American Journal of Epidemiology Vol. 126, No. 4: 629-637
Copyright © 1987 by The Johns Hopkins University School of Hygiene and Public Health
research-article |
LIPOPROTEINS AS MEDIATORS FOR THE EFFECTS OF ALCOHOL CONSUMPTION AND CIGARETTE SMOKING ON CARDIOVASCULAR MORTALITY: RESULTS FROM THE LIPID RESEARCH CLINICS FOLLOW-UP STUDY
1Departments of Community and Family Medicine and Medicine, University of California San Diego, La Jolla, CA
2Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma Oklahoma City, OK
3Department of Epidemiology, University of North Carolina Chapel Hill, NC
4Department of Biostatistics, University of North Carolina Chapel Hill, NC
5Lipid Research Clinic, Department of Preventive Medicine and Environmental Health, University of Iowa Hospital Iowa City, IA
Reprint requests to Dr. Basil M. Rifkind, Lipid Metabolism-Atherogenesis Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Federal Building, Room 401, Bethesda, MD 20892.
Criqui, M. H. (Dept of Community and Family Medicine, U. of California, San Diego, La Jolla, CA 92093), L. D. Cowan, H. A. Tyroler, S. Bangdiwala, Q. Heiss, R. B. Wallace, and R. Conn. Upoproteins as mediators for the effects of alcohol consumption and cigarette smoking on cardiovascular mortality: results from the Upid Research Clinics Follow-up Study. Am J Epidemiol 1987; 126:629–37.
Because alcohol consumption is associated with increased high density lipoprotein (HDL) cholesterol and decreased low density lipoprotein (LDL) cholesterol, and cigarette smoking is associated with lower HDL cholesterol and higher LDL cholesterol, there has been speculation that the protective effect of moderate alcohol consumption and/or the noxious effect of cigarette smoking for cardiovascular disease might be mediated in large part by a lipoprotein mechanism. The authors examined this question in a prospective study of 7,481 men and women in 10 North American populations initially seen in 1972–1976 and followed for an average of 8.5 years. Moderate alcohol consumption was weakly protective for cardiovascular disease, while cigarette smoking was strongly and significantly associated with cardiovascular disease mortality. As expected, LDL cholesterol was positively related and HDL cholesterol was inversely related to cardiovascular disease mortalIty. However, multivarlable analysis of cardiovascular disease mortality alternately excluding and including HDL cholesterol and LDL cholesterol as covariates indicated that the effect of alcohol consumption on cardiovascular disease mortality was independent of an LDL cholesterol pathway and only partially mediated by an HDL cholesterol pathway, while the effect of cigarette smoking was independent of both the HDL cholesterol and LDL cholesterol pathways, suggesting alternative biologic mechanisms of action for both alcohol consumption and cigarette smoking on cardiovascular disease.
alcohol drinking; cardiovascular diseases; coronary disease; lipoproteins; lipoproteins, HDL cholesterol; lipoproteins, LDL cholesterol; smoking
The authors thank Hope Bryan, Rebecca Caruso, Jane Kinsey, Carol Carver, and Allen Rosen for technical assistance with the manuscript.
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