Impaired HDL response to fat in men with coronary artery disease

A low HDL cholesterol is found frequently in subjects with premature corona ry artery disease. We speculated that individuals with a normal total chole sterol and coronary artery disease have an impaired HDL response to dietary fat. Twenty-one men with recently diagnosed coronary artery disease and to tal plasma cholesterol of <6 mmol/l were matched by age, weight and cholest erol with 26 men with no personal or family history of coronary artery dise ase. They were placed sequentially on a 25% fat diet for 2 weeks, a high ca rbohydrate supplement which reduced fat to 16% of energy for 3 weeks and a high monounsaturated fat supplement which increased fat to 35% for a final 3-week period. Half of the subjects underwent an intravenous glucose tolera nce test at the end of the intervention periods. The high fat supplement in creased HDL cholesterol from 0.79 to 0.89 mmol/l in the men with coronary a rtery disease while HDL increased from 0.88 to 1.05 mmol/l in the control g roup (P < 0.05 for group difference). Plasma triglyceride fell by 0.79 and 0.45 mmol/l in cases and controls respectively (P < 0.05 for group differen ce). LDL cholesterol fell by 0.2 mmol/l in both groups. Men with coronary a rtery disease had an enhanced insulin response during the intravenous gluco se tolerance test (P < 0.03) particularly in the low fat phase. Thus men wi th premature coronary artery disease and a low HDL cholesterol appear to ha ve an impaired elevation of HDL cholesterol in response to dietary fat, and insulin resistance may underlie this response. (C) 2000 Elsevier Science I reland Ltd. All rights reserved.