Differential Effect of National Cholesterol Education Program (NCEP) Step II Diet on HDL Cholesterol, Its Subfractions, and Apoprotein A-I Levels in Hypercholesterolemic Women and Men After 1 Year

Abstract

Abstract-We previously reported that high density lipoprotein cholesterol (HDL-C) decreases more in hypercholesterolemic (HC) women than in HC men ingesting an National Cholesterol Education Program (NCEP)Step II diet for 6 months. We examined these subjects to determine whether the differential HDL-C reduction persists after 12 months and whether it is associated with decreased HDL 2 -C and apoprotein A-I. Subjects were screened from an industrial workforce and were defined as HC if 2 low density lipoprotein cholesterol measurements were Ն75th percentile or defined as combined hyperlipidemic (CHL) if triglycerides were also Ն75th percentile. The subjects were then taught the NCEP Step II diet in 8 weekly classes and counseled quarterly. Seventy-three HC and 92 CHL women (mean ages 43 and 44 years, respectively) and 112 HC and 106 CHL men (ages 45 and 41 years, respectively) were studied. All groups reported similar total fat (24% to 26% kcal) and saturated fat (7.1% to 7.9% kcal) intakes at 1 year. HDL-C decreased 7.6% in HC women (PϽ0.01), exceeding the nonsignificant 1.3% decrease in HC men (Pϭ0.000). HDL 2 -C decreased 16.7% in HC women (PϽ0.01) compared with the nonsignificant 0.5% increase in HC men (Pϭ0.000). In CHL women and men, HDL-C decreased 3.5% and 3.9% (both PϽ0.01); HDL 2 -C decreased more in women (7.1%, PϽ0.01) than in men (4.3%, a nonsignificant difference). Apoprotein A-I decreased significantly (5.3%, PϽ0.01) in HC women only. Plasma triglycerides were unchanged. Low density lipoprotein cholesterol and weight changes were not different among the 4 groups. HDL-C, HDL 2 -C, and apoprotein A-I levels decreased more in HC women than in HC men after following the NCEP Step II diet for 1 year, continuing a trend observed with HDL-C at 6 months. The total HDL-C and HDL 2 -C reductions narrow the baseline differences between men and women by 50%. Whether this reduction impacts women's protection from cardiovascular disease deserves future study. Nonetheless, the results point to sex-based differences in intrahepatic glucose and fatty acid metabolism linked to alterations in HDL formation and removal. Key Words: hypercholesterolemia Ⅲ combined hyperlipidemia Ⅲ HDL cholesterol Ⅲ apoA-I Ⅲ low fat diet H eart disease is the most common cause of death in women and men in the United States. 1 Hypercholesterolemia is a major modifiable cardiovascular disease (CVD) risk factor in both sexes. [2][3][4] Dietary modification to lower LDL cholesterol (LDL-C) is the primary strategy for the population-based reduction in CVD risk. 5,6 The National Cholesterol Education Program (NCEP) recommends reducing saturated fat intake in 2 steps, to Ͻ10% of calories (step I) and Ͻ7% of calories (step II), in the initial management of individuals with hypercholesterolemia, regardless of sex, before instituting pharmacological measures. 6 Recently, we reported sex-equivalent reductions in LDL-C but significantly greater HDL cholesterol (HDL-C) reductions in hypercholesterolemic (HC) women compared with men 6 months after inst...

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