Obesity, lipoproteins, and heart disease.

Studies of lipoproteins in this homogenous study population indicate clear and consistent associations between obesity and abnormalities in lipoproteins. These include both increases in VLDL and lower HDL, which were observed in both men and women. A high production of total body cholesterol in obese subjects, probably associated with increased flux of glucose and free fatty acids, leads to a greater production of VLDL. This, in turn, creates a greater flux of metabolic products of VLDL either back to the liver or through LDL. Obesity induces an increase in hepatic lipase, perhaps in women because of lower estrogen levels, which is associated with lower HDL concentrations, and altered HDL composition. Several of these observed changes, such as the greater proportion of VLDL remnants, the greater flux of particles through the LDL compartment, and the altered HDL composition, may be associated with increased atherosclerosis. However, preliminary data do not show a relationship between obesity and death from coronary heart disease in this population. More studies are needed to resolve this apparent conflict.