II

BACKGROUND: Coronary artery disease (CAD) is the major cause of death in Canadian adults. Regional differences in the prevalence of CAD in C anada are due, in part, to differences in cardiovascular risk factor d istributions. Two hundred and forty-nine patients of predominantly Fre nch Canadian descent (greater than 90%), aged less than 60 years (202 men and 47 women) with angiographically documented CAD were examined i n a cardiology secondary prevention clinic and their cardiovascular ri sk factors and lipoprotein cholesterol levels were determined. OBJECTI VES: To determine the prevalence of cardiovascular risk factors in a g roup of French Canadian subjects compared with subjects screened for t he Quebec Heart Health Survey and to determine the impact of the Natio nal Cholesterol Education Program II (NCEP II) on screening and treatm ent of these patients. METHODS: Observation study of free-living subje cts with CAD, compared with a reference group. RESULTS: Mean ages were 48.6+/-6.8 and 50.6+/-6.4 years for men and women, respectively. On a verage, the patients were on a diet containing approximately 31% of ca lories as fat, with. 9.7% as saturated fats at the time of blood sampl ing. The mean number of risk factors was the same in men and women (3. 5+/-,2 Cor men versus 3.2+/-1.3 for women; P not significant) but thei r prevalence differed between sexes. Family history of CAD was seen in 78.5% of men versus 77.3% of women (P not significant), smoking (defi ned as more than 10 cigarettes per day in the year preceding the clini cal evaluation) in 45.7% of men versus 41.9% of women (P not significa nt), a history of smoking in 75.5% of men versus 69.8% of women (P not significant) and diabetes in 14.7% of men and 25% of women (P not sig nificant). There was less hypertension in men (31.4% versus 52.3%, P=0 .015) and fewer men had a low density lipoprotein cholesterol of 3.4 m mol/L or greater (66.8% in men versus 83% in women, P<0.05). Men, howe ver, had a higher prevalence of reduced high density lipoprotein chole sterol (less than 0.9 mmol\L, 57.4% in men versus 31.9% in women, P<0. 01). Only approximately 5% of premature CAD patients had familial hype rcholesterolemia. Compared with a reference group from the Quebec Hear t Health Survey, men and women with CAD had a higher prevalence of car diovascular risk factors. With a cut-off point for total cholesterol o f 5.2 mmol/L, 26.2% of men and 17% of women had 'normal' cholesterol l evels; of these, 67.9% of men and 25% of women had high density lipopr otein less than 0.9 mmol/L. CONCLUSIONS: French Canadian men and women with CAD have a high prevalence of all cardiovascular risk factors. T he patients are representative of the Montreal urban area and findings of the present study may not apply to the Quebec population with resp ect to the prevalence of risk factors. Under the treatment recommendat ions of NCEP II, 66.8% of men and 83% of women are candidates for drug therapy of dsyslipoproteinemia aimed at reducing low density lipoprot ein cholesterol levels. According to these data, cardiovascular risk s tratification must be based on a complete lipoprotein profile or miscl assification, especially in men, may occur.