Obesity and lipoprotein cholesterol in the Framingham Offspring Study

This study examines the relationship between obesity and low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and very-low-density lipoprotein (VLDL) cholesterol in 4260 young adult men and women. The strongest association between obesity and LDL cholesterol was found in 20-29-year-old males, the weakest in 40-49-year-old males. Conversely, in women the relationship between LDL cholesterol and obesity was modest except in the oldest (40-49 year) age group. An inverse relationship between obesity and HDL cholesterol was of similar shape and strength in all sex and age-specific groups. When the ratio of total cholesterol (TCHOL) to HDL cholesterol was compared in lean and grossly obese 20-29-year-old males, substantial differences were found. Since other data show this index of the lipoprotein profile to be the single best indicator of coronary heart disease (CHD) risk, it would appear that the atherogenic potential of obesity is greater than would be suggested by the relatively weak association between obesity and TCHOL or any single lipoprotein cholesterol. These data also suggest that the impact of obesity as a risk factor for CHD may have been underestimated. The paucity of lean males 40-49-year-old prevents firm conclusions about the CHD risk in such a group. Indirect evidence indicates that lean 40-49-year-old men would have a markedly more favorable lipoprotein profile and consequently a much lower risk of CHD.