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Papers In Press, published online ahead of print February 16, 2004
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CEO, Pacific Health Research Institute, Honolulu, HI 96813
Corresponding Author: jdcurb{at}phrihawaii.org
Objective: 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 anti-atherogenic or whether CETP has the opposite effect due to its role in reverse cholesterol transport. Methods and Results: In a 7-year follow-up of 2340 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 to 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. Conclusion: 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.
Revised on February 6, 2004
Accepted on February 9, 2004
A prospective study of HDL cholesterol and cholesteryl ester transfer protein gene mutations and the risk of coronary heart disease in the elderly
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