THE RELATION OF DOCUMENTED CORONARY-ARTERY DISEASE TO LEVELS OF TOTALCHOLESTEROL AND HIGH-DENSITY-LIPOPROTEIN CHOLESTEROL

Recommendations for identifying persons at high risk for coronary hear t disease are based primarily on levels of total and low-density lipop rotein cholesterol. We examined whether, given knowledge of these leve ls, information on the high-density lipoprotein cholesterol level woul d improve the prediction of arteriographically documented coronary art ery disease among 591 men. We found that even at levels of total and l ow density lipoprotein cholesterol considered desirable, high-density lipoprotein cholesterol was inversely related to disease severity. For example, among the 112 men with a total cholesterol level <180 mg per dl, the mean occlusion score (representing the overall severity of di sease) was 107 among men with a high-density lipoprotein cholesterol l evel less than or equal to 30 mg per dl us a mean score of 52 among me n with levels greater than or equal to 45 mg per dl. Furthermore, men with low levels of both low-density lipoprotein cholesterol (<110 mg p er dl) and high-density lipoprotein cholesterol (less than or equal to 30 mg per dl) had as much occlusive disease as did men with high leve ls of both lipoprotein fractions. Given information on the ratio of hi gh-density lipoprotein cholesterol to total cholesterol, the actual le vels of the lipoprotein fractions did nor improve disease prediction. Our results emphasize the importance of considering high-density lipop rotein cholesterol when assessing coronary heart disease risk.