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Choice and Use of Blood Lipid Tests: An Epidemiologic Perspective

Choice and Use of Blood Lipid Tests: An Epidemiologic Perspective Abstract • Serum cholesterol is a useful test in asymptomatic adults who are interested in preventing coronary heart disease (CHD). It guides the decision to recommend a fat-controlled diet to reduce the serum cholesterol level; this intervention probably decreases the risk of CHD in patients with high levels (eg, >240 mg/dL), but not in those with lower levels (the majority). The potential effect of such intervention on absolute (attributable) CHD risk is relatively large in males and in patients with other risk factors. Dietary intervention probably has less effect on CHD risk than eliminating smoking or controlling hypertension. Lipid and lipoprotein tests other than cholesterol are not generally needed, although high-density lipoprotein cholesterol may be useful in certain situations. These epidemiologic considerations, tempered by the preferences of the patient, are useful for individualizing preventive medicine decisions. (Arch Intern Med 1983;143:667-673) References 1. Steinberg D: Research related to underlying mechanisms in atherosclerosis. Circulation 1979;60:1559-1565.Crossref 2. Havel RJ: Approach to the patient with hyperlipidemia. Med Clin North Am 1982;66:319-333. 3. Hulley SB, Rhoads GG: The plasma lipoproteins as risk factors: Comparison of electrophoretic and ultracentrifugation results. Metabolism 1982;31:773-777.Crossref 4. Maloney TW, Rogers DE: Medical technology: A different view of the contentious debate over costs. N Engl J Med 1979;301:1413-1419.Crossref 5. Canadian Task Force on the Periodic Health Examination: The periodic health examination. Can Med Assoc J 1979;121:3-45. 6. Medical Practice Committee, American College of Physicians: Periodic health exam: A guide for designing individualized preventive health care in the asymptomatic patient. Ann Intern Med 1981;95:729-732.Crossref 7. Stamler J: Lifestyles, major risk factors, proof and public policy. Circulation 1978;58:3-19.Crossref 8. Conference on the health effects of blood lipids: Optimal distributions for populations: Workshop report. Prev Med 1979;8:612-732.Crossref 9. Nutrition and Your Health: Dietary Guidelines for Americans . Department of Health, Education, and Welfare and Department of Agriculture, 1980. 10. Grundy SM, Bilheimer D, Blackburn H, et al: Rationale of the diet-heart statement of the American Heart Association: Report of the Nutrition Committee. Circulation 1982;65:839-854Crossref 11. Food and Nutrition Board of the National Research Council: Toward Healthful Diets . Washington, DC, National Academy of Sciences, 1980. 12. James TN: Presidential address: Sure cures, quick fixes and easy answers. Circulation 1981;63:1199-1202.Crossref 13. Oliver MF: Serum cholesterol: The knave of hearts and the joker. Lancet 1981;2:1090-1095.Crossref 14. Hulley SB, Sherwin RS, Nestle M, et al: Epidemiology as a guide to clinical decisions: II. Dietary fat and CHD. West J Med 1981;135:25-33. 15. Hulley SB, Rosenman RH, Bawol RD, et al: Epidemiology as a guide to clinical decisions: The association between triglyceride and CHD. N Engl J Med 1980;302:1383-1389.Crossref 16. Gordon T, Castelli WP, Hjortland MC, et al: High-density lipoprotein as a protective factor against coronary heart disease: The Framingham Study. Am J Med 1977;62:707-714.Crossref 17. Heiss G, Johnson NJ, Reiland S, et al: The epidemiology of plasma HDL cholesterol levels: The LRC Program Prevalence Study. Circulation 1980;62( (suppl 4) ):116-136.Crossref 18. Havel RJ: High-density lipoproteins, cholesterol transport and CHD. Circulation 1979;60:1-3.Crossref 19. Shekelle RB, Shryock AM, Paul O, et al: Diet, serum cholesterol, and death from CHD: The Western Electric Study. N Engl J Med 1981;304:65-70.Crossref 20. Symposium report on dietary factors relating to the nation's health. Am J Clin Nutr 1979;32:2621-2747. 21. The Coronary Drug Project Research Group: The Coronary Drug Project: Findings leading to further modifications of its protocol with respect to dextrothyroxine. JAMA 1972;220:996-1008.Crossref 22. Coronary Drug Project Research Group: Clofibrate and niacin in coronary heart disease. JAMA 1975;231:360-381.Crossref 23. Committee of Principal Investigators: WHO cooperative trial on primary prevention of IHD using clofibrate to lower serum cholesterol: Mortality follow-up. Lancet 1980;2:380-385. 24. The Lipid Research Clinics Program: The coronary primary prevention trial: Design and implementation. J Chronic Dis 1979;32:609-631.Crossref 25. Oliver MF: Risks of correcting the risks of coronary disease and stroke with drugs. N Engl J Med 1982;306:297-298.Crossref 26. Ederer F, Leren P, Turpeinen O, et al: Cancer among men on cholesterol-lowering diets: Experience from five clinical trials. Lancet 1971;2:203-206.Crossref 27. Connor WE, Connor SL: The dietary treatment of hyperlipidemia. Med Clin North Am 1982;66:485-518. 28. Anderson JT, Grande F, Keys A: Independence of the effects of cholesterol and degree of saturation of the fat in the diet on serum cholesterol in man. Am J Clin Nutr 1976;29:1181-1189. 29. Caggiula AW, Christakis G, Farrand M, et al: The Multiple Risk Factor Intervention Trial: IV. Intervention on blood lipids. Prev Med 1981;10:443-475.Crossref 30. MRC Research Committee: Controlled trials of soya bean oil in myocardial infarction. Lancet 1968;2:693-699. 31. Frantz ID Jr, Dawson EA, Kuba K, et al: Minnesota coronary survey: Effect of diet on cardiovascular events and deaths. Circulation 1975;52 ( (suppl 2) ):4. 32. Dayton S, Pearce ML, Hashimoto S, et al: A controlled clinical trial of a diet high in unsaturated fat. Circulation 1969;39 and 40( (suppl 2) ):1-63. 33. Leren P: Oslo Diet-Heart Study: Eleven-year report. Circulation 1970;42:935-942.Crossref 34. Miettinen M, Turpeinen O, Karvonen MJ, et al: Effect of cholesterol-lowering diet on mortality from CHD and other causes: A 12-year trial in men and women. Lancet 1972;2:835-838.Crossref 35. Hjermann I, Velve Byre K, Holme I, et al: Effect of diet and smoking intervention on the incidence of coronary heart disease. Lancet 1981;2: 1303-1310.Crossref 36. MRFIT Research Group: Multiple Risk Factor Intervention Trial: Risk factor changes and mortality results. JAMA 1982;248:1465-1477.Crossref 37. Sherwin R: Controlled trials of the diet-heart hypothesis: Some comments on the experimental unit. Am J Epidemiol 1978;108:92-99. 38. Zukel WJ, Paul O, Schnaper HW: The Multiple Risk Factor Intervention Trial: I. Historical perspectives. Prev Med 1981;10:387-401.Crossref 39. The Pooling Project Research Group: Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events. J Chronic Dis 1978;31:201-306.Crossref 40. Liu K, Stamler J: The two lowest quintiles of serum cholesterol and risk of CHD. CVD Epidemiol Newsletter, AHA . 1982;31:13. 41. Kannel WB, Gordon T: The search for an optimum serum cholesterol. Lancet 1982;2:374-375.Crossref 42. Heiss G, Tanni I, Davis C, et al: Lipoprotein-cholesterol distributions in selected North American populations: The Lipid Research Clinics Program Prevalence Study. Circulation 1980;61:302-315.Crossref 43. Kark JD, Smith AH, Hames CG: The relationship of serum cholesterol to the incidence of cancer in Evans County, Georgia. J Chronic Dis 1980;33:311-322.Crossref 44. Beaglehole R, Foulkers MA, Prior IAM, et al: Cholesterol and mortality in New Zealand Maoris. Br Med J 1980;1:285-287.Crossref 45. Feinleib M: On a possible inverse relationship between serum cholesterol and cancer mortality. Am J Epidemiol 1981;114:5-10. 46. Kagen A, McGee DL, Yarro K, et al: Serum cholesterol and mortality in a Japanese-American population: The Honolulu Heart Program. Am J Epidemiol 1981;114:11-20. 47. Rose G, Shipley MJ: Plasma lipids and mortality: A source of error. Lancet 1980;1:523-526.Crossref 48. International Collaborative Group: Circulating cholesterol level and risk of death from cancer in men aged 40 to 69 years. JAMA 1982;248:2853-2859.Crossref 49. Gordon T, Kannel WB, Castelli WP, et al: Lipoproteins, cardiovascular disease and death: The Framingham study. Arch Intern Med 1981;141: 1128-1131.Crossref 50. Ueshima H, Iida M, Komachi Y: Is it desirable to reduce total serum cholesterol level as low as possible? Prev Med 1979;8:104-111.Crossref 51. Kark JD, Smith AH, Hames CG: Serum retinol may explain the inverse serum cholesterol and cancer association. Br Med J 1982;284: 152-154.Crossref 52. Pierce ML, Dayton S: Incidence of cancer in men on a diet high in polyunsaturated fat. Lancet 1971;1:464-467.Crossref 53. Phillips RL: Role of lifestyle and dietary habits in risk of cancer among Seventh-Day Adventists. Cancer Res 1975;35:3513-3522. 54. Committee on Diet Nutrition and Cancer: Diet, Nutrition, and Cancer . Washington, DC, National Academy Press, 1982. 55. Coronary Drug Project Research Group: Natural history of myocardial infarction in the CDP: Long-term prognostic importance of serum lipid levels. Am J Cardiol 1978;42:489-498.Crossref 56. May GS, Eberlein KA, Furberg CD, et al: Secondary prevention after myocardial infarction: A review of long-term trials. Prog Cardiovasc Dis 1982;24:331-352.Crossref 57. Wilhelmsen L, Bengtsson C, Elmfeldt D, et al: Multiple risk prediction of myocardial infarction in women as compared with men. Br Heart J 1977;39:1179-1185.Crossref 58. Cohen JD, Grimm RH, Smith WM: Multiple Risk Factor Intervention Trial: VI. Intervention on blood pressure. Prev Med 1981;10:501-518.Crossref 59. Hughes GH, Hymowitz N, Ockene JK, et al: The Multiple Risk Factor Intervention Trial: V. Intervention on smoking. Prev Med 1981;10:476-500.Crossref 60. HDFP Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program. JAMA 1979;242:2562-2571.Crossref 61. WHO/ISH Mild Hypertension Liaison Committee: Trials of the treatment of mild hypertension. Lancet 1982;1:149-156. 62. Fries ED: Should mild hypertension be treated? N Engl J Med 1982;307:306-309.Crossref 63. Kannel WB: Update on the role of cigarette smoking in coronary artery disease. Am Heart J 1981;101:319-328.Crossref 64. Rose G, Hamilton PJS, Colwell L, et al: A randomized controlled trial of antismoking advice: Ten-year results. J Epidemiol Community Health 1982;36:102-108.Crossref 65. Truett G, Cornfield J, Kannel W: A multivariate analysis of the risk of CHD in Framingham. J Chronic Dis 1967;20:511-524.Crossref 66. Barrett-Connor E: HDL-cholesterol as an independent negative risk factor for deaths in the LRC program populations. Am J Epidemiol 1980;112:427. 67. Wilson PW, Garrison RJ, Castelli WP, et al: Prevalence of coronary heart disease in the Framingham Offspring Study: Role of lipoprotein cholesterols. Am J Cardiol 1980;46:649-654.Crossref 68. Hulley SB: The high-density lipoproteins: An epidemiological review. Adv Exp Med Biol 1978;109:295-315. 69. Eder HA, Gidez LI: The clinical significance of the plasma high-density lipoproteins. Med Clin North Am 1982;66:431-440. 70. Hulley SB, Gordon S: Alcohol and HDL-cholesterol: Causal inference from diverse study designs. Circulation 1981;64( (suppl 3) ):63-67. 71. Gordon T, Ernst N, Fisher M, et al: Alcohol and HDL cholesterol. Circulation 1981;64( (suppl 3) ):67-72. 72. Huttenen JK, Lansimies E, Vourtilainen E, et al: Effect of moderate physical exercise on serum lipoproteins: Circulation 1979;60:1220-1229.Crossref 73. Leon AS, Conrad J, Hunninghake DB, et al: Effects of a vigorous walking program on body composition, and carbohydrate and lipid metabolism of obese young men. Am J Clin Nutr 1979;32:1776-1787. 74. Hulley SB, Ashman P, Kuller L, et al: HDL-cholesterol levels in the MRFIT. Lipids 1979;14:119-125.Crossref 75. Dwyer T, Calvert GD, Bayhurst KI, et al: Diet, other lifestyle factors and HDL cholesterol in a population of Australian male service recruits. Am J Epidemiol 1981;114:683-696. 76. Klatsky AL, Friedman GD, Siegelaub AB: Alcohol and mortality: A ten-year Kaiser-Permanente experience. Ann Intern Med 1981;95:139-145.Crossref 77. Eckhardt MJ, Harford TC, Kaelber CT, et al: Health hazards associated with alcohol consumption. JAMA 1981;246:648-666.Crossref 78. Froelicher VF: Exercise and health. Am J Med 1981;70:987-988.Crossref 79. Van Italie TB: Obesity: Adverse effects on health and longevity. Am J Clin Nutr 1979;32:2723-2733. 80. Kuller L: Control of cigarette smoking from a medical perspective. Am Rev Public Health 1982;3:153-178.Crossref 81. Heyden S, Heiss G, Hames CG, et al: Fasting triglycerides as predictors of total and CHD mortality in Evans County, Georgia. J Chronic Dis 1980;33:275-282.Crossref 82. Lippel K, Tyroler H, Eder H, et al: Relationship of hypertriglyceridemia to atherosclerosis. Atherosclerosis 1981;1:406-417. 83. Bachorik PS, Wood PDS: Laboratory considerations in the diagnosis and management of hyperlipoproteinemia , in Rifkind BM, Levy RI (eds): Hyperlipidemia: Diagnosis and Therapy . New York, Grune & Stratton Inc, 1977, pp 41-69. 84. Lipid Research Clinics Program: Cholesterol and triglyceride concentrations in serum-plasma pairs. Clin Chem 1977;23:60-63. 85. Spitzer WD, Brown BP: Unanswered questions about the periodic health examination. Ann Intern Med 1975;83:257-263.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Choice and Use of Blood Lipid Tests: An Epidemiologic Perspective

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American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
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0003-9926
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1538-3679
DOI
10.1001/archinte.1983.00350040057007
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Abstract

Abstract • Serum cholesterol is a useful test in asymptomatic adults who are interested in preventing coronary heart disease (CHD). It guides the decision to recommend a fat-controlled diet to reduce the serum cholesterol level; this intervention probably decreases the risk of CHD in patients with high levels (eg, >240 mg/dL), but not in those with lower levels (the majority). The potential effect of such intervention on absolute (attributable) CHD risk is relatively large in males and in patients with other risk factors. Dietary intervention probably has less effect on CHD risk than eliminating smoking or controlling hypertension. Lipid and lipoprotein tests other than cholesterol are not generally needed, although high-density lipoprotein cholesterol may be useful in certain situations. These epidemiologic considerations, tempered by the preferences of the patient, are useful for individualizing preventive medicine decisions. (Arch Intern Med 1983;143:667-673) References 1. Steinberg D: Research related to underlying mechanisms in atherosclerosis. Circulation 1979;60:1559-1565.Crossref 2. Havel RJ: Approach to the patient with hyperlipidemia. Med Clin North Am 1982;66:319-333. 3. Hulley SB, Rhoads GG: The plasma lipoproteins as risk factors: Comparison of electrophoretic and ultracentrifugation results. Metabolism 1982;31:773-777.Crossref 4. Maloney TW, Rogers DE: Medical technology: A different view of the contentious debate over costs. N Engl J Med 1979;301:1413-1419.Crossref 5. Canadian Task Force on the Periodic Health Examination: The periodic health examination. Can Med Assoc J 1979;121:3-45. 6. Medical Practice Committee, American College of Physicians: Periodic health exam: A guide for designing individualized preventive health care in the asymptomatic patient. Ann Intern Med 1981;95:729-732.Crossref 7. Stamler J: Lifestyles, major risk factors, proof and public policy. Circulation 1978;58:3-19.Crossref 8. Conference on the health effects of blood lipids: Optimal distributions for populations: Workshop report. Prev Med 1979;8:612-732.Crossref 9. Nutrition and Your Health: Dietary Guidelines for Americans . Department of Health, Education, and Welfare and Department of Agriculture, 1980. 10. Grundy SM, Bilheimer D, Blackburn H, et al: Rationale of the diet-heart statement of the American Heart Association: Report of the Nutrition Committee. Circulation 1982;65:839-854Crossref 11. Food and Nutrition Board of the National Research Council: Toward Healthful Diets . Washington, DC, National Academy of Sciences, 1980. 12. James TN: Presidential address: Sure cures, quick fixes and easy answers. Circulation 1981;63:1199-1202.Crossref 13. Oliver MF: Serum cholesterol: The knave of hearts and the joker. Lancet 1981;2:1090-1095.Crossref 14. Hulley SB, Sherwin RS, Nestle M, et al: Epidemiology as a guide to clinical decisions: II. Dietary fat and CHD. West J Med 1981;135:25-33. 15. Hulley SB, Rosenman RH, Bawol RD, et al: Epidemiology as a guide to clinical decisions: The association between triglyceride and CHD. N Engl J Med 1980;302:1383-1389.Crossref 16. Gordon T, Castelli WP, Hjortland MC, et al: High-density lipoprotein as a protective factor against coronary heart disease: The Framingham Study. Am J Med 1977;62:707-714.Crossref 17. Heiss G, Johnson NJ, Reiland S, et al: The epidemiology of plasma HDL cholesterol levels: The LRC Program Prevalence Study. Circulation 1980;62( (suppl 4) ):116-136.Crossref 18. Havel RJ: High-density lipoproteins, cholesterol transport and CHD. Circulation 1979;60:1-3.Crossref 19. Shekelle RB, Shryock AM, Paul O, et al: Diet, serum cholesterol, and death from CHD: The Western Electric Study. N Engl J Med 1981;304:65-70.Crossref 20. Symposium report on dietary factors relating to the nation's health. Am J Clin Nutr 1979;32:2621-2747. 21. The Coronary Drug Project Research Group: The Coronary Drug Project: Findings leading to further modifications of its protocol with respect to dextrothyroxine. JAMA 1972;220:996-1008.Crossref 22. Coronary Drug Project Research Group: Clofibrate and niacin in coronary heart disease. JAMA 1975;231:360-381.Crossref 23. Committee of Principal Investigators: WHO cooperative trial on primary prevention of IHD using clofibrate to lower serum cholesterol: Mortality follow-up. Lancet 1980;2:380-385. 24. The Lipid Research Clinics Program: The coronary primary prevention trial: Design and implementation. J Chronic Dis 1979;32:609-631.Crossref 25. Oliver MF: Risks of correcting the risks of coronary disease and stroke with drugs. N Engl J Med 1982;306:297-298.Crossref 26. Ederer F, Leren P, Turpeinen O, et al: Cancer among men on cholesterol-lowering diets: Experience from five clinical trials. Lancet 1971;2:203-206.Crossref 27. Connor WE, Connor SL: The dietary treatment of hyperlipidemia. Med Clin North Am 1982;66:485-518. 28. Anderson JT, Grande F, Keys A: Independence of the effects of cholesterol and degree of saturation of the fat in the diet on serum cholesterol in man. Am J Clin Nutr 1976;29:1181-1189. 29. Caggiula AW, Christakis G, Farrand M, et al: The Multiple Risk Factor Intervention Trial: IV. Intervention on blood lipids. Prev Med 1981;10:443-475.Crossref 30. MRC Research Committee: Controlled trials of soya bean oil in myocardial infarction. Lancet 1968;2:693-699. 31. Frantz ID Jr, Dawson EA, Kuba K, et al: Minnesota coronary survey: Effect of diet on cardiovascular events and deaths. Circulation 1975;52 ( (suppl 2) ):4. 32. Dayton S, Pearce ML, Hashimoto S, et al: A controlled clinical trial of a diet high in unsaturated fat. Circulation 1969;39 and 40( (suppl 2) ):1-63. 33. Leren P: Oslo Diet-Heart Study: Eleven-year report. Circulation 1970;42:935-942.Crossref 34. Miettinen M, Turpeinen O, Karvonen MJ, et al: Effect of cholesterol-lowering diet on mortality from CHD and other causes: A 12-year trial in men and women. Lancet 1972;2:835-838.Crossref 35. Hjermann I, Velve Byre K, Holme I, et al: Effect of diet and smoking intervention on the incidence of coronary heart disease. Lancet 1981;2: 1303-1310.Crossref 36. MRFIT Research Group: Multiple Risk Factor Intervention Trial: Risk factor changes and mortality results. JAMA 1982;248:1465-1477.Crossref 37. Sherwin R: Controlled trials of the diet-heart hypothesis: Some comments on the experimental unit. Am J Epidemiol 1978;108:92-99. 38. Zukel WJ, Paul O, Schnaper HW: The Multiple Risk Factor Intervention Trial: I. Historical perspectives. Prev Med 1981;10:387-401.Crossref 39. The Pooling Project Research Group: Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events. J Chronic Dis 1978;31:201-306.Crossref 40. Liu K, Stamler J: The two lowest quintiles of serum cholesterol and risk of CHD. CVD Epidemiol Newsletter, AHA . 1982;31:13. 41. Kannel WB, Gordon T: The search for an optimum serum cholesterol. Lancet 1982;2:374-375.Crossref 42. Heiss G, Tanni I, Davis C, et al: Lipoprotein-cholesterol distributions in selected North American populations: The Lipid Research Clinics Program Prevalence Study. Circulation 1980;61:302-315.Crossref 43. Kark JD, Smith AH, Hames CG: The relationship of serum cholesterol to the incidence of cancer in Evans County, Georgia. J Chronic Dis 1980;33:311-322.Crossref 44. Beaglehole R, Foulkers MA, Prior IAM, et al: Cholesterol and mortality in New Zealand Maoris. Br Med J 1980;1:285-287.Crossref 45. Feinleib M: On a possible inverse relationship between serum cholesterol and cancer mortality. Am J Epidemiol 1981;114:5-10. 46. Kagen A, McGee DL, Yarro K, et al: Serum cholesterol and mortality in a Japanese-American population: The Honolulu Heart Program. Am J Epidemiol 1981;114:11-20. 47. Rose G, Shipley MJ: Plasma lipids and mortality: A source of error. Lancet 1980;1:523-526.Crossref 48. International Collaborative Group: Circulating cholesterol level and risk of death from cancer in men aged 40 to 69 years. JAMA 1982;248:2853-2859.Crossref 49. Gordon T, Kannel WB, Castelli WP, et al: Lipoproteins, cardiovascular disease and death: The Framingham study. Arch Intern Med 1981;141: 1128-1131.Crossref 50. Ueshima H, Iida M, Komachi Y: Is it desirable to reduce total serum cholesterol level as low as possible? Prev Med 1979;8:104-111.Crossref 51. Kark JD, Smith AH, Hames CG: Serum retinol may explain the inverse serum cholesterol and cancer association. Br Med J 1982;284: 152-154.Crossref 52. Pierce ML, Dayton S: Incidence of cancer in men on a diet high in polyunsaturated fat. Lancet 1971;1:464-467.Crossref 53. Phillips RL: Role of lifestyle and dietary habits in risk of cancer among Seventh-Day Adventists. Cancer Res 1975;35:3513-3522. 54. Committee on Diet Nutrition and Cancer: Diet, Nutrition, and Cancer . Washington, DC, National Academy Press, 1982. 55. Coronary Drug Project Research Group: Natural history of myocardial infarction in the CDP: Long-term prognostic importance of serum lipid levels. Am J Cardiol 1978;42:489-498.Crossref 56. May GS, Eberlein KA, Furberg CD, et al: Secondary prevention after myocardial infarction: A review of long-term trials. Prog Cardiovasc Dis 1982;24:331-352.Crossref 57. Wilhelmsen L, Bengtsson C, Elmfeldt D, et al: Multiple risk prediction of myocardial infarction in women as compared with men. Br Heart J 1977;39:1179-1185.Crossref 58. Cohen JD, Grimm RH, Smith WM: Multiple Risk Factor Intervention Trial: VI. Intervention on blood pressure. Prev Med 1981;10:501-518.Crossref 59. Hughes GH, Hymowitz N, Ockene JK, et al: The Multiple Risk Factor Intervention Trial: V. Intervention on smoking. Prev Med 1981;10:476-500.Crossref 60. HDFP Cooperative Group: Five-year findings of the Hypertension Detection and Follow-up Program. JAMA 1979;242:2562-2571.Crossref 61. WHO/ISH Mild Hypertension Liaison Committee: Trials of the treatment of mild hypertension. Lancet 1982;1:149-156. 62. Fries ED: Should mild hypertension be treated? N Engl J Med 1982;307:306-309.Crossref 63. Kannel WB: Update on the role of cigarette smoking in coronary artery disease. Am Heart J 1981;101:319-328.Crossref 64. Rose G, Hamilton PJS, Colwell L, et al: A randomized controlled trial of antismoking advice: Ten-year results. J Epidemiol Community Health 1982;36:102-108.Crossref 65. Truett G, Cornfield J, Kannel W: A multivariate analysis of the risk of CHD in Framingham. J Chronic Dis 1967;20:511-524.Crossref 66. Barrett-Connor E: HDL-cholesterol as an independent negative risk factor for deaths in the LRC program populations. Am J Epidemiol 1980;112:427. 67. Wilson PW, Garrison RJ, Castelli WP, et al: Prevalence of coronary heart disease in the Framingham Offspring Study: Role of lipoprotein cholesterols. Am J Cardiol 1980;46:649-654.Crossref 68. Hulley SB: The high-density lipoproteins: An epidemiological review. Adv Exp Med Biol 1978;109:295-315. 69. Eder HA, Gidez LI: The clinical significance of the plasma high-density lipoproteins. Med Clin North Am 1982;66:431-440. 70. Hulley SB, Gordon S: Alcohol and HDL-cholesterol: Causal inference from diverse study designs. Circulation 1981;64( (suppl 3) ):63-67. 71. Gordon T, Ernst N, Fisher M, et al: Alcohol and HDL cholesterol. Circulation 1981;64( (suppl 3) ):67-72. 72. Huttenen JK, Lansimies E, Vourtilainen E, et al: Effect of moderate physical exercise on serum lipoproteins: Circulation 1979;60:1220-1229.Crossref 73. Leon AS, Conrad J, Hunninghake DB, et al: Effects of a vigorous walking program on body composition, and carbohydrate and lipid metabolism of obese young men. Am J Clin Nutr 1979;32:1776-1787. 74. Hulley SB, Ashman P, Kuller L, et al: HDL-cholesterol levels in the MRFIT. Lipids 1979;14:119-125.Crossref 75. Dwyer T, Calvert GD, Bayhurst KI, et al: Diet, other lifestyle factors and HDL cholesterol in a population of Australian male service recruits. Am J Epidemiol 1981;114:683-696. 76. Klatsky AL, Friedman GD, Siegelaub AB: Alcohol and mortality: A ten-year Kaiser-Permanente experience. Ann Intern Med 1981;95:139-145.Crossref 77. Eckhardt MJ, Harford TC, Kaelber CT, et al: Health hazards associated with alcohol consumption. JAMA 1981;246:648-666.Crossref 78. Froelicher VF: Exercise and health. Am J Med 1981;70:987-988.Crossref 79. Van Italie TB: Obesity: Adverse effects on health and longevity. Am J Clin Nutr 1979;32:2723-2733. 80. Kuller L: Control of cigarette smoking from a medical perspective. Am Rev Public Health 1982;3:153-178.Crossref 81. Heyden S, Heiss G, Hames CG, et al: Fasting triglycerides as predictors of total and CHD mortality in Evans County, Georgia. J Chronic Dis 1980;33:275-282.Crossref 82. Lippel K, Tyroler H, Eder H, et al: Relationship of hypertriglyceridemia to atherosclerosis. Atherosclerosis 1981;1:406-417. 83. Bachorik PS, Wood PDS: Laboratory considerations in the diagnosis and management of hyperlipoproteinemia , in Rifkind BM, Levy RI (eds): Hyperlipidemia: Diagnosis and Therapy . New York, Grune & Stratton Inc, 1977, pp 41-69. 84. Lipid Research Clinics Program: Cholesterol and triglyceride concentrations in serum-plasma pairs. Clin Chem 1977;23:60-63. 85. Spitzer WD, Brown BP: Unanswered questions about the periodic health examination. Ann Intern Med 1975;83:257-263.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Apr 1, 1983

References