Lipids and lipoproteins in symptomatic coronary heart disease. Distribution, intercorrelations, and significance for risk classification in 6,700 men and 1,500 women. The Bezafibrate Infarction Prevention (BIP) Study Group, Israel.

BACKGROUND: Lipid and lipoprotein profiles of coronary heart disease (CHD) patients have usually not included data on high density lipoprotein cholesterol (HDL-C), except in small groups, and have not included information on women. Both aspects are meaningful in the evaluation of patients for risk classification and for the importance of HDL-C in dictating further evaluation. METHODS AND RESULTS: In the screening phase of a clinical trial, we obtained lipid and lipoprotein levels under Centers for Disease Control-standardized procedures in more than 6,700 men and 1,500 women aged 40-72 years. Mean total cholesterol (TC) was higher in women (by 15-24 mg/dl) but changed little with age. Mean HDL-C, however, progressively increased with increased age for both sexes (34.4 at age of less than 50 years to 37.5 mg/dl at age 65 or older in men and from 41.3 to 44.5 mg/dl for the respective age groups in women). Triglycerides (TG) were lower in elderly groups, particularly in men (151 mg/dl in 65-year-olds versus 189 in counterparts less than 50 years). The number of previous infarctions, severity of congestive heart failure, and severity of angina were negatively correlated with mean HDL-C in a dose-response manner, whereas the association with mean TG was inverted, creating a mirror image of that observed with HDL-C. More than half of patients (52%) with TC less than 200 mg/dl exhibited HDL-C levels consistent with the accepted "high-risk" range of less than 35 mg/dl, whereas an increasing percentage of desirable HDL-C level was found with increasing levels of TC (14% with HDL-C greater than or equal to 45 mg/dl at TC less than 200 mg/dl increasing gradually to 28% in patients with TC greater than 260 mg/dl). CONCLUSIONS: These results provide previously unavailable information on the lipid profile of female patients and appear to strongly establish the case for obtaining all three standard blood lipid determinations (TC, HDL-C, and TG) in coronary patients as well as in the framework of detecting and classifying individuals at high risk for CHD.