ABSTRACTS

CIGARETTES, COFFEE, AND OTHER ASSOCIATIONS WITH HDL

CHOLESTEROL IN THE GENERAL POPULATION

Russell V. Luepker, MD, FACC; David R. Jacobs, PhD; Peter Hannan, MS; Elizabeth Brewer, BS, Henry L. Taylor, PhD; University of Minnesota, Minneapolis, MN

High density lipoprotein cholesterol is consistently related inversely to coronary heart disease (CHD) in numerous prospective studies. HDL is also associated with

physiologic and health behavior characteristics. To evaluate those relationships, 632 adults (age 20-59) from

a geographic based random sample were surveyed. Measures included fasting plasma, blood pressure (BP), height,

weight, treadmill performance (ET), and questions about nutrition and health habits.

Participation rates in this population sample were consistently high (>80%). In univariate analysis, HDL was

positively and significantly related to female sex (F), and exogenous hormone use (H), and negatively related to

cigarette usage (GIG), body mass index (BMI), triglycer- ides (TG), very low density lipoprotein cholesterol (VLDL), and low density lipoprotein cholesterol (LDL). HDL "as not related to total cholesterol (TC), BP, reported physical activity (PA), fitness by ET or reported alcohol (EtOH),

tea, or coffee usage. Multivariate analysis demonstrated HDL independently

related positively to F, H, age, heavy PA, EtOH, heavy coffee intake (>8 cups/day), and negatively to BMI, GIG, TG, VLDL, and LDL. It "as not related to moderate coffee usage, ET, TC, or moderate PA.

HDL is related to many modifiable health character- istics in these epidemiological data. Causal connections cannot be evaluated from these data; however, they must be considered in postulating mechanisms, evaluating patients, or planning intervention strategies.

TOTAL CHOLESTEROL/HIGH DENSITY LIPOPROTEIN RATIO CORRE- LATES WITH THE PRESENCE BUT NOT SEVERITY OF CORONARY ARTERY DISEASE Gordon L. Pierpont, MD, John 0. Swanson, MD, and Arnold Adicoff, MD, FACC, VA Medical Center and University of Minnesota, Minneapolis, Minnesota

Elevated serum low density lipoprotein is considered a risk factor for developing coronary artery disease (CAD), whereas elevated high density lipoprotein (HDL) apoears to have 3 protecting effect, and total cholesterol (C) to HDL ratio has been suggested as an improved method for assessing risk. We determined C, HDL, and triglycerides (trigl) in 189 patients (pts) undergoing diagnostic car- diac catheterization to determine if they correlate with the severity of CAD assessed as number of vessels (II ves) involved with >70% stenosis. Results (mg/dl+SEM):

il "es 0 1 2 3 N pts 32 40 51 66

age 522 1.8 53? 1.6 56+ 1.2 56: 1.2 C 2122 7.7 25Ot10.7 244~ 8.5 2502 6.2 HDL 54? 2.3 43? 1.8 45? 1.8 411 1.2 C/HDL 4.1? 0.2 6.1+ 0.3 5.7? 0.2 6.4? 0.3 Trig1 14ot12.3 212A28.8 204t21.4 231214.7

Using analysis of variance, pts with no CAD differed from those with CAD in HDL (p<.OO5), trig1 (n<.Ol), C (p<.DOS), and C/HDL (p<.Oc)S), but no significant differences were found between pts with CAD having different II ves involved. There were no significant differences between the groups in age, and although the 0 ves group had more females than the others, there were no differences in C, HDL, C/HDL or trig1 between males and females with no CAD. !,Je conclude that C/HDL correlates with the presence but not severity of CAD.

ANGIOGRAPHIC CORRELATION OF CORONARY ARTERY DISEASE WITH HIGH DENSITY LIPOPROTEIN CHOLESTEROL IN ASYMPTOMATIC MEN Gregory S. Uhl, M.D., R. George Troxler, M.D., James R. Hickman, Jr., M.D., and Dale Clark, Ph.D., USAF School of Aerospace Medicine, Brooks Air Force Base, Texas.

There appears to be an inverse relationship of high density lipoprotein cholesterol (HDL) and the risk of coronary artery disease (CAD). Fasting serum cholesterol (Chol) and HDL were determined on 572 asymptomatic (Asx) aircrew screened for CAD. Of these, 132 had an abnormal

treadmill (TM) and underwent coronary angiography. CAD, defined as >50% narrowing in any major vessel, "as found in 16 with the rest having minimal (N=14) or no CAD (N= 102). The mean +SEM for Chol, HDL, and Chol/HDL are pre- sented below:

Normal (N=102) CAD (~=16) Chol mg% 216 ? 3.6 286 i 16.3**

HDL mg% 50 * 1.1 39 f 2.9*

Chol/HDL 4.4 f 0.1 7.5 + 1.6***

"p co.02 **p <O.OOl ***p <<O.OOl The mean ?SEM values in the cath normals did not differ significantly from those values in the whole population. The 14 men with minimal CAD had Chol and Chol/HDL values that differed from the normals (p c.001). Only 2/16 CAD patients had Chol/HDL ~6.0 while 4 cath normals had a ratio'6.0. Only 42/440 men with normal TM had a Chol/ HDL >6.0. That is, only 9.5% of patients with a normal TM had a ratio >6 while 87% of those with CAD had Chol/HDL >6. The sensitivity for detecting CAD of Chol/HDL >6.0

"as 87% (14/6), specificity 96% (98/102) and a predictive value of 77% (19/18) in an asx population with prevalence of 12% (16/132). Thus (1) Asx men with CAD have signifi- cantly lower HDL and higher Chol and Chol/HDL than normals, (2) A Chol/HDL >6.0 in Asx men with abnormal TM is an accu- rate predictor of CAD and (3) Even minimal CAD (lesions <50%) are identified by Chol/HDL above the norm.

FOLLOW-UP OF PATIENTS WITH CHEST PAIN AND NORMAL CORONARY

ARTERIOGRAPHY Ira S. Ockene. MD. FACC: Marilyn Shay, RN: Bonnie H. Weiner. MD: Joseoh S. Alnert. MD. FACC: James E. Da1en.m. . , I

FACC, University of I‘:assachusetts Medical Center, Worcester, Massachusetts.

Approximately 10% of pts referred for coronary arterio- graphy (CA) because of chest pain are found to have angiographically normal coronary arteries. The good

prognosis‘of these pts has been well documented, but their functional and sociological status has been less well studied. 56 pts (26 H, 30 F, mean age 47) referred

for CA because of chest pain and found to have normal

coronary angiography with no other heart disease were followed up at a mean interval of 15.2 + 9.0 months. 17 pts (30%) were pain free. 29 (52%) had fewer episodes,

and in only 10 (18%) "as the pain unchanged or more frequent. 15 (27%) were still on pronranolol and 22 (39%) remained on nitrates.

Work disability Pt feels heart disease

Pre Cath Post Cath

35 (63%) 22 (39%)

present 43 (77%) 21 (38%)

Pt feels heart is normal 9 (16%) 24 (43%)

All of these pts had been told that they had normal hearts, and noncardiac chest pain. Despite this, 39%

remain disabled, and 38% still feel they have heart disease. These pts represent a large, poorly dealt with health problem, and might benefit from further rehabili-

tation.

February 1980 The American Journal of CARDIOLOGY Volume 45 447