Interrelations of lipids and lipoproteins with coronary artery disease mortality in 19 countries.

Coronary risk factors differ in importance from country to country, but a proportion of interpopulation differences in coronary artery disease (CAD) mortality is probably closely related to interpopulation differences in total serum cholesterol levels. Interpopulation differences in high density lipoprotein (HDL) cholesterol levels supposedly do not explain interpopulation differences in CAD mortality, although HDL cholesterol may be an important negative risk factor within a population. Age- and sex-specific serum cholesterol, triglyceride and HDL cholesterol levels have been sought for 27 industrialized countries for which the World Health Organization has reliable mortality data. At least partially complete information was obtained from 19 countries, derived from national or regional studies in middle-aged subjects, and this has been related to CAD mortality rates. In men, 45% of the interpopulation variation in CAD mortality was explained by variation in serum cholesterol levels; 32% by variation in HDL cholesterol; and 55% by variation in the ratio of total serum cholesterol/HDL cholesterol. CAD mortality in men did not correlate with a population's serum triglyceride levels. In women, the only significant correlate of interpopulation variation in CAD mortality was the ratio of total serum cholesterol/HDL cholesterol, which explained 31% of the variation in CAD mortality. These findings highlight the contributions of total serum cholesterol and the ratio of total serum cholesterol/HDL cholesterol to CAD mortality in men at the international level and have implications for individual members of a population. Similar analyses in women were not particularly informative.