To Investigate the reasons for the lack of sex differences In high density llpoprotelns (HDL) observed In population studies of the Plma Indians, we selected 18 lean (9 men, 9 women, body mass Index (BMI) < 27) and 22 obese (12 men, 10 women, BMI > 27) Plma Indians for an Inpatlent study of HDL composition. We measured lipase activities and steroid hormone concentrations, both of which have previously been Implicated In the control of HDL. The lean women had higher concentrations of HDL and HDL 2 than did either the obese women or the lean or obese men. Lean women had significantly lower hepatic lipase activities and significantly higher concentrations of estradlol compared to obese women. Lean women also had different HDL 2 composition, as Indicated by the molar ratio of HDL 2 cholesterol/A-l. Significant negative correlations between HDL and obesity measured by either BMI or percent body fat were observed In both sexes, but the slope of the relationship was steeper In women. Significant negative associations were observed between HDL or HDL 2 concentrations and hepatic lipase In both sexes, and there were significant positive associations between HDL 2 and plasma estradlol In women. The data suggest that obesity In this population has a stronger negative Influence on HDL concentrations In women, possibly through changes In estradlol and hepatic lipase activities. Since there are so few lean women In the Plma population, the net result Is that HDL levels In women In the population as a whole do not differ from those of men. (Arteriosclerosis 7:292-300, May/June 1987) P opulation studies have shown that women usually have a lower prevalence of coronary heart disease than do men. 1 2 The difference has been attributed in part to their high density lipoprotein (HDL) concentrations, since In most populations HDL is higher in women than in men 3 ' 4 and since HDL concentrations have been shown to be inversely associated with the prevalence and incidence of coronary heart disease.5 " 7 Because of these observations, it is of Interest to understand the mechanisms that control HDL and why HDL concentrations are influenced by sex.There are some populations in which HDL appear to be similar in men and women.8 " 12 One of these, the Pima Indian population, is especially interesting. Although there is a low prevalence of coronary heart disease (CHD) in the nondlabetics, 13 the men appear to have a higher prevalence of CHD than do the women. The HDL concentrations Received September 4, 1986; revision accepted January 28, 1987. in this population are low in both sexes, and no differences in HDL or HDL subtractions were observed between the men and the women when 1391 individuals were sampled in a population survey. 10 The previous data on lipoproteins in this population were obtained on samples from outpatients. We, therefore, decided to examine more thoroughly the HDL composition in Pima subjects stabilized on the metabolic ward. We recruited groups of lean and obese men and women In order to examine the relationships b...