This study quantified the risk of coronary heart disease (CHD) according to change in HDL cholesterol in 4,501 male physicians enrolled in the Physician’s Health Study and followed for 14 years. Men were divided into four categories: 1- decrease (≥-2.5 mg/dl), 2- no change (-2.5 to +2.5 mg/dl), 3- small increase (+2.5 to +12.5 mg/dl), and 4- large increase (≥12.5 mg/dl). Hazard ratios for CHD (acute myocardial infarction or cardiac death) were adjusted for age, initial HDL cholesterol levels, diabetes, hypertension, non-HDL cholesterol, and history of cholesterol medication. Compared to individuals who decreased their HDL cholesterol during the 14-year follow-up, the hazard ratio for those with no change was 0.66 (95% CI: 0.40-1.09), for those with a small increase the HR was 0.56 (95% CI: 0.35-0.89), and for those with a large increase the HR was 0.43 (95% CI, 0.23-0.83). Additional analyses revealed that the magnitude of the association between changes in HDL cholesterol and CHD risk varied among subgroups of age, body mass index, and alcohol consumption. Results of the Physician’s Health Study confirmed the inverse and graded association between HDL cholesterol concentrations and CHD risk.
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