Abstract
High density lipoprotein cholesterol (HDL-C) levels are inversely associated with the incidence of coronary heart disease (CHD) in middle-aged individuals; in the elderly, the association is less clear. Genetic factors, including variations in the cholesteryl ester transfer protein (CETP) gene, play a role in determining HDL-C levels. Controversy remains about whether CETP deficiency and the resultant rise in HDL-C are antiatherogenic, or whether CETP has the opposite effect due to its role in reverse cholesterol transport. In a seven-year follow-up of 2340 men aged 71-93 in the Honolulu Heart Program, the age-adjusted CHD incidence rates were significantly lower in men with high versus low HDL-C levels. After adjustment for age, hypertension, smoking, and total cholesterol, the relative risk of CHD for those with HDL-C levels >or=60 mg/dl, compared with those with HDL-C levels <40 mg/dl, was 0.6. Men with a CETP mutation had the lowest rates of CHD, although this was not statistically significant. These data indicate that HDL-C remains an important risk factor for CHD in the elderly. Whether a CETP mutation offers additional protection against CHD warrants further investigation.
Highlights
High density lipoprotein cholesterol (HDL-C) levels are inversely associated with the incidence of coronary heart disease (CHD) in middle-aged individuals; in the elderly, the association is less clear
We have previously shown in elderly Japanese-American men of the Honolulu Heart Program (HHP) that the prevalence of cholesteryl ester transfer protein (CETP) mutations is high and often associated with elevated concentrations of HDL-C [13]
Crude and age-adjusted incidence rates of CHD in personyears were estimated according to ranges of HDL-C concentrations and by CETP mutation status based on the 7 years of followup data that were available for the 2,340 men without prevalent disease, who were examined from 1991 to 1993 [18]
Summary
High density lipoprotein cholesterol (HDL-C) levels are inversely associated with the incidence of coronary heart disease (CHD) in middle-aged individuals; in the elderly, the association is less clear. Genetic factors, including variations in the cholesteryl ester transfer protein (CETP) gene, play a role in determining HDL-C levels. Men with a CETP mutation had the lowest rates of CHD, this was not statistically significant These data indicate that HDL-C remains an important risk factor for CHD in the elderly. A prospective study of HDL-C and cholesteryl ester transfer protein gene mutations and the risk of coronary heart disease in the elderly. Genetic factors, including variations in the cholesteryl ester transfer protein (CETP) gene, are thought to play a major role in the determination HDL-C levels.
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