Background: Studies have shown high-density lipoprotein cholesterol (HDL-C) to be a strong predictor of cardiovascular disease (CVD) risk.
Methods: Determinants of HDL-C and apoprotein AI concentrations were evaluated cross-sectionally in 1987 among 429 women, ages 45-54, from a population-based study of CVD risk factors through menopause (the Healthy Women Study, University of Pittsburgh).
Results: Subjects were healthy and not taking hormone replacement therapy. Results showed levels of HDL-C (mg/dl) to range from 23 to 117, HDL2-C from 0 to 53, HDL3-C from 16 to 66, and apoprotein AI from 87 to 204. Multivariate analyses which included age, cigarettes/day, alcohol intake (g/day), physical activity (Paffenbarger questionnaire), body mass index (BMI), and waist/hip ratio (WHR) showed that women who smoked greater than or equal to 20 cigarettes a day, reported little or no alcohol intake, expended less than 500 kcal/week, and were in the highest quintile of BMI and WHR had, on average, 33 mg/dl lower HDL-C than slender, nonsmoking women who drank moderately and exercised. HDL2-C showed a similar pattern, whereas the HDL3-C concentration had only a modest association with these factors. HDL-C was somewhat lower among women who had stopped menstruating than among premenopausal women. The apoprotein AI level was associated with alcohol intake (positively) and BMI (negatively).
Conclusion: Theoretically, by raising their HDL-C by 10 mg/dl, women could reduce their CVD risk by as much as one-third (based on results from the Framingham Heart Study). As CVD is the leading cause of death among postmenopausal women, the potential impact of such a reduction in risk would be large.