Relation of serum total cholesterol and high-density lipoprotein cholesterol percentage to the incidence of definite coronary events: Twenty-year follow-up of the donolo-Tel Aviv prospective coronary artery disease study

This 20-year follow-up report presents the incidence of definite coronary events and its relation to serum total cholesterol (TC) and α-lipoprotein cholesterol percentage (percentage of serum TC bound with α-lipoprotein), now usually called high-density lipoprotein cholesterol percentage (HDL-C%). The cohort consists of 1,454 men and 1,481 women, presumably healthy, aged 35 to 64 years at the time of entrance examination in 1964. During the follow-up period 123 men and 44 women died from coronary disease. Ninety-six men and 42 women had nonfatal myocardial infarctions. The incidence of definite coronary events increased from 6% in men with TC levels of less than 200 mg/dl to 25% in men with levels of more than 264 mg/dl. The corresponding figures in women were 3% and 10%. The incidence of definite coronary events was inversely correlated to HDL-C%. The incidence of definite coronary events in 225 men with HDL-C% of less than 14% was 28%, and in 669 men with HDL-C% of 21% or more, 7%. The corresponding figures in 234 women with HDL-C% of less than 17% was 14%, and in 853 women with HDL-C% of 23% or more, 2%. Two HDL-C% subsets were assessed: “low” and “high” subsets refer to HDL-C% of less than 21% and 21% or more, respectively, in men and less than 23% and 23% or more in women. The excessive risk of definite coronary events of low HDL-C% compared to high HDL-C% subsets in subsequent TC ranges of less than 200, 200 to 224, 225 to 249, 250 to 264 and more than 264 mg/dl in men was 5, 2, 6, 2 and 1.2, respectively. The corresponding excessive risk in women was 5, 3, 2, 3 and 5. Thus, within each of the TC subsets, from less than 200 mg/dl to to more than 264 mg/ dl, HDL-C% of less than 21% in men, and less than 23 % in women indicate a risk 2 to 4 times higher for coronary disease than that in persons with HDL-C% over these levels and define a subset of normal cholesterol high-risk persons with TC of less than 200 mg/dl and 200 to 224 mg/dl and low HDL-C%.