Serum
Lipid Levels in Tehranian people
Authors:
A.A.Akbari Kamrani MD
Assist. Prof. Clinical Sciences,
University Of Social Welfare & Rehabilitation / Tehran / Iran
A.R.Kaldi (PhD)
Associate Prof. Basic Sciences,
University Of Social Welfare & Rehabilitation / Tehran / Iran
F. Hashemi MD
|
Abstract
Introduction:
This research was conducted to investigate serum lipid
levels of Tehranian people.
Materials
and methods: 2000 participants' ages more than 60
years (1198 females and 802 males) who were living in
Tehran, selected by random sampling process. Data , in
the cross - section study ( Nov. 2000 to March 2001 )
were used to determine Serum Lipid Levels : Total cholesterol
(TC ) , High - density lipoprotein cholesterol ( HDL -
C ) , Low - density Lipoprotein Cholesterol ( LDL - C
) , and Triglycerides ( TG ) , Samples were Fast at least
( 12 - 14) hrs , the values were analyzed by sex and age.
Results:
- Mean Serum Triglycerides (TG)
Concentration of older people above 60 years was 181
mg / dl; TG was significantly greater in Females than
males (187 vs. 173 mg / dl, P < .000).
- Mean Serum TG Concentration
in elderly Females decreases with increasing age , this
declining was significant , ( TG of decades 7 , 8 ,
9 were 192 , 182 , 144 mg / dl - P < .001 ).
- Mean Serum TG Concentration
in elderly males decreases with increasing age. But
this declining was not significant (decades 7, 8, 9
were 179, 166, 153 mg / dl).
- Mean Serum Total Cholesterol
(TC) Concentration of older people above 60 years was
218 mg / dl. TC was significantly greater in females
than males. (228 vs. 203 mg / dl, P < .000).
- Mean Serum TC Concentration
in elderly Females decreases with increasing age , this
declining was significant , ( TC of decades 7 , 8 ,
9 - were 230 , 227 , 210 mg / dl - P < .004 ).
- Mean Serum TC Concentration
in elderly males decreases with increasing age , this
declining was significant , ( TC of decades 7 , 8 ,
9 , were 206 , 198 , 193 , P < .004 ).
- - Mean Serum HDL - c Concentration
of older people above 60 years was 47 mg / dl , HDL
- c was Significantly greater in Females than males
( 49 vs. 44 mg / dl P < .000 ).
- Mean Serum HDL - c Concentration
in elderly Female had no Significant Changes with increasing
age (HDL - c. F decades 7, 8, 9 were 50, 48, 46 mg /
dl).
- Mean Serum HDL - c Concentration
in elderly male had not Significant Changes with increasing
age (HDL - c of decades 7 , 8 , 9 , were 44 , 44 , 44
mg / dl ).
- Mean Serum LDL - c Concentration
of older people above 60 years was 138 mg / dl. LDL
- c was significantly greater in females than males
(145 vs 128 mg / dl P < .000).
- Mean Serum LDL - c Concentration
in elderly Female had no Significant Changes with increasing
age (LDL - c of decades 7, 8, 9 were 144, 147, 141 mg
/ dl).
- Mean Serum LDL - c Concentration
in elderly male had no significant Changes with increasing
age (LDL - c of decades 7, 8, 9 were 130, 128, 118 mg
/ dl).
63.4% of Population had TC values above 200 mg / dl,
and 55.8% had LDL
- c values above 130 mg / dl,
that due to NCEP guidelines is a high risk group for
cardiovascular disease (CVD).
Conclusion:
Because CVD events are increased by elevated Total
Cholesterol and LDL Cholesterol, and high prevalence of
Lipoproteinemia in older people in Tehran, design and
execution of Comprehensive Geriatric assessment is needed
to reduce patients at high risk of Cardiac events.
Keywords:
Lipids - Lipoproteins, Tehran.
1 - HDL
- c = High Density Lipoprotein
2 - LDL - c = Low Density Lipoprotein
3 - NCEP = Nation Cholesterol Education Program, 4 - CGA
= Comprehensive Geriatric Assessment
|
The major cause
of death and handicap among adults is coronary blood vessel
heart disease. [3-7] In epidemiology studies between
Athrovascularosis coronary blood vessel heart disease and the
levels of Lipoprotein serums, the relationship has been clearly
and distinctly defined [8-10]. Although, there is
much evidence regarding the fact Etrovascularosis begins from
childhood [11-12] it may be that Athrovascularosis
could be taken into account as the inevitable result of adulthood.
Most adults have one or more risk factors for coronary blood
vessel heart diseases (CAD) [13]. Occurrence of elements
of danger, or risk factors, is reduced slightly after the age
of 75 [14]. Of course this reduction may be related
to natural survival, as people of higher risk factors will die
in lower ages.
Despite this
reduction, with ageing, the total mortality risk and morbidity
due to coronary blood vessel heart disease (CAD) increases in
adults. Danger elements related to heart and coronary diseases
in adults mostly include lipoprotein disorder, smoking, blood
pressure level increase, and diabetes [15]. Preventative
philosophy of danger elements related to coronary blood vessel
heart disease, exists for adults as it does for other age groups.
In the Bronx ageing study, the HDL cholesterol levels of less
than 30 mg /liter dc in men between 75 to 85 years of age, was
observed alongside the increase in MI and death rate of the
group. At the same time, the LDL cholesterol level was more
than 171 mg/liter dc in women of the same age group which led
to a higher increase in MI and death rate. [16] People
over the age of 65 with coronary blood vessel heart disease
are the main group with lipid disorders. The high level of blood
cholesterol in this group generally causes an increased risk
of a return of MI in men and women. In the Framingham study,
the total cholesterol levels higher than 275 mg/liter dc, increase
the risk of a return of MI and death due to coronary disease
by more than 4 times.
Also, the general risk of death in this group as compared with
adults was total cholesterol less than 200 mg/liter dc which
is 3 times higher [17].
Such observations
and the results, clearly show the importance of tertiary prevention
in coronary blood vessel heart disease adult patients through
the reduction of blood lipids.
Such extensive
and scientific studies on Dislipoproteinemia in children and
young people of the city population of Tehran [1],
and also the Lipid surface serum studies of the adult population
of Tehran [2] has been carried out by Azizi and associates.
But, until the present time, there have been no extensive studies
in the area of the occurrence of dislipoprotienemia in adults
over the age of 60. The aim of this research is the study of
serum lipoprotein concentration, total cholesterol - triglyceride-
HDL and LDL, as well as allocation of amount of occurrence of
dislioboprotienemia in adults over the age of 60 and residing
in Tehran. This study has been carried out on 2000 people over
the age of 60, who have referred to clinical and laboratory
centers within the city of Tehran between the period of Nov.
2000 and March 2001.
According to
observational design, a cross-sectional study of the descriptive
type among referrals to various clinical and laboratory centers
within the city of Tehran - (Northern- Southern- Eastern- Western
areas) was carried out.
2000 people
60 years of age and above were chosen at random and studied.
The dependent factors in this age study were (independent low-association
variable) and sex (named sexual status variable) - and the dependant
variables in this study were total cholesterol (Tc), HDL, LDL
and triglyceride (TG).
Total serum
lipoprotein concentration, HDL, LDL and TG was collected if
fasting samples were collected.
In this study,
2000 people of 60 years and over, of which 1198 were old women
(59.9%) and 802 were old men (40.1%) - and the study took place
between the period of November. 2000 and March 2001.
The natural
limit of cholesterol concentration LDL-c from the viewpoint
of the possibility of occurrence of coronary blood vessel heart
disease, has been considered according to the American cholesterol
training programs (NCEP) [18]. In consideration of
this, total cholesterol concentration of less than 170 mg/liter
dc is considered as natural; between 172 -200 is considered
as relatively dangerous, and more than 200 mg/liter dc as highly
dangerous for those having coronary blood vessel heart disease.
Also, for LDL amounts less than 110 mg/liter dc are considered
as natural; between 110 - 130 is considered as relatively dangerous,
and more than 130 mg/liter dc as highly dangerous.
The groups studied
were divided into two age groups of male and female- and in
each group, a division was made according to each decade of
age, meaning that within the female or male groups, 70s age
group, 80s and 90s and over age groups were considered. This
statistical analysis was carried out on a computer, utilizing
the Statistical Package For Social Sciences (SPSS) software
and the average results were displayed within the article, charts
and tables as deviation of average and percentages. The age
definitions were specified within the age grouping divisions
in each of the decades of age in the case of total cholesterol
concentration - LDL - HDL- and TG. The average amounts were
understood after comparison through variance analysis of the
two sexes and within the age groups, with the meaningful p value
less than 5%.
Age and sex
distribution - among the 2000 people of 60 years and over, 1198
were old women (59.9%) and 802 were old men (40.1%) - in the
female group 62.9% were within the 70s age range, 32.2% within
the 80s age range and 5.5% within the 90s and over age range.
In the male group 61.6% were within the 70s age range, 31.9%
within the 80s age range and 6.5% within the 90s and over age
range.
Levels of
Serum Lipoprotein:
TG:
The average
concentration of TG among the total population studied was 181.67
mg/ liter dc with a minimum of 35 and a maximum of 980 mg/liter
dc - in the female group the average TG concentration was 187.3
and in the male group 173.25 mg/liter dc, the conclusion of
this variation was (P<.000).
In the female
group the average concentration of TG in the 70s, 80s and 90s
divisions were 192.78, 182.79, and 144.84 mg/ liter dc respectively,
and the reduction in each decade has the following statistical
meaning: (P<.001). In the male group the average concentration
of TG in the 70s, 80s and 90s divisions were 179.07, 166.13,
and 153.04 mg/ liter dc respectively, and the reduction in each
decade, where we observed the swift reduction of TG with the
increase in age. Therefore, this reduction is not statistically
meaningful.
TC:
The average
concentration of TC among the total population studied was 218.61
mg/ liter dc with a minimum of 101 and a maximum of 557 mg/liter
dc. In the female group the average TC concentration was 228.87
and in the male group 203.24 mg/liter dc. The conclusion of
this variation, in statistical terms was (P<.000). 63.4%
of the total TC population was above 200 mg, 23.5% had TG levels
of 160 - 200 mg and 12.9% of the TC population was less than
120 mg.
In the female
population, the average TC levels in the 70s, 80s and 90s divisions
were 230.97, 227.52, and 210.59 respectively, which has the
following statistical meaning: (P<.004). 73.1% of the female
TC was above 200, 18.9% of the TC was 110-200 and 8% was less
than 170 mg/liter dc.
In the male
population, the average TC levels in the 70s, 80s and 90s divisions
were 206.69, 198.65, and 193.00 respectively, which has the
following statistical meaning: (P<.004). 49.1% of the male
TC was above 200, 30.4% of the TC was 170-200 and 20% was less
than 170 mg/liter dc.
HDLc:
The average
HDL concentration among the total population studied was 47.35
mg/ liter dc with a minimum of 15 and a maximum of 97 mg/liter
dc - in the female group the average was 49.40 and in the male
group 44.31 mg/liter dc, the conclusion of this variation among
the two groups was (P<.000).
10% of the female
population had HDL levels of less than 32 mg and 25% of the
main population had HDL levels of less than 34 mg/liter dc.
In the female
group the average HDL concentration in the 70s, 80s and 90s
divisions were 50.13, 48.04, and 46.81 mg/ liter dc respectively,
which reduction is not statistically meaningful.
In the male
group the average HDL concentration in the 70s, 80s and 90s
divisions were 44.14, 44.73, and 44.03 mg/ liter dc respectively,
and the reduction is therefore not statistically meaningful.
LDLc:
The average
LDL concentration among the total population studied was 138.70
mg/ liter dc with a minimum of 32 and a maximum of 441 mg/liter
dc. In the female group the average was 145.18 and in the male
group 128.97 mg/liter dc- This difference is therefore statistically
meaningful: (P<.000). 62.2% of the female group population
had over 130 mg of LDL, while 19.6% had 110 - 130 mg of LDL,
18.2% had less than 110 mg/liter dc of LDL. In the male population,
46.2% had over 130 mg of LDL, while 22.8% had 110 - 130 mg of
LDL, 13% had less than 110 mg/liter dc of LDL.
Within the total
population studied (total of male and female), 55.8% had over
130 mg of LDL, while approximately 20.9% had 110 - 130 mg of
LDL, and 23.3% had less than 110 mg/liter dc of LDL
Charts 1,
2, and 3 show the results of these studies.
Chart 1
Chart 2
Chart 3
Of the population
studied, 63.4% of the population had TC of above 200 mg/liter
dc, 55.8% of the LDLc population had over 130 mg/liter dc. According
to the new plans of the US Cholesterol Training Program (NCEP),
these groups are considered as the highest risk groups of coronary
blood vessel heart disease and must be supervised and treated.
The National US Nutrition and Health Program (NHANES) has successfully
been able to reduce blood lipid levels in a long-term program;
[19]. According to the announcement of this centre
the average TC of people between the ages of 65 and 75 in 1960
was 230 mg/liter dc and in 1998 it reached 218 mg/liter dc.
Also, the average concentration of TG in women between the ages
of 65 and 75 in the same period was 266 and 234 mg/liter dc
respectively. According to the information from the centre,
the average concentration of Blood Lipids increases from the
third decade to the seventh or eighth of life, and we are faced
with the reduction in concentration of Blood Lipids generally
after the age of 75. This reduction in lipid concentration may
be related to the elimination of high cholesterol populations,
which may be due to death, or perhaps from malnutrition of the
elderly, or because of the illnesses accompanying advanced age
periods [19]. Of course the reduction of blood TC
at a level of less than 160 mg/liter dc which is called hypo-cholestyramine,
is considered a danger to adults and according to their studies
made, death from non-coronary or heart cases within this group
is 40 to 50% higher than the elderly with equivalent cholesterol
levels - the greatest reason for death among the hypo-cholestyramine
groups have been homogenic intracranial - blood and lymph cancers
- COPD, hepatic diseases and Sirius?serous diseases. [14]
And therefore hypo-cholestyramine has recently in itself become
considered as a marker for hidden cancers.
According to (NHANES) III data, the average concentration of
TG in men of the 20-34 age group was 112 mg, in the 55-64 age
group this amount was 162 mg, and in the 65-75 age group it
was 159 mg, which increased with the increase of age, and from
approximately the age of 65 it began to decline. In women of
the 20-34 age group the average TG concentration was 101 mg,
in the 55-64 age group this amount was 164 mg, and in the 65-75
age group it was 155 mg/liter dc.
The strong reduction
of blood TG can also be observed in women after the age of 65,
and such changes in relation with TC, HDLc and LDLc are reported
as follows:
Average TC concentration -
|
20-34
Age Group
----------------------------
|
50-64
Age Group
----------------------------
|
65-75 Age
Group
---------------------------- |
<75
Age Group
-------------------------- |
| M: 189
mg/liter dc |
221 mg/liter
dc |
218 mg/liter
dc |
205 mg/liter
dc |
| F: 185
mg/liter dc |
237 mg/liter
dc |
233 mg/liter
dc |
230 mg/liter
dc |
We also observed
the reduction in TC concentration after the age of 65.
The average
LDL concentration in men of 55-64 is 142 mg/liter dc and in
the 65-75 group it is 140 mg/liter dc, while in women of 55-64
it is 145 mg/liter dc and in the 65-75 group it is 147 mg/liter
dc, and even the women about 75 years of age this is also 147
mg/liter dc and therefore in the female group the average concentration
of LDLc does not show any reduction with increase of age.
The average
HDLc in men of 55-64 is 47 mg/liter dc and in the 65-75 group
it is 45 mg/liter dc, while in women of 55-64 it is 56 mg/liter
dc and in the 65-75 group it is 56mg/liter dc. There is no reduction
also observed here. At the same time, it has become clear that
in all the Lipid divisions, the average concentration level
is higher in women than in men.
According to the II program of (NCEP ATP), over 2 million people
above the age of 65 suffer from coronary blood vessel heart
disease and over 3.1 million people over the age of 65 suffer
from increases in blood lipid levels without heart problems,
who must be under supervision and treatment.
Based on the
research carried out by Azizi and associates [1]
in Iran, the average concentration of blood lipids in people
under the age of 19 is as follows:
| TG = 103
mg/liter dc |
TC = 170
mg/liter dc |
| LDLc =
105 mg/liter dc |
HDLc =
45 mg/liter dc |
Also, this
average for adults between 20-65 years;[2], are respectively
TG = 173 mg/liter dc, TC = 210 mg/liter dc, LDLc = 133 mg/liter
dc, HDLc = 43 mg/liter dc, which clearly shows the increase
of lipids with the increase of age.
In our study,
which was carried out on people from the age of 60 and above,
the average of blood lipids were in order:
| TG = 181
mg/liter dc |
TC = 218
mg/liter dc |
| LDLc
= 138 mg/liter dc |
HDLc
= 47 mg/liter dc |
This again
shows the trend of lipid increase with the increase of age.
But in consideration of this average in each decade, [7,8,9]
as is shown in chart 2 and 3, the highest amount is related
to the 70s, at the age of 65 and later, and for each decade,
in both men and women, a decrease in the concentration of lipid
levels is expected.
In chart 1,
the average concentration of all blood lipids in women is more
than in men.
And this difference
is meaningful in all blood lipid divisions as P<.000.
In both age
groups also, in each decade, we are faced with a reduction of
blood lipids, which reduction is meaningful in the TC division
of men, and in the female group, the TG and TC divisions are
meaningful. The changes in the HDLc and LDLc levels have a changing
trend of increase in each decade of age which is of course not
considered meaningful. And probably the most changes with increase
of age is related to a reduction in the blood TG concentration
and this factor has had an effect on the reduction of TC concentration
in elderly people.
In studies carried
out by Ghanbarian and associates, [20] on 414 women
and 541 men above the age of 65 from the study group of Lipids
and glucose in Tehran, in the main group 24 - 29 - 25 - 27 %
respectively had < 240 TC and <200 TG, and <160 LDLc,
and <25 HDLc mg/liter dc, and the same statistics for the
female group were 45, 40,50,12% respectively.
In our studies
which were established according to the new guidelines by (NCEP),
in which a TC level of about 200 mg, and LDLc levels above 130
mg are considered as highly dangerous for coronary blood vessel
heart diseases. In the male group above the age of 60, the amount
is 49.3% of cholesterol above 200 mg/liter dc and 46.2% LDLc
about 130 mg/liter dc.
In the female
group above the age of 60, the amount is 73.1% of cholesterol
above 200 mg/liter dc and 62.2% LDLc about 130 mg/liter dc,
which is considered as the most dangerous group in the opinion
of CAD.
Although, with
the comparison of the average concentration of blood lipid of
people studied by us, no special differences were seen compared
with the averages given by (NHANES) III data, it seems that
in both population groups under study, the amount of female
blood lipids is higher than the male population, and by taking
into account the newly presented criteria for the omission of
coronary blood vessel heart disease factors, a high percentage
of people are considered by CAD to possess the risk factor for
contracting Dislipoproteinemia. If each 1% reduction of LDLc
in the blood creates a 2% reduction in death due to heart diseases,
the results produced from specific attention paid to Lipoprotein
serum concentration levels in adults facing the dangers of coronary
diseases may be reflected on.
(NHANES) III:
National Health and Nutrition Examination Survey
(NCEP ATP): National Cholesterol Education Program - Achft Treatment
Panel
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