Saturday REDUCED HIGH-DENSITY LIPOPROTEIN IN WOMEN AGED 40-41 USING ORAL
CONTRACEPTIVES
Consultation Bureau Heart Project* A. C. ARNTZENIUS
Department of Cardiology, Leiden University C. M.
VAN
GENT
H.
VAN DER
Gaubius Institute, Health Research
VOORT
Organisation
I0
June I978
Gordon in the Framingham study as having found an inverse relation between cigarette consumption and plasma-H.D.L.-cholesterol. Reduced plasma-H.D.L. may accelerate the development of atherosclerosis by impairing the clearance of cholesterol from the arterial wall.3 The mechanism by which use of oral contraceptives may contribute to circulatory diseases4is not entirely clear. However, these agents substantially increase serum-triglycerides and modestly increase serum-cholesterol.6-8 We investigated mean serum-H.D.L.-Çholesterol of oral-contraceptive users aged about 40 years and in controls of the same age.
C. I. STEGERHOEK Consultation Bureau for Tuberculosis, Leiden
Materials and Methods
K. STYBLO
Serum-H.D.L.-cholesterol concentrations were measured in the general population of Leiden in 1976. The investigation was part of the Consultation Bureau Heart Project (C.B. heart project). The C.B. heart project9,IO is a community project on coronary risk detection and modification, operating in six towns -Amsterdam, Doetinchem, Leiden, Maastricht, Rotterdam, and Tilburg (Netherlands). About 12 000 men and women are screened annually for symptoms and family history of C.H.D., smoking habits, height and weight, electrocardiogram (E.C.G.), blood-pressure, serum-cholesterol, urinary albumin and sugar, and use of oral contraceptive. Standard techniques are used and total serum-cholesterol is determined in a chemical laboratory which uses Prague (W.H.O.) as a reference centre.11 Protocol, training of staff, standardisation, quality control, attendance of the invited population as well as adherence to intervention measures and results have been reported elsewhere. So that results in different towns could be compared we decided to examine an age-group of around 40 years as part of the screened population in 4 towns (of which Leiden was one). Therefore, all people aged 40-41 years registered with the municipality of Leiden were asked to take part in the survey. 73 of the eligible population attended. A further 9, were excluded because they had either been examined previously in a comparable study carried out by a group of Dutch industrial physicians or were being treated for heartdisease. 471 men and 447 women were examined from March 1 to July 30, 1976..Non-fasting serum-H.D.L.-cholesterol was determined in the Gaubius Institute Leiden by means of the Huang method’2 (calibrated by the Abell method) after precipitation of the other lipoproteins. 13I
Organisation for Health Research T.N.O.,
The Hague
In a survey of risk factors for coronary heart-disease (C.H.D.) in a Leiden population aged 40-41 years, mean serum-high-density-lipoprotein (H.D.L.)-cholesterol was significantly higher in 447 women (47·94 mg/dl) than in 471 men (42·40 mg/dl). No association was found between serum-H.D.L.cholesterol and systolic or diastolic blood-pressure, obes-
Summary
ity, or electrocardiographic changes. Cigarette smoking and use of oral contraceptives were strongly associated with reduced serum-H.D.L.-cholesterol. The difference in serum-H.D.L.-cholesterol concentrations between women who were on oral contraceptives and those who were not was independent of the effect of smoking. The finding of a low mean serum-H.D.L.-cholesterol concentration in pill users who smoke (i.e., similar to that in men of the same age; 43·0 mg/dl and 42·4 mg/dl in women and men, respectively) is disturbing since low serum-H.D.L.-cholesterol is a major C.H.D. risk factor and because of the reported increase in mortality from circulatory diseases in women using oral contraceptives. mean
Introduction Low tein is
plasma-H.D.L.-cholesterol-high-density-lipopro-
major risk factor for coronary heart-disease (C.H.D.).1.2 In the Framingham study a weak correlaa
tion was found between H.D.L. cholesterol and total cholesterol and a considerable negative correlation between H.D.L. cholesterol and triglycerides. Plasma-H.D.L.-cholesterol was low in obesity and diabetes but no relation was found between H.D.L. cholesterol and cigarette smoking. However, Goldbourt and Medalie are cited by *Royal
Dutch t uberculosis Association (K.N.C.V.) Box 146, The Hague, Netherlands
Cardiology, P.O
Department of Preventive
Results concentration of serum-H.D.L.cholesterol significantly higher in women (47-94 mg/dl) than in men (42-40 mg/dl) in Leiden. Serum-H.D.L. concentrations were arbitrarily divided into "raised" (>50 mg/dl), "in between" (40-50 mg/dl), and "low" (
CONTRACEPTIVES
Consultation Bureau Heart Project* A. C. ARNTZENIUS
Department of Cardiology, Leiden University C. M.
VAN
GENT
H.
VAN DER
Gaubius Institute, Health Research
VOORT
Organisation
I0
June I978
Gordon in the Framingham study as having found an inverse relation between cigarette consumption and plasma-H.D.L.-cholesterol. Reduced plasma-H.D.L. may accelerate the development of atherosclerosis by impairing the clearance of cholesterol from the arterial wall.3 The mechanism by which use of oral contraceptives may contribute to circulatory diseases4is not entirely clear. However, these agents substantially increase serum-triglycerides and modestly increase serum-cholesterol.6-8 We investigated mean serum-H.D.L.-Çholesterol of oral-contraceptive users aged about 40 years and in controls of the same age.
C. I. STEGERHOEK Consultation Bureau for Tuberculosis, Leiden
Materials and Methods
K. STYBLO
Serum-H.D.L.-cholesterol concentrations were measured in the general population of Leiden in 1976. The investigation was part of the Consultation Bureau Heart Project (C.B. heart project). The C.B. heart project9,IO is a community project on coronary risk detection and modification, operating in six towns -Amsterdam, Doetinchem, Leiden, Maastricht, Rotterdam, and Tilburg (Netherlands). About 12 000 men and women are screened annually for symptoms and family history of C.H.D., smoking habits, height and weight, electrocardiogram (E.C.G.), blood-pressure, serum-cholesterol, urinary albumin and sugar, and use of oral contraceptive. Standard techniques are used and total serum-cholesterol is determined in a chemical laboratory which uses Prague (W.H.O.) as a reference centre.11 Protocol, training of staff, standardisation, quality control, attendance of the invited population as well as adherence to intervention measures and results have been reported elsewhere. So that results in different towns could be compared we decided to examine an age-group of around 40 years as part of the screened population in 4 towns (of which Leiden was one). Therefore, all people aged 40-41 years registered with the municipality of Leiden were asked to take part in the survey. 73 of the eligible population attended. A further 9, were excluded because they had either been examined previously in a comparable study carried out by a group of Dutch industrial physicians or were being treated for heartdisease. 471 men and 447 women were examined from March 1 to July 30, 1976..Non-fasting serum-H.D.L.-cholesterol was determined in the Gaubius Institute Leiden by means of the Huang method’2 (calibrated by the Abell method) after precipitation of the other lipoproteins. 13I
Organisation for Health Research T.N.O.,
The Hague
In a survey of risk factors for coronary heart-disease (C.H.D.) in a Leiden population aged 40-41 years, mean serum-high-density-lipoprotein (H.D.L.)-cholesterol was significantly higher in 447 women (47·94 mg/dl) than in 471 men (42·40 mg/dl). No association was found between serum-H.D.L.cholesterol and systolic or diastolic blood-pressure, obes-
Summary
ity, or electrocardiographic changes. Cigarette smoking and use of oral contraceptives were strongly associated with reduced serum-H.D.L.-cholesterol. The difference in serum-H.D.L.-cholesterol concentrations between women who were on oral contraceptives and those who were not was independent of the effect of smoking. The finding of a low mean serum-H.D.L.-cholesterol concentration in pill users who smoke (i.e., similar to that in men of the same age; 43·0 mg/dl and 42·4 mg/dl in women and men, respectively) is disturbing since low serum-H.D.L.-cholesterol is a major C.H.D. risk factor and because of the reported increase in mortality from circulatory diseases in women using oral contraceptives. mean
Introduction Low tein is
plasma-H.D.L.-cholesterol-high-density-lipopro-
major risk factor for coronary heart-disease (C.H.D.).1.2 In the Framingham study a weak correlaa
tion was found between H.D.L. cholesterol and total cholesterol and a considerable negative correlation between H.D.L. cholesterol and triglycerides. Plasma-H.D.L.-cholesterol was low in obesity and diabetes but no relation was found between H.D.L. cholesterol and cigarette smoking. However, Goldbourt and Medalie are cited by *Royal
Dutch t uberculosis Association (K.N.C.V.) Box 146, The Hague, Netherlands
Cardiology, P.O
Department of Preventive
Results concentration of serum-H.D.L.cholesterol significantly higher in women (47-94 mg/dl) than in men (42-40 mg/dl) in Leiden. Serum-H.D.L. concentrations were arbitrarily divided into "raised" (>50 mg/dl), "in between" (40-50 mg/dl), and "low" (
