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* Pacific Health Research Institute, Honolulu, HI
Honolulu Heart Program, Kuakini Medical Center, Honolulu, HI
John A. Burns School of Medicine, Departments of Health Science and Epidemiology, Geriatric Medicine, and Medicine, University of Hawaii at Manoa, Honolulu, HI
** Division of Biostatistics and Epidemiology, University of Virginia School of Medicine, Charlottesville, VA
National Institute for Occupational Safety and Health, Health Effects Laboratory Division, Morgantown, WV
Columbia University, New York, NY
1 To whom correspondence should be addressed. e-mail: jdcurb{at}phrihawaii.org
High density lipoprotein cholesterol (HDL-C) levels are inversely associated with the incidence of coronary heart disease (CHD) in middle-aged individuals; in the elderly, the association is less clear. Genetic factors, including variations in the cholesteryl ester transfer protein (CETP) gene, play a role in determining HDL-C levels. Controversy remains about whether CETP deficiency and the resultant rise in HDL-C are antiatherogenic, or whether CETP has the opposite effect due to its role in reverse cholesterol transport. In a seven-year follow-up of 2,340 men aged 71–93 in the Honolulu Heart Program, the age-adjusted CHD incidence rates were significantly lower in men with high versus low HDL-C levels. After adjustment for age, hypertension, smoking, and total cholesterol, the relative risk of CHD for those with HDL-C levels 
60 mg/dl, compared with those with HDL-C levels <40 mg/dl, was 0.6. Men with a CETP mutation had the lowest rates of CHD, although this was not statistically significant.
These data indicate that HDL-C remains an important risk factor for CHD in the elderly. Whether a CETP mutation offers additional protection against CHD warrants further investigation.
Abbreviations: BMI, body mass index; CETP, cholesteryl ester transfer protein; CHD, coronary heart disease; CVD, cardiovascular disease; HDL-C, high density lipoprotein cholesterol; HHP, Honolulu Heart Program; LDL-C, low density lipoprotein cholesterol; MI, myocardial infarction
Supplementary key words epidemiology • risk factors • high density lipoprotein cholesterol
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