Potential for increasing high-density lipoprotein cholesterol, subfractions HDL 2-C and HDL 3-C, and apoprotein Al among middle-age women

Abstract

Background. Studies have shown high-density lipoprotein cholesterol (HDL-C) to be a strong predictor of cardiovascular disease (CVD) risk. Methods. Determinants of HDL-C and apoprotein AI concentrations were evaluated cross-sectionally in 1987 among 429 women, ages 45–54, from a population-based study of CVD risk factors through menopause (the Healthy Women Study, University of Pittsburgh). Results. Subjects were healthy and not taking hormone replacement therapy. Results showed levels of HDL-C (mg/dl) to range from 23 to 117, HDL 2-C from 0 to 53, HDL 3-C from 16 to 66, and apoprotein AI from 87 to 204. Multivariate analyses which included age, cigarettes/day, alcohol intake (g/day), physical activity (Paffenbarger questionnaire), body mass index (BMI), and waist/hip ratio (WHR) showed that women who smoked ⩾ 20 cigarettes a day, reported little or no alcohol intake, expended less than 500 kcal/week, and were in the highest quintile of BMI and WHR had, on average, 33 mg/dl lower HDL-C than slender, nonsmoking women who drank moderately and exercised. HDL 2-C showed a similar pattern, whereas the HDL 3-C concentration had only a modest association with these factors. HDL-C was somewhat lower among women who had stopped menstruating than among premenopausal women. The apoprotein AI level was associated with alcohol intake (positively) and BMI (negatively). Conclusion. Theoretically, by raising their HDL-C by 10 mg/dl, women could reduce their CVD risk by as much as one-third (based on results from the Framingham Heart Study). As CVD is the leading cause of death among postmenopausal women, the potential impact of such a reduction in risk would be large.