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Can It Be Too Low?

Mark A. Hlatky, MD; Stephen B. Hulley, MD, MPH

Arch Intern Med. 1981;141(9):1132.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

For two decades, the Framingham study has provided valuable information about plasma lipoproteins and the epidemiology of coronary heart disease (CHD). First, low-density lipoprotein (LDL) cholesterol (roughly equivalent to total plasma cholesterol) was found to be directly related to the risk of CHD; then, high-density lipoprotein (HDL) cholesterol was found to be inversely related. The most recent report (p 1128) examines illnesses other than CHD and uncovers a provocative finding: low levels of LDL predict high rates of stroke and cancer.

What is the explanation for this association? There are several possibilities.

1. It is due to chance. The tests of statistical significance show this is unlikely. Furthermore, similar results have been found in many,1-7 though not all,8 other epidemiologic studies.
   
2. It is due to bias. The Framingham study has become a modern classic precisely because its prospective cohort design removes most of the usual biases. A special one that might
   

Author Affiliations
Robert Wood Johnson Clinical Scholars Program University of California, San Francisco; Robert Wood Johnson Clinical Scholars Program Department of Epidemiology and International Health University of California, San Francisco USPHS Hospital 15th Avenue and Lake Street San Francisco, CA 94118

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