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...

SUMMARY 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.TWO MECHANISMS by which diet may impinge on coronary heart disease (CHD) are frequently postulated -obesity and serum cholesterol. Dietary alterations can alter both body weight and serum cholesterol levels. Therefore, it is reasonable to suggest reducing the risk of CHD by means of a diet that reduces obesity and elevated serum cholesterol. This still leaves moot the importance of dietary factors, either through the specified mechanisms or through others, in accounting for the different levels of CHD risk actually observed between or within populations. MethodsIn 1965, a 24-hour dietary recall was incorporated in the standardized examinations given men in three different prospective cardiovascular studies supported by the National Heart, Lung, and Blood Institute: the Framingham Study, the Honolulu Heart Study and the Puerto Rico Heart Health Program.The population studied in the Puerto Rico Heart Health Program' consisted of men born between 1900 and 1919 who lived in three urban and four rural districts in and around San Juan. In the 45-64-year age group, 8218 men were free of CHD and had complete 24-hour dietary recall interviews at the time of their initial examination, which took place in [1965][1966][1967][1968]

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This is an epidemiological study of coronary heart disease in a general population in North Dakota. A number of provocative findings appear in this preliminary report. Among them is the differential risk of developing coronary disease as between farmers and other occupational groups, and the role of factors other than diet in determining the development of the condition.

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