n inverse relationship between high-density lipoprotein (HDL) cholesterol and cardiovascular diseases has been demonstrated in epidemiologic studies, 1,2 and is often explained by the capacity of HDL to transport cholesterol from peripheral tissues to the liver, known as reverse cholesterol transport. 3 In this process, pre--HDL, a quantitatively minor subfraction of HDL, is thought to play a critical role because it acts as an efficient acceptor in the cholesterol efflux process from the plasma membrane of peripheral cells. 3,4 Phospholipid transfer protein (PLTP) is capable of generating pre--HDL by inducing HDL conversion, a process that remodels a homogeneous HDL fraction into populations of large and small HDL particles. [5][6][7][8] The transfer of phospholipids to immature HDL in the process of HDL maturation is also essential in maintaining reverse cholesterol transport. 5,9,10 In addition, PLTP has other roles, such as the transfer oftocopherol to cell membrane for the maintenance of endothelial function, or the transfer of lipopolysaccharide to Circulation Journal Vol.68, January 2004 lipoproteins, which leads to neutralization of its potent inflammatory function. 5 Altogether, PLTP can be considered to play an important role in the prevention of atherosclerosis, and thus it has recently attracted much attention.Previous studies regarding PLTP examined its phospholipid transfer activity in patho-physiologic states in human or experimental models. 11-14 Sandwich enzyme-linked immunosorbent assay with 2 monoclonal antibodies to human PLTP has been recently introduced to assay PLTP concentration, 15,16 but the significance of the PLTP concentration in human diseases is incompletely understood. 5,17 It is, therefore, important to evaluate whether an elevated concentration of serum PLTP is associated with an increased or decreased risk of cardiovascular diseases. We examined serum PLTP in relation to newly diagnosed cardiovascular diseases in a middle-aged worksite-based cohort of men in Japan. We also examined the association of serum PLTP concentration with other cardiovascular risk factors.
Methods
SubjectsThe present analysis is based on a cohort of male workers in a worksite in Aichi prefecture, central Japan. 18,19 Its aim was to determine factors associated with the development of cardiovascular diseases. The study began in 1997, when 2,896 male employees of a manufacturing company, aged 34-59 years, were recruited as potential participants. A self-administered questionnaire was used to assess the