LETTER TO THE EDITOR
Mild hypercholesterolemia and premature heart disease
Alberto Batalla, MDa,
Julián R. Reguero, MDb,
Sergio Hevia, MDb,
Gustavo I. Cubero, MDb and
Arturo Cortina, MDb
a Department of Cardiology, Cabueñes Hospital, Gijon, Spain
b Department of Cardiology, Central Hospital of Asturias, Oviedo, Spain
In a recent study published in the Journal by Akosah et al. (1), the investigators found that the presence of borderline or mild hypercholesterolemia has significant effects on the development of premature coronary heart disease.
In this way, a group of 229 male patients <50 years of age (mean age 43 ± 5 years), who were admitted to our Coronary Care Unit as a result of an episode of coronary disease were prospectively studied. During the acute phase and by means of a structured questionnaire, the presence of smoking habits, hypertension, diabetes and dyslipemia were recorded. A physical examination and fasting analysis were also done. Due to clinical instability or persistent myocardial ischemia, 132 patients underwent a cardiac catheterization. In accordance with a previous report (2) we considered as normolipemia a total cholesterol/HDL cholesterol ratio (Tchol/HDL)  5. Two groups were established on this basis. To determine new coronary events, a mean follow-up of 32 ± 13 months was carried out. For statistical analysis, the chi square test and Fisher exact test were applied.
Our study was observational and did not suppose any intervention in the treatment. In the acute phase we found that 160 patients (73%) were smokers; 84 (36%) presented arterial hypertension; 21 (9%) had diabetes; and 181 (77%) had dyslipemia. In the follow-up, 45 patients (20%) retained smoking habits; 76 (34%) had arterial hypertension; 22 (10%) had diabetes; and 172 (75%) had dyslipemia.
The distribution of coronary lesions in the patients who underwent a cardiac catheterization were: normal coronariography, 13 patients (10%); one vessel, 49 patients (37%); two vessels, 42 patients (32%); and three vessels, 28 patients (21%).
No differences were found in the prevalence of smoking habits (93% of our patients were smokers) and diabetes in either group (Tchol/HDL  5 vs. Tchol/HDL <5) (3).
Nor were there any differences in the appearance of angina, myocardial infarction, heart failure, mortality and the need for coronary revascularization in the follow-up period. Significant data are shown in Table 1.
We concluded that our patients, who were younger than 50 years of age, with ischemic heart disease, and who showed a Tchol/HDL ratio 5, present less prevalence of hypertension and show more frequently an absence of significant coronary lesions in comparison with those patients with an altered lipid profile. Furthermore, no additional benefits were found in relation to new coronary events (fatal and nonfatal). We interpret that this lack of benefit might be due to the high percentage of smokers in both groups. Finally, our data are coincident with those reported previously (4), showing that a normal lipid profile does not confer additional benefit to smokers.
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References
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- Akosah KO, Gower E, Groon L, Rooney BL, Schaper A. Mild hypercholesterolemia and premature heart disease: do the national criteria underestimate disease risk? J Am Coll Cardiol. 2000;35:1178–1184[Abstract/Free Full Text]
- Assmann G, Schulte H. The Prospective Cardiovascular Munster Study: prevalence and prognostic significance of hyperlipidemia in men with systemic hypertension. Am J Cardiol. 1987;59:9G–17G[CrossRef][Medline]
- Batalla A, Reguero JJR, Cubero GI, et al. Relationship between dyslipemic and other risk factors in men with early coronary disease. (abstr)Rev Esp Cardiol. 1999;52(Suppl 4):103[Medline]
- Jee SH, Suh I, Kim IS, Appel LJ. Smoking and atherosclerotic cardiovascular disease in men with low levels of serum cholesterol. JAMA. 1999;282:2149–2155[Abstract/Free Full Text]
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J. H. Cole, J. I. Miller III, L. S. Sperling, and W. S. Weintraub
Long-term follow-up of coronary artery disease presenting in young adults
J. Am. Coll. Cardiol.,
February 19, 2003;
41(4):
521 - 528.
[Abstract]
[Full Text]
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