High density lipoprotein cholesterol: prognosis after myocardial infarction. The Israeli Ischemic Heart Disease Study.

In people without overt clinical coronary heart disease (CHD), reduced levels of high density lipoprotein cholesterol (HDLC) are a known predictor of a first myocardial infarction (MI), and of death from CHD. Less is known about the role of HDLC in the prognosis of patients with coronary heart disease. In 130 men with electrocardiographic evidence of myocardial infarction examined in the Israeli Ischemic Heart Disease Study in 1963, the relationship of HDLC to prognosis was examined. Approximately 60% (77 men) died between 1963 and 1978. Analysis of mortality by HDLC quartiles revealed the highest rate, 74%, in the bottom HDLC quartile (less than 30 mg/dl). Quartile analysis was also performed for HDLC as a per cent of total cholesterol (PHDL), known as a better predictor of CHD incidence. Mortality was as high as 81% in the bottom quartile (PHDL less than 13%), with a relative mortality risk of 1.71 for subjects in the bottom quartile compared to those in the top quartile (PHDL greater than or equal to 19%). Initial mean PHDL in patients surviving 15 years was significantly higher than in those dying during that time (17.8% versus 16.2%, p less than 0.05). Multivariate analysis, using the Cox proportional hazards model, indicated an association close to conventional statistical significance between HDLC and long-term mortality (p = 0.069). The results are comparable with those reported by the Coronary Drug Project Study. Further investigations of larger cohorts of CHD survivors are needed before firm conclusions about the role of HDLC and the potential for the use of HDLC affecting drugs or lifestyle changes can be drawn.