Twenty-year trends in serum cholesterol, hypercholesterolemia, and cholesterol medication use - The Minnesota Heart Survey, 1980-1982 to 2000-2002
ABSTRACT Although US cholesterol concentrations have dropped, &50% of adults have total cholesterol concentrations > or =5.18 mmol/L, putting them at "borderline-high risk" for heart disease. Whether the decline has continued into the 21st century is unknown. We assessed 20-year trends in cholesterol, hypercholesterolemia, lipid-lowering drug use, and cholesterol awareness, treatment, and control from Minnesota Heart Survey (MHS) data.
Five independent, cross-sectional, population-based surveys of 2500 to 5000 adults were conducted in the Minneapolis-St. Paul, Minn, area from 1980 to 2002. Mean (nonfasting) total cholesterol concentrations have continued a 20-year decline, punctuated by an intervening lull. Age-adjusted mean total cholesterol concentrations in 2000 to 2002 were 5.16 and 5.09 mmol/L for men and women, respectively (in 1980 to 1982, 5.49 and 5.38 mmol/L for men and women, respectively) However, the decline has not been uniform across all age groups. Middle-aged to older people have shown substantial decreases, but younger people have shown little overall change and recently had increased total cholesterol values. The mean prevalence of hypercholesterolemia in 2000 to 2002 was 54.9% for men and 46.5% for women and has decreased significantly for both during the study. Age-adjusted mean high-density lipoprotein cholesterol concentrations in 2000 to 2002 were 1.09 and 1.40 mmol/L for men and women, respectively, and were not different from the prior survey. Lipid-lowering drug use rose significantly for both sexes aged 35 to 74 years. Awareness, treatment, and control of hypercholesterolemia have increased; however, more than half of those at borderline-high risk remain unaware of their condition.
Although hypercholesterolemia prevalence continued to fall, significant population segments still have cholesterol concentrations near or at the level of increased risk.
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ABSTRACT: Dyslipidemia, a known cardiovascular risk factor, is extremely common among Saudis, both adults and children. The impact, however, of dyslipidemia and several other lipid disorders in patients with congestive heart failure in this particular population has not been documented. This study aims to fill the gap. This retrospective, single center study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Of the 500 cases seen during the period between 2002 and 2008, 392 were included in the study. Charts were reviewed and information on medical history, medications, and lipid status were documented. Low HDL-cholesterol level was the most common lipid disorder with 82.9%, followed by hypertriglyceridemia (35.2%), atherogenic dyslipidemia (27.8%), and hypercholesterolemia (9.2%). Diabetes mellitus was the single most significant predictor of mortality (p = 0.001). Among the lipid disorders, only low levels of HDL-cholesterol contributed to significant mortality risk [OR 1.29 (Confidence Interval 1.04-1.59) (p-value < 0.01)] adjusted for age, gender and statin use. The results of this study suggest that emphasis should be on the elevation of HDL-cholesterol levels among subjects with congestive heart failure, without compromising any ongoing management of LDL-lowering drugs. Management should not be limited to conventional statin use and should promote other treatments to elevate HDL-cholesterol levels.Journal of the Saudi Heart Association 12/2014; 61(2). DOI:10.1016/j.jsha.2014.12.003
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ABSTRACT: Background The prevalence and determinants of dyslipidemia patterns among Hispanics/Latinos are not well known. Methods Lipid and lipoprotein data were used from the Hispanic Community Health Study / Study of Latinos -- a population-based cohort of 16,415 US Hispanic/Latinos ages 18-74. National Cholesterol Education Program cutoffs were employed. Differences in demographics, lifestyle factors, biological and acculturation characteristics were compared among those with and without dyslipidemia. Results Mean age was 41.1 years and 47.9% were male. The overall prevalence of any dyslipidemia was 65.0%. The prevalence of elevated LDL-C was 36.0% and highest among Cubans (44.5%; p<0.001). Low HDL-C was present in 41.4% and did not significantly differ across Hispanic background groups (p=0.09). High triglycerides were seen in 14.8% of Hispanics/Latinos, most commonly among Central Americans (18.3%; p<0.001). Elevated non-HDL-C was seen in 34.7% with the highest prevalence among Cubans (43.3%; p<0.001). Dominicans consistently had a lower prevalence of most types of dyslipidemia. In multivariate analyses, the presence of any dyslipidemia was associated with increasing age, body mass index and low physical activity. Older age, female gender, diabetes, low physical activity, and alcohol use were associated with specific dyslipidemia types. Spanish-language preference and lower educational status were associated with higher dyslipidemia prevalence. Conclusion Dyslipidemia is highly prevalent among US Hispanics/Latinos; Cubans seem particularly at risk. Determinants of dyslipidemia varied across Hispanic backgrounds with socioeconomic status and acculturation having a significant effect on dyslipidemia prevalence. This information can help guide public health measures to prevent disparities among the US Hispanic/Latino population.The American Journal of Medicine 12/2014; 127(12). DOI:10.1016/j.amjmed.2014.07.026 · 5.30 Impact Factor
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ABSTRACT: The etiology of an ischemic stroke remains undetermined in 20-35% of cases and many patients do not have any of the conventional risk factors. Increased visceral adipose tissue (VAT) is a suggested new risk factor for both carotid artery atherosclerosis (CAA) and atrial fibrillation (AF), but its role in the remaining stroke population is unknown. We assessed the amount of VAT in patients with embolic stroke of undetermined source (ESUS) after excluding major-risk cardioembolic sources, occlusive atherosclerosis, and lacunar stroke. Altogether 58 patients (mean age 57.7±10.2 years, 44 men) with ischemic stroke of unknown etiology but without CAA, known AF or small vessel disease underwent computed tomography angiography and assessment of VAT. For comparison VAT values from three different reference populations were used. Conventional risk factors (smoking, hypertension, diabetes, increased total and LDL-cholesterol, decreased HDL-cholesterol) were also registered. Mean VAT area was significantly higher in stroke patients (205±103 cm2 for men and 168±99 cm2 for women) compared to all reference populations (P<0.01). 50% of male and 57% of female patients had an increased VAT area. In male patients, VAT was significantly higher despite similar body mass index (BMI). Increased VAT was more common than any of the conventional risk factors. Increased VAT was found in over half of our patients with ESUS suggesting it may have a role in the pathogenesis of thromboembolism in this selected group of patients.PLoS ONE 03/2015; 10(3):e0120598. DOI:10.1371/journal.pone.0120598 · 3.53 Impact Factor