SUMMARYThe 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 DURING THE PAST TWO DECADES considerable progress has been made delineating the role of the plasma lipoproteins in the development of coronary heart disease (CHD). Interest has focused chiefly on the very low density and low density lipoproteins (VLDL and LDL); there has been relatively little interest in the role of the high density lipoproteins (HDL), which ordinarily carry about 20% of the total plasma cholesterol. (In electrophoretic terms, HDL and LDL correspond to alpha and beta, while VLDL corresponds to prebeta.) The neglect of HDL cholesterol is curious since as early as 1951 Barr et al. reported that healthy men had higher levels of alpha (or high density) lipoprotein than did men with CHD.1 This early observation was confirmed in subsequent cross-sectional studies;2-7 moreover, women, who have less CHD than men, were noted to have higher levels of this lipoprotein.5The Cooperative Lipoprotein Phenotyping Study of subjects drawn from epidemiologic studies of five diverse populations provides an excellent data base for examining the role of the various lipid fractions in coronary heart disease. In this report fasting levels of HDL, LDL and total cholesterol, and triglyceride are related to CHD prevalence. MethodsData from five study populations participating in the Cooperative Lipoprotein Phenotyping Study served as the basis for this report. The overall design and methods of these studies, all of which were derived from ongoing prospective studies of cardiovascular disease, have been described previously.""' Briefly they were: a population of male Civil 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.Service employees in Albany, New York; a general population of black and white men and women in Evans County, Georgia; a general population of men and women in Framingham, Massachusetts; and general populations of men of Japanese ancestry living in Honolulu and San Francisco. In Albany and Framingham entire cohorts were invited to participate in the Cooperative Lipoprotein Phenotyping Study. The other three studies invited only random samples of their total st...

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