Cholesterol and beta lipoproteins in the serums of Americans: Well persons and those with coronary heart disease

Abstract

1. 1. The serum S f12–20 and S f20–100 lipoproteins and cholesterol have been described for 1,968 adults who appeared well and fulfilled simple clinical criteria of “normalcy”, for 273 men with evidence of definite myocardial infarction in the past, for 141 men with definite angina pectoris, and for 23 women with evidence of myocardial infarction. These measurements were related to sex, age and body weight. 2. 2. The most characteristic attribute of serum lipid measurements in adults of similar age and sex and clinical status is their large variability. 3. 3. Among well people under fifty years of age, men show higher levels of all these serum lipids than do age-matched women. 4. 4. The age trend of serum lipid levels is different for the two sexes. Women show a steady increase with age throughout the age span studied. After the age of sixty the serum cholesterol levels of women exceed those of men. 5. 5. The trends of serum lipid levels with age are partly attributable to fattening with age. 6. 6. The 273 men with established myocardial infarction were found to have both serum cholesterol and lipoprotein levels which were higher, on the average, than those found in age-matched men without obvious disease. This finding supports the belief that clinical manifestations of atherosclerosis are associated with a disorder of lipid metabolism. 7. 7. The serum lipid levels of twenty-three women with myocardial infarction were similar to those of men with the same disease and were higher than age-matched women without obvious disease. 8. 8. The serum lipid levels of 141 men with angina pectoris only were intermediate between those of well men and men with myocardial infarction. 9. 9. The small size and great variability of these differences of serum lipid levels between well men and women and those with angina pectoris or myocardial infarction prevent efficient application of serum cholesterol and lipoprotein levels by themselves to the clinical prediction of coronary heart disease among individuals. 10. 10. Neither S f12–20 nor S f20–100 nor cholesterol showed any clear individual superiority in prognostication of coronary heart disease, nor could any combination of these be found which sufficiently improved the discrimination between sick and well people to offer clinical utility. 11. 11. The differences in serum lipid levels between groups of well and diseased men vary with age. The difference in serum cholesterol levels, especially, is greatest for the young men, that is, the fourth decade in this study, and tends to diminish for older groups. 12. 12. These observations do not reveal the same absolute levels of serum lipoproteins in men with coronary heart disease, or in well men, as have been reported by other workers. The presence of a lipid defect in men with coronary heart disease is confirmed but the magnitude of this is less than reported by others. 13. 13. The measurement of total serum cholesterol remains the most practicable laboratory measurement for aiding in the identification of people with gross disturbances of lipid metabolism which predispose to coronary heart disease.