Abraham Kagan

HDL cholesterol and other lipids in coronary heart disease. The cooperative lipoprotein phenotyping study.

The relation between coronary heart disease (CHD) prevalence and fasting lipid levels was assessed by a case-control study in five populations with a total of 6859 men and women of black, Japanese and white ancestry drawn from subjects aged 40 years and older from populations in Albany, Framingham, Evans County, Honolulu and San Francisco. In each major study group mean levels of high density lipoprotein (HDL) cholesterol were lower in persons with CHD than in those without the disease. The average difference was small - typically 3–4 mg/dl - but statistically significant. It was found in most agerace-sex specific groups. The inverse HDL cholesterol-CHD association was not appreciably diminished when adjusted for levels of low density lipoprotein (LDL) cholesterol and triglyceride. LDL, total cholesterol and triglycerides were directly related to CHD prevalence; surprisingly, these findings were less uniformly present in the various study groups than the inverse HDL cholesterol-CHD association.

Serum lipoproteins and coronary heart disease in a population study of Hawaii Japanese men.

To ascertain the frequency of defined hyperlipoproteinemia and to investigate the relation between lipoprotein fractions and coronary heart disease, we measured serum lipoprotein cholesterol levels in a population-based sample of Hawaii Japanese men 50 to 72 years old. Type II hyperlipoproteinemia was present in 3 per cent of 1859 men, and Type IV in 26 per cent. Relative risks for coronary heart disease, based on 264 prevalence cases, were found to be 1.8, 1.8 and 0.46, between the upper and lower quartiles of total, beta, and alpha cholesterol, respectively. We found no significant relation between triglyceride and coronary heart disease. The inverse relation of alpha cholesterol of prevalence of coronary heart disease was independent of beta cholesterol, obesity, and other factors. The data suggest the need for further evaluation of the protective effect of the alpha lipoprotein fraction on the development of coronary heart disease.

ALCOHOL AND BLOOD LIPIDS: The Cooperative Lipoprotein Phenotyping Study

Data from five study populations participating in the Cooperative Lipoprotein Phenotyping Study indicate strong relations between reported alcohol consumption and blood-lipids. Alcohol consumption was positively associated with high-density-lipoprotein cholesterol level in all populations (r from 0-16 to 0-30), the lipid level appearing to be a graded response even over the low levels of alcohol consumption reported. Less strong but consistently negative correlations were found with low-density-lipoprotein cholesterol. Plasma-triglycerides showed a modest positive correlation with alcohol. The five populations were those of the Albany, Evans County, Framingham, Honolulu, and San Francisco Studies.

Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: Incidence of myocardial infarction and death from coronary heart disease

The incidence of myocardial infarction and death from coronary heart disease was studied in defined samples of 45 to 68 year old Japanese men in Japan, Hawaii and California. The incidence rate was lowest in Japan where it was half that observed in Hawaii (P less than 0.01). The youngest men in the sample in Japan were at particularly low risk. The incidence among Japanese men in California was nearly 50 percent greater than that of Japanese in Hawaii (P less than 0.05). A striking increase in the incidence of myocardial infarction appears to have occurred in the Japanese who migrated to the United States; this increase is more pronounced in California than in Hawaii.

Coffee, Alcohol and Risk of Coronary Heart Disease among Japanese Men Living in Hawaii

We examined the relation of coffee and alcohol consumption to the risk of coronary heart disease during a six-year period in a cohort of 7705 Japanese men living in Hawaii. The analysis was based on 294 new cases of coronary heart disease. There was a positive association between coffee intake and risk, but it became statistically insignificant when cigarette smoking was taken into account. There was a strong negative association between moderate alcohol consumption (up to 60 ml per day), mainly from beer, and the risk of nonfatal myocardial infarction and death from coronary heart disease. This association remained significant in multivariate analysis, taking into account smoking and other risk factors. The correlation of alcohol consumption with the level of alpha cholesterol (positive) and beta cholesterol (negative) may partly account for the observed negative association between alcohol and coronary heart disease.

Factors related to stroke incidence in Hawaii Japanese men. The Honolulu Heart Study.

As part of an ongoing longitudinal study of coronary heart disease and stroke among Japanese men in Hawaii, 8,006 men of Japanese ancestry living on the island of Oahu and aged 45–68 at entry examination have been followed by reexamination and surveillance. One hundred and eleven were found to have evidence of prior stroke at the time of the initial examination. During a six-year follow up period of the remaining 7,895 men, 94 developed definite thromboembolic stroke, 33 definite intracranial hemorrhage, and 6 developed stroke of unknown type. The principal risk factors for thromboembolic stroke were: elevated blood pressure, glucose intolerance, age, and electrocardiographic evidence of left ventricular hypertrophy or strain. Attributes associated with increased risk of intracranial hemorrhage were elevated blood pressure, electrocardiographic evidence of left ventricular hypertrophy or strain, and alcohol intake. Serum cholesterol level was negatively associated with risk of intracranial hemorrhage.

Some Factors Associated with the Development of Coronary Heart Disease—Six Years' Follow-Up Experience in the Framingham Study

AT FRAMINGHAM, MASS., the National Heart Institute has been conducting a prospective longitudinal study of factors related to the development of cardiovascular disease. A random sample consisting of two-thirds of the adult population, aged 29-62 years, was chosen for study. The sample size and age distribution were chosen to provide an adequate group of persons to be observed 20 or more years in which there would be a sufficient number of susceptible individuals. It was possible to bring in for examination 68.6 per cent (4,469) of the 6,510 selected. A group of 740 volunteers was added to supplement the initial group of respondents for prospective study (Table 1).1 Follow-up of this group has been carried on for four biennial examinations representing six years of observation. A previous report has confirmed that certain factors are associated with increased risk of development of coronary heart disease.2 Most important of these are hypercholesterolemia and hypertension. Many factors appear to be related to the development of coronary heart disease. The exact interplay of these factors and a possible common denominator important in the pathogenesis of coronary heart disease remain to be determined. No one factor has been clearly demonstrated to be essential.

Diet and its relation to coronary heart disease and death in three populations.

Baseline 24-hour dietary recalls from 16,349 men ages 45–64 years who had no evidence of coronary heart disease (CHD) were obtained in three prospective studies: the Framingham Study (859 men), the Honolulu Heart Study (7272 men) and the Puerto Rico Heart Health Program (8218 men). These men were followed for up to 6 years for the first appearance of CHD or death. Men who had a greater caloric intake or a greater caloric intake per kilogram of body weight were less likely to develop CHD manifest as myocardial infarction (MI) or CHD death, even though men of greater weight were more likely to develop CHD. This may reflect the benefit of greater physical activity. Men who consumed more alcohol were less likely to develop CHD, but more likely to die of causes other than CHD, particularly in the Honolulu study. In the Honolulu and Puerto Rico studies, but not in the Framingham study, men who consumed more starch were less likely to develop MI or CHD death. There was an inverse relation between starch intake and serum cholesterol, but it was too weak to explain fully the inverse starch-CHD association. There was also no evidence that the inverse relation between starch intake and incidence of CHD in the Honolulu and Puerto Rico studies was an indirect result of differences in fat intake. While the findings suggest additional areas for research, none of them would lead to an alteration of currently recommended preventive diets that emphasize lowering fat intake, because in isocaloric diets the logical way to balance a decreased fat intake is to increase the consumption of foods containing starch.

Differences in Coronary Heart Disease in Framingham, Honolulu and Puerto Rico

Abstract An effort to evaluate geographic differences in prevalence and incidence of coronary heart disease in men from Framingham, Japanese from Honolulu, and residents of Puerto Rico was made, using comparable methodology and criteria. The prevalence of CHD was twice as great in Framingham as in Honolulu and Puerto Rico. CHD incidence by ECG alone, by CHD death, or by both was from 2 to 4 times as high in Framingham as in Honolulu and Puerto Rico. There was a striking agreement among the studies with respect to the relationship of baseline characteristics to subsequent incidence of CHD. In particular, all three studies found a positive association of serum cholesterol and blood pressure to subsequent CHD incidence. A similar relationship was encountered with cigarette smoking in Framingham and Honolulu but not in Puerto Rico. All three found little or no relationship to the various measures of clinical and subclinical diabetes. A number of other variables showed relationships that were similar in all three studies. On the other hand, relative weight was a much weaker risk factor in Framingham than in Honolulu or Puerto Rico. Since serum cholesterol levels and the amount of cigarette smoking differ in the three populations it is logical to inquire whether this could account for the differences in CHD incidence. The answer is clear that the average Honolulu Japanese and Puerto Rican has a lower CHD incidence than his counterpart in Framingham. Even after allowing for differences in population characteristics, the difference is statistically significant and about 2-1 in magnitude. This suggests that new factors or explanations should be sought in order to clarify the additional protection against coronary heart disease found in some populations.

Alcohol and mortality: The Honolulu heart study

It has been shown previously that coronary heart disease was less likely to develop in Japanese men in Honolulu who drank alcoholic beverages than in those who abstained, and that the more they drank (up to about 60 ml/day of ethanol) the lower the risk. In this report on the same men, it is shown that the same sort of relation holds for mortality from coronary heart disease but that the reverse is true for death from cancer and from stroke. Men who drank were more likely to die from these causes than those who abstained, and the more they drank the greater the risk of death. Men who drank relatively large amounts were more likely to die from cirrhosis of the liver than other men. The resultant curve for total mortality is u-shaped, the lowest risk being for men who consumed from 1 to 10 ml/day of ethanol. Even at that low level of consumption, however, the risk of death from cancer or stroke was greater than it was for nondrinkers. In short, for this population of Japanese men, alcohol consumption appears to have some benefits and some hazards with regard to mortality, and the benefit or hazard depends on which cause of death is being considered.