Do serum cholesterol and relative body weight differ between men with coronary heart disease and matched healthy controls across different populations?
Serum cholesterol levels are consistently higher in coronary patients compared to matched controls across different populations, supporting the association between elevated cholesterol and coronary heart disease.
Men under 66 years of age suffering from unequivocal coronary heart disease in the Twin Cities of Minnesota and in Naples, Italy, were compared with clinically healthy men matched in place of residence, age, type of occupation, and socioeconomic status. The Twin Cities patients ( N = 72) did not differ in relative body weight from their controls ( N = 338) and the average relative weight of both groups was less than either of the 2 Naples coronary groups and the upper class Naples control subjects. The average relative body weight of the upper class Naples coronary patients ( N = 54) was insignificantly greater than that of their controls ( N = 89). The Naples working class coronary patients ( N = 54) had a significant tendency to be more often overweight than their controls ( N = 144). The serum total cholesterol concentration was significantly higher in each of the 3 groups of coronary patients than in their corresponding controls and the 3 groups, control and coronary, formed a sharp progression from high to low cholesterol values in the order: Twin Cities, Naples upper class, Naples working class. In the Naples working class, separation into manual and sedentary workers disclosed no differences in either relative body weight or serum cholesterol. The differences in serum cholesterol were accounted for by cholesterol in beta-lipoprotein. None of the 3 control groups differed in alpha-lipoprotein cholesterol concentration but in each of the 3 populations the coronary patients tended to have lower alpha values than their controls. The cholesterol data are compatible with the hypothesis that the 3 populations have different frequency distributions of cholesterol values, the coronary patients in each population tending to be drawn from the upper end of the corresponding population distribution, with no general critical level distinguishing all coronary patients as a total group. In the past several years coronary patients in the Twin Cities tend to be so frequently on diets or drugs to control cholesterol that it is increasingly difficult to find patients who may properly characterize the natural history of the disease. The patients reported here were free from this complication.
Keys et al. (Thu,) studied this question.