High Cholesterol In Younger Men Linked To Increased Long-Term Risk Of Death From Heart Disease

CHICAGO - Younger men with high cholesterol levels face a greater risk of death from coronary heart disease and cardiovascular disease later in life, and have a lower shorter life expectancy, according to an article in the July 19 issue of The Journal of the American Medical Association (JAMA).

Jeremiah Stamler, MD, of Northwestern University Medical School, Chicago, and colleagues evaluated the impact of serum cholesterol on men with no history of diabetes mellitus or heart attack. The men were under the age of 40 when they enrolled in three large long-term medical studies:

-- 11,017 men aged 18 to 39 were screened in 1967-1973 for the Chicago Heart Association Detection Project in Industry (CHA), and were followed up for 25 years.

-- 1,266 men aged 25 to 39 were examined in 1959-1963 for the Peoples Gas Company Study (PG), and were followed up for 34 years.

-- 69,205 men aged 35 to 39 were screened in 1973-1975 in 18 U.S. cities for the Multiple Risk Factor Intervention Trial (MRFIT), and were followed up for 16 years.

Coronary heart disease (CHD) accounted for 26 percent of all deaths in the CHA, 34 percent of deaths in the PG, and 28 percent of deaths in the MRFIT. Cardiovascular disease (CVD) accounted for 34 percent, 42 percent, and 39 percent of deaths, respectively.

The researchers found that men in all three studies were at greater risk if their cholesterol was at higher than recommended levels. "These results demonstrate a continuous, graded relationship of serum cholesterol level to long-term risk of CHD, CVD, and all-cause mortality; substantial absolute risk and absolute excess risk of CHD and CVD death for younger men with elevated serum cholesterol levels; and longer estimated life expectancy for younger men with favorable serum cholesterol levels," they write.

For men whose cholesterol measured 240 or greater, the risk of dying from CHD was 2.2 to 3.6 times greater than for men with cholesterol levels under 200. The risk of death from CVD was 2.10 to 2.87 times greater, and the risk of death from all causes was 1.31 to 1.49 times greater.

Lower serum cholesterol levels translated into an estimated greater life expectancy of 6.1 years for men in the CHA study, 8.7 years for men in the PG study and 3.8 years for men in the MRFIT.

There was no significant relation of baseline serum cholesterol levels to cancer deaths, the risk of death from violent causes, or the risk of death from other causes.

The authors conclude that the study results, along with previously published findings, provide powerful additional support to current public policy.

"First, the results underline the strategic importance of population-wide primary prevention of unfavorable serum cholesterol levels (and other major risk factors), by improvement of lifestyles -- particularly primary eating habits -- from conception and weaning on, so that a progressively higher proportion of adults of all ages are at low risk," they write.

"Second, they support population-wide efforts to identify children, teenagers, and young adults -- as well as others -- with unfavorable serum cholesterol levels (and other major risk factors), so that early therapeutic efforts can be instituted, first and foremost, to improve nutrition," they conclude.

Editor’s Note: The Chicago Heart Association Detection Project in Industry (CHA) Study and the Peoples Gas Company Study have been supported by the American Heart Association and its Chicago and Illinois Affiliates; the National Heart, Lung, and Blood Institute; the Chicago Health Research Foundation; and private donors. The CHA Study was supported also by the Illinois Regional Medical Program. The Multiple Risk Factor Intervention Trial has been a collaborative research endeavor with the National Heart, Lung, and Blood Institute.