Enhanced risk of coronary heart disease mortality in lean hypertensive men.

A recently presented hypothesis contends that the excess coronary heart disease mortality associated with hypertension is more prominent in lean men than in overweight men. This hypothesis was addressed using data collected in the Israeli Ischemic Heart Disease Study (n = 10,059). The ratios of age-adjusted 15-year death rates in hypertensive and normotensive men were 4.7, 2.8, 2.0, and 1.9 in the Quetelet index groups of less than 2.29, 2.29 to 2.56, 2.56 to 2.83 and greater than 2.83 g/cm2, respectively. The corresponding ratios for all-cause mortality were 2.2, 2.1, 2.0, and 1.7, respectively. The group with the highest all-cause age-adjusted mortality, at 33.6%, was that of the leanest (less than 2.29 g/cm2, bottom 20% of the Quetelet index distribution) hypertensive subjects. The same group also displayed the highest coronary heart disease mortality (age-adjusted rate, 18.2%). The findings persisted for both smokers and nonsmokers and after exclusion of men with coronary heart disease or diabetics at intake, men on antihypertensive medication, or those who died in the first 2 years of follow-up (1963-1965). A multivariate risk score for developing myocardial infarction was calculated, based on levels of age, systolic blood pressure, total cholesterol, high density lipoprotein cholesterol, cigarette smoking, diabetes mellitus, and Quetelet index. This score varied little across the four Quetelet index groups in hypertensive men: 5-year mean estimated risks of myocardial infarction were between 70 and 74/1000. In normotensive men the scores increased from 19/1000 in the leanest subjects to 29/1000 in the overweight ones.(ABSTRACT TRUNCATED AT 250 WORDS)

Distributions of total cholesterol, triglycerides, and high-density lipoprotein cholesterol in Israeli Jewish children of different geographic-ethnic origins, ages 9-17 years.

To determine age and ethnic patterns of blood lipid levels in childhood and adolescence and to extend previous adult and late adolescent Israeli data to prepubertal ages, the levels of plasma total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) were determined among 1,153 schoolchildren in the area of Petah-Tikva. Half of the children were born to immigrants from Yemen. Among boys, TC levels progressively decreased as age increased from 10-11 to 14-15 years (159 to 142 mg/dl). The age-specific TC and HDL-C means among boys are compatible with an initial swift fall with age, followed by a rise restricted to TC during puberty. Among girls, progressively lower means through ages 12-13 and increasingly higher ones for older age groups are also compatible with puberty-determined changes, previously observed in American cohorts. The differences in TC were only partly accounted for by lower HDL-C means at higher ages (52 mg/dl in the youngest and 45 mg/dl in the oldest age group, respectively, among boys, compared with 53 mg/dl for girls at both ages 9 and 16-17). TG levels in boys, but not in girls, showed age differences paralleling those found for HDL-C, but in an inverse direction. TC means were lower as age increased only among female offspring of European-born Jews (159 to 148 mg/dl, ages 9-12 compared with ages 13-17), a phenomenon that requires further study. Overall, TC and HDL-C were clearly higher among girls than boys beginning at ages 12-13, with little or no sex differences in TG. The sex differences in TC, contrary to previous studies, were not fully accounted for by HDL-C sex differences. The ethnic variability paralleled previous findings in Israeli adults and adolescents, showing low TC levels among male offspring of Yemenite and other Asian-born fathers. The ethnic differences among girls were small. No specific pattern of age-related lipid changes was found in the group of Yemenite origin, who represented offspring of parents with notoriously low levels of coronary heart disease incidence.

High-density lipoprotein cholesterol: correlation with biochemical, anthropometric, behavioral, and clinical parameters in 6,500 Israeli men.

Correlations of high-density lipoprotein cholesterol (HDL-C), expressed in either absolute or relative terms, with a series of coronary risk factors and other variables were examined in the Israeli Ischemic Heart Disease Study sample. The Quetelet overweight index showed the highest correlations with HDL-C (r = -0.21) as well as with HDL-C as a percentage of total cholesterol (TC) (HDL/TC; r = -0.28). Additional negative inverse associations were statistically different from zero but small. High-density lipoprotein cholesterol and HDL/TC were significantly reduced in cigarette smokers, and HDL/TC was significantly reduced in men with myocardial infarction or angina pectoris and (albeit marginally) in diabetes mellitus as well. The presence of these diseases correlated poorly with HDL-C (absolute values). The associations of HDL-C and HDL/TC with the Quetelet index persisted after adjustment for cigarette smoking and vice versa. Reported dietary intake failed to explain HDL-C or HDL/TC variability among individuals. The "net" relationship of HDL-C to several variables was examined in a multiple regression analysis. The Quetelet index accounted for 0.21 of a multiple correlation coefficient of 0.28 (i.e., a very small proportion of explained variability). This magnitude is of an order similar to multiple correlations found in our study for total cholesterol, systolic blood pressure, and serum uric acid. It indicates that our knowledge of the determinants of HDL-C in adults is insufficient. The possible roles of several anthropometric and behavioral variables in determining HDL-C levels are considered, as is the possible genetic factor in dictating interindividual HDL-C variability.