High-density lipoprotein cholesterol and angiographic coronary artery disease in black patients

Predictors of coronary lesions complexity in patients with stable coronary artery disease

Only a few studies focused on the predictors of the SYNTAX score (SS). We evaluated the independent clinical predictors of SS in 436 consecutive patients with stable angina pectoris who underwent coronary angiography. Estimated glomerular filtration rate (eGFR) was calculated. The mean SS was 25.8 ± 13.7. High-sensitivity C-reactive protein and low-density lipoprotein cholesterol levels gradually rise while high-density lipoprotein cholesterol (HDL-C), triglycerides, and eGFR levels gradually decline from low to high SS tertile. Multivariate logistic regression analysis revealed that diabetes (P = .005), left ventricular ejection fraction ([LVEF]; P < .001), previous statin use (P = .02), HDL-C level (P < .001), and eGFR (P < .001) were independent predictors of SS. In conclusion, the presence of diabetes mellitus, no previous statin use, and lower values of HDL-C, LVEF, and eGFR were independent predictors of coronary heart disease complexity. This study has been accepted to present at the 28th Turkish National Cardiology Congress.

Ethnicity and cardiovascular disease prevention in the United Kingdom: a practical approach to management

The United Kingdom is a diverse society with 7.9% of the population from black and minority ethnic groups (BMEGs). The causes of the excess cardiovascular disease (CVD) and stroke morbidity and mortality in BMEGs are incompletely understood though socio-economic factors are important. However, the role of classical cardiovascular (CV) risk factors is clearly important despite the patterns of these risk factors varying significantly by ethnic group. Despite the major burden of CVD and stroke among BMEGs in the UK, the majority of the evidence on the management of such conditions has been based on predominantly white European populations. Moreover, the CV epidemiology of African Americans does not represent well the morbidity and mortality experience seen in black Africans and black Caribbeans, both in Britain and in their native African countries. In particular, atherosclerotic disease and coronary heart disease are still relatively rare in the latter groups. This is unlike the South Asian diaspora, who have prevalence rates of CVD in epidemic proportions both in the diaspora and on the subcontinent. As the BMEGs have been under-represented in research, a multitude of guidelines exists for the 'general population.' However, specific reference and recommendation on primary and secondary prevention guidelines in relation to ethnic groups is extremely limited. This document provides an overview of ethnicity and CVD in the United Kingdom, with management recommendations based on a roundtable discussion of a multidisciplinary ethnicity and CVD consensus group, all of whom have an academic interest and clinical practice in a multiethnic community.

Correlates of serum high-density lipoprotein cholesterol: a community-based study of middle-aged and older men and women in Japan

The authors examined the relationships of high-density lipoprotein (HDL) cholesterol with sex, age, body composition, and lifestyle related factor including dietary patterns, alcohol consumption, smoking, and physical activity in a community-based sample from Mie prefecture, Japan. The study population comprised of 463 men (65.7+/-8.6 years) and 845 women (61.9+/-10.1 years) who participated in an annual healthy examination and a lifestyle related survey in 2001. Using factor analysis based on data from the lifestyle-related questionnaires, three dietary patterns were identified: prudent, Western, and high-salt dietary patterns. Univariate and multivariate analyses indicated that important predictors of higher HDL cholesterol levels were being female and a higher frequency of alcohol consumption. Less strongly related were age and a prudent dietary pattern. Smoking and body mass index (BMI) were strongly negatively related to HDL cholesterol levels. We suggested that efforts to reduce coronary heart disease risks focus on weight control and good daily lifestyles in middle-aged and older Japanese population.

A review on ethnic differences in plasma triglycerides and high-density-lipoprotein cholesterol: is the lipid pattern the key factor for the low coronary heart disease rate in people of African origin?

Black people in the UK, in the Caribbean, and to a lesser extent in the USA, experience coronary heart disease events at different rates than white people. Despite having higher prevalence of hypertension, cigarette smoking and diabetes, black males have significantly lower coronary heart disease rates than white males, whereas no significant differences have been detected in females. The only known risk factor differences that could account for the difference in CHD rates are higher HDL cholesterol and lower triglycerides that are seen in blacks compared with whites. Obesity and, in particular abdominal obesity, seems to determine TG and HDL cholesterol levels: black males are less centrally obese than whites, while total adiposity and central distribution of fat is more predominant in black females compared with white females. We propose that the less degree of abdominal adiposity observed in black males is related with an increased anti-lipolytic effect of insulin, which could account for low triglycerides and high HDL cholesterol levels, and consequently explain the higher protection from coronary heart disease experienced by black males compared with whites and black females.

Correlates of high-density lipoprotein cholesterol in black and white women

The relationships of high-density lipoprotein (HDL) cholesterol with body composition, leisure-time physical activity, cigarette smoking, and education were examined in a community-based sample of 480 Black and 1337 White women. Univariate and multivariate analyses indicated inverse associations of HDL with body mass index and waist-to-hip ratio in both groups, and with cigarette smoking and low educational attainment among White women only. Since correlates of HDL cholesterol differ for Black and White women, further investigation of the differences in these correlates is warranted.

Education, race, and high-density lipoprotein cholesterol among US adults

OBJECTIVES

Although educational achievement is positively related to levels of high-density lipoprotein cholesterol (HDL-C) among White adults, there is an inverse association among Blacks. We assessed whether this interaction could be attributed to differences in the relation of education to correlates of HDL-C.

METHODS

Cross-sectional analyses were based on data from 8391 White and 995 Black adults who participated in the Second National Health and Nutrition Examination Survey.

RESULTS

Associations between education and HDL-C levels varied from negative (Black men), to nearly nonexistent (White men and Black women), to positive (White women). Mean HDL-C levels were higher among Blacks than among Whites, but differences varied according to educational achievement. Among adults with less than 9 years of education, mean levels were 6 to 10 mg/dL higher among Blacks, but the radical difference was less than 1 mg/dL among adults with at least 16 years of education. About 20% to 40% of these differences could be accounted for by obesity, alcohol consumption, and other characteristics.

CONCLUSIONS

Because of the implications for coronary heart disease risk, consideration should be given to behavioral characteristics associated with the interaction between race and educational achievement.

Usefulness of the total cholesterol to high-density lipoprotein cholesterol ratio in predicting angiographic coronary artery disease in women

To investigate the relation between lipids and angiographic coronary artery disease (CAD) in women, fasting lipid profiles were obtained on 108 women undergoing coronary angiography (group I). CAD, defined as greater than or equal to 25% luminal diameter narrowing in a major coronary artery, was present in 57 (53%). Neither serum total cholesterol nor triglyceride levels correlated with the presence of CAD. Mean total/high-density lipoprotein (HDL) cholesterol ratio was higher among women with than without CAD (5.5 +/- 0.3 vs 4.2 +/- 0.2, p less than 0.0001). Multiple regression analyses identified a higher total/HDL cholesterol ratio as the variable most predictive of the presence (p less than 0.001), extent (number of narrowed arteries) (p less than 0.0001), and severity (% maximum stenosis) (p less than 0.001) of CAD. Age and lack of estrogen use were also independently associated with the presence of CAD, age and low-density lipoprotein cholesterol level were additional indicators of extent, and age was the only other discriminator of severity of CAD. In 56 women with total cholesterol less than 200 mg/dl (group II), mean total/HDL cholesterol ratio was higher in women with (n = 24) than without CAD (4.3 +/- 0.2 vs 3.5 +/- 0.2, p = 0.01). Higher total/HDL cholesterol ratio was the variable most predictive of the presence of CAD (p = 0.01), and the lone variable associated with severity (p less than 0.001) after adjustment for other risk factors. Age was independently associated with presence and extent, and hypertension was also independently related to extent.(ABSTRACT TRUNCATED AT 250 WORDS)

Serum lipids, lipoproteins and apolipoproteins in black patients with angiographically defined coronary artery disease

The association between angiographically defined coronary artery disease (CAD) and serum lipids, lipoproteins, and apolipoproteins was evaluated in 151 black men and 245 black women. Patients with 70% or greater narrowing of at least one coronary artery or greater than or equal to 50% stenosis of the left main coronary artery (n = 179) were compared to those with lesions of less than 50% stenosis (n = 217) for total cholesterol (TC), low density lipoprotein-cholesterol (LDL-C), high density lipoprotein-cholesterol (HDL-C), LDL-C/HDL-C, triglycerides, apolipoprotein A-I, apolipoprotein B, and apolipoprotein A-I/B. A consistently more atherogenic pattern of lipids, lipoproteins, and apolipoproteins occurred only among the women. Using stepwise selection multiple logistic regression analysis, the ratio of apolipoprotein A-I/B (odds ratio = 0.38, 95% confidence limits 0.24-0.61) was the only statistically significant association of CAD in women, after adjusting for the effects of age, body mass index, and histories of smoking, hypercholesterolemia, hypertension, and diabetes. When stratified by median of total cholesterol, the ratio of apolipoprotein A-I/B was the most strongly associated with the presence of CAD in the lower half of the total cholesterol distribution (less than 208 mg/dl), whereas in the upper half of the total cholesterol distribution the total cholesterol/HDL-C ratio was more strongly associated with CAD. None of the variables studied was associated with CAD in men. These results support other studies suggesting that apolipoproteins may be better predictors of CAD.

Black/white differences in risk factors for arteriographically documented coronary artery disease in men

Although the leading cause of death among black men in the United States is coronary artery disease (CAD), risk factors have not been well documented in black populations. Therefore, possible racial differences in the relation of several characteristics to the extent of CAD were assessed in 4,722 white and 169 black men who underwent arteriography. Associations between an occlusion score (ranging from 0 to 300), reflecting the severity of CAD, and levels of total and high-density lipoprotein (HDL) cholesterol, triglycerides, cigarette smoking, alcohol intake, relative weight, systemic hypertension and diabetes mellitus were examined. Most risk factors were significantly related to the extent of CAD in both races, but lipid levels showed stronger associations with CAD among blacks: correlations between CAD and total cholesterol were 0.16 (whites) vs 0.29 (blacks) and associations with HDL cholesterol were -0.22 (whites) vs -0.49 (blacks). In addition, at adverse levels of certain risk factors, blacks had more extensive CAD than did whites: mean occlusion scores were 148 (whites) and 238 (blacks) at HDL cholesterol levels less than 30 mg/dl. As assessed by multiple linear regression, however, only triglyceride levels were differentially related to CAD between whites (beta = 0) and blacks (beta = 0.47), p less than 0.01 for racial contrast. These results document the importance of risk factors in black men and indicate black/white differences in the relation of triglycerides to CAD.

Coronary artery disease in blacks of lower socioeconomic status: angiographic findings from the Cook County Hospital Heart Disease Registry

During a 4-year period, 1,022 blacks underwent angiography at our institution for the presumptive diagnosis of coronary artery disease (CAD). Among the 454 men, at least one coronary stenosis was demonstrated in 288 cases (63%), while significant narrowing was found in 242 of 568 women (43%). Despite the frequent finding of normal coronary arteries, those patients with significant CAD had severe disease. Thus among men with CAD, left main stenosis was present in 7% and three-vessel narrowing was seen in 53%; among the women, 8% had left main stenosis and three-vessel disease was present in 52%. Two countervailing processes appear to be occurring, namely (1) identification of true coronary symptoms is difficult in this group of patients and (2) diagnosis of true cases occurs late in the course of the disease and the distribution of the number of vessels involved is skewed upwards. Increased echocardiographically determined left ventricular mass and hypertension were prevalent among all groups. These data suggest that the approach to the diagnosis of CAD in the black population is difficult and severe CAD occurs frequently.