Study on Urban North Indians Incidence of Dyslipidemia among Different Age Groups

Abstract

Background: Coronary artery disease is a known entity of morbidity and mortality in industrialised countries. It is a major public health problem around the world. Coronary artery disease increase incidence in Indian population at least 10 years before in age than other ethnic groups. There are a numbers of factors associated with atherosclerosis the most important one is dyslipidemia. Recent studies suggest that over the span of 20 years, the total amount of triglycerides, cholesterol and Low Density Lipoproteins (LDL) `levels is usually increased in young urban populations. So, a study was performed out to know the prevalence of dyslipidemia in urban North Indians among different set of age groups. Methods: This is a descriptive cross-sectional study which was carried out on patients visiting to the blood collection centre of the Department of Pathology. Patients were divided into 3 groups with age 18 year to 40 year, 41 year to 60 year and >60 year by involving 1989 subjects of whom 532 were between 18 year to 40 year, 522 were between 41year to 60 year and 935 were > 60 year of age. This study included measurement of fasting serum lipid profile comprising of, Low Density Lipoprotein (LDL), High Density Lipoproteins (HDL), Triglycerides and total cholesterol. Results: Number of subjects studied, the prevalence of dyslipidemia was higher in <60 years age population. A remarkable difference in mean was observed statistically with the levels of triglycerides, LDL and total cholesterol of this age group ranging from 18-40 years and for those who are >60 years. A remarkable difference for the levels of HDL was not found in age group between 18-40 years and > 40 years to 60 years. Mean cholesterol level was observed to be elevated between the age group 18-40 years. The mean peak triglycerides were observed in age group between 41-60 years. This elevated mean HDL levels were noticed in the age group who are > 60 years of age. Conclusions: Elevated percentage of dyslipidemia was observed in less than 60yrs age groups. Large population study is required to substantiate the results of this study. It is necessary to plan out comprehensive strategies for the screening and awareness in all ages on periodic basis.

Full text

Citation: Sharique Ahmad, Saba Naziya, Mohd. Anwar, Tanish Baqar, Saeeda Wasim, Huma Parveen (2022). Study on
Urban North Indians Incidence of Dyslipidemia among Different Age Groups. Saudi J Pathol Microbiol, 7(6): 240-244.
240
Saudi Journal of Pathology and Microbiology
Abbreviated Key Title: Saudi J Pathol Microbiol
ISSN 2518-3362 (Print) |ISSN 2518-3370 (Online)
Scholars Middle East Publishers, Dubai, United Arab Emirates
Journal homepage: https://saudijournals.com
Original Research Article
Study on Urban North Indians Incidence of Dyslipidemia among Different
Age Groups
Dr. Sharique Ahmad1*, Dr. Saba Naziya2, Dr. Mohd Anwar3, Tanish Baqar4, Dr. Saeeda Wasim5, Dr. Huma Parveen6
1Professor, Department of Pathology, Era's Lucknow Medical College and Hospital, Era University, Lucknow, Uttar Pradesh, India-
226003
2Junior Resident, Department of Pathology, Era's Lucknow Medical College and Hospital, Era University, Lucknow, Uttar Pradesh,
India-226003
3Department of Transfusion Medicine, SGPGI, Lucknow, Uttar Pradesh – 226003, India
4Undergraduate student, Era's Lucknow Medical College and Hospital, Era University, Lucknow, Uttar Pradesh, India -226003
5Nova IVF Fertility, Hazratganj, Lucknow, Uttar Pradesh, 226001, India
6Junior Resident, Department of Pathology, Era's Lucknow Medical College and Hospital, Era University, Lucknow, Uttar Pradesh,
India -226003
DOI: 10.36348/sjpm.2022.v07i06.003 | Received: 13.05.2022 | Accepted: 18.06.2022 | Published: 23.06.2022
*Corresponding author: Dr. Sharique Ahmad
Professor, Department of Pathology, Era's Lucknow Medical College and Hospital, Era University, Lucknow, Uttar Pradesh, India-
226003
Abstract
Background: Coronary artery disease is a known entity of morbidity and mortality in industrialised countries. It is a major
public health problem around the world. Coronary artery disease increase incidence in Indian population at least 10 years before
in age than other ethnic groups. There are a numbers of factors associated with atherosclerosis the most important one is
dyslipidemia. Recent studies suggest that over the span of 20 years, the total amount of triglycerides, cholesterol and Low
Density Lipoproteins (LDL) `levels is usually increased in young urban populations. So, a study was performed out to know the
prevalence of dyslipidemia in urban North Indians among different set of age groups. Methods: This is a descriptive cross-
sectional study which was carried out on patients visiting to the blood collection centre of the Department of Pathology.
Patients were divided into 3 groups with age 18 year to 40 year, 41 year to 60 year and >60 year by involving 1989 subjects of
whom 532 were between 18 year to 40 year, 522 were between 41year to 60 year and 935 were > 60 year of age. This study
included measurement of fasting serum lipid profile comprising of, Low Density Lipoprotein (LDL), High Density
Lipoproteins (HDL), Triglycerides and total cholesterol. Results: Number of subjects studied, the prevalence of dyslipidemia
was higher in <60 years age population. A remarkable difference in mean was observed statistically with the levels of
triglycerides, LDL and total cholesterol of this age group ranging from 18- 40 years and for those who are >60 years. A
remarkable difference for the levels of HDL was not found in age group between 18 – 40 years and > 40 years to 60 years.
Mean cholesterol level was observed to be elevated between the age group 18 – 40 years. The mean peak triglycerides were
observed in age group between 41-60 years. This elevated mean HDL levels were noticed in the age group who are > 60 years
of age. Conclusions: Elevated percentage of dyslipidemia was observed in less than 60yrs age groups. Large population study
is required to substantiate the results of this study. It is necessary to plan out comprehensive strategies for the screening and
awareness in all ages on periodic basis.
Keywords: Dyslipidemia, Total Cholesterol, Low Density Lipoproteins & Triglyceride.
Copyright © 2022 The Author(s): This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International
License (CC BY-NC 4.0) which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use provided the original
author and source are credited.
BACKGROUND
The established and known risk factor for
cardiovascular diseases are elevated blood lipid levels.
Globally, 4.5% of the total deaths are observed in
population suffering from high total cholesterol levels
[1-4]. In the occurrence of major heart diseases
dyslipidemia plays a major contributing determinant
like ischemic heart disease. National cholesterol
education programme (NCEP) defined as dyslipidemia
is hypertriglyceridemia (serum triglyceride >
150mg/dl), hypercholesterolemia (serum cholesterol
>200 mg/dl), and high LDL cholesterol (LDL
cholesterol > 130mg/dl). India is expected to have 60%
of the world’s cardiovascular disease patient burden,
many studies documented by year 2020 [5].

Sharique Ahmad et al; Saudi J Pathol Microbiol, Jun, 2022; 7(6): 240-244
© 2022 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 241
Indians have unique model of dyslipidemia
associated with increased Triglyceride levels, lower
high-density lipoprotein (HDL-C), and increase level of
small dense low-density lipoprotein (LDL-C), there are
no high level of representative studies on dyslipidemia
to evaluate the immensity of the problem existing in
India. In the adults above 20 years of age, the estimate
of prevalence of Coronary Heart Disease (CHD) varies
from 3-4% in the rural population and 8 -10% in urban
population and 3-4% in rural population, representing a
2 folds rise in the rural population and six time more in
urban population between the years 1960 and 2000.
Lifestyle including physical inactivity, sedentary
lifestyle, no exercise and increased consumption of
saturated fat, which are associated with urbanization,
are associated with adverse change in the lipid profile.
Dyslipidemia having potential risk factor of
pathophysiology of cardiovascular disease and it is a
modifiable risk factor for the coronary artery disease [6-
8].
National cholesterol education programme
(NCEP), hence framed objective for the diagnosis,
monitoring and curability of increased blood cholesterol
in adults population. Effective control of the blood lipid
levels reduces cardiovascular morbidity and mortality.
The critical part of management of Chronic heart
disease and people at risk of CHD involves knowledge,
knowledge regarding the lipid profile and the
significance of each parameter [9, 10].
The purpose of present study was to find out
the prevalence of dyslipidemia in urban north Indian
population the age range between 18 to >60 years of
age to ensure correct arrangement of health care
measure for both primary (1⁰) and secondary(2⁰)
prevention of cardiovascular diseases [6].
METHODS
A descriptive cross sectional study targeting
urban north Indian population was conducted by the
department of Pathology on 1989 patients, ≥18 years of
age in both the sex, patients who volunteered to
participate and give fasting blood sample for this study
who visited to the blood collection centre of Pathology
department. The population under study was divided
into 3 groups. Group 1 consisted of members the age
group between 18 to 40 years, Group 2 consisted of
members the age group between 41 to 60 years and
Group 3 consisted of age group >60 years of age.
Exclusion criteria consisted of patients with <18 years
of age and patient who have history of coronary heart
diseases, patients who are critically ill, patients agony
with acute or chronic illness or are on hypolipidemic
drugs.
After a fasting period of 8–12 hours for lipid
profile analysis, 5ml of venous blood samples were
collected from the median cubital vein in the morning
with all aseptic precautions taken, after obtaining
informed consent from all the subjects as part of health
screening and Ethical clearance was obtained prior to
starting the study started from the Institutional ethics
committee.
Estimation of fasting lipid profile
The samples so drawn from the median cubital
vein after taking all aseptic precaution, at room
temperature blood clot. Serum was obtained by 3000
rpm centrifugation for 10 minutes by laboratory
centrifuge machine. The serum sample obtained was
investigated by cholesterol oxidase - peroxidase
(CHOD- POD, End Point) for Total cholesterol,
Enzymatic glycerine phosphate oxidase peroxidase
(GPO-PAP) for Triglycerides. High Density
Lipoprotein Cholesterol and Low Density Lipoprotein
cholesterol were evaluated within one hour of collection
by using autoanalyzer by Homogenous Method and
Direct Measurement. SPSS software version 22 was
used for Data collection statistically. Each group were
determined by Mean, standard deviation, and standard
error by using Pearson Chi-square test and Univariate
analysis was implemented. Students and p- value was
calculated by Comparison of differences in mean of
these groups. t-test considered significant when P-value
was <0.05.
RESULTS
Through the results so obtained, we estimated
the fasting lipid profile in urban North Indian
population among different age groups. 1989 persons
were enrolled for participating in this study. The
subjects under this study were further divided into 3
groups. Group 1 between the age group of 18 - 40
years, group 2 were age group between 41-60 years and
group 3 with the age of >60 years. Out of 1989, 532
were 18 to 40 years of age, 522 were 41 to 60 years of
age and 935 were >60 years.
The socio-demographic profile data of the
study participant were collected. 70% male participant
were found in this study subjects. Fasting lipid assay of
all study participant included total cholesterol, HDL
cholesterol, LDL cholesterol, & triglycerides.
The results of all 3 groups were tabulated with
cholesterol<200 & >200mg/dl, HDL >45 & <45 mg/dl,
triglycerides <150 & >150 mg/dl, LDL < 100 & >100
mg/dl.
In mean cholesterol, LDL Cholesterol and
triglycerides between age groups of <40 & >60 years
statistically significant difference was found. Between
the age group <40 year and 41 to 60 years, no
statistically significant difference was found (Table 1).
Among all 3 groups elevated mean serum
cholesterol was observed in age group between 18 - 40

Sharique Ahmad et al; Saudi J Pathol Microbiol, Jun, 2022; 7(6): 240-244
© 2022 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 242
years. In > 60 years age group mean HDL was elevated.
The age group between 41 to 60 years elevated mean triglyceride level 146.21 was found and age group
between 18 - 40 years.
Table 1: Lipid Profile Differences in Age group between 18 to 40 Years & more than 60 Years
Lipid Profile
Age Group
N
Mean ± SD
‘p’ Value
Total Cholesterol
1
532
181.48 ± 41.31
3
520
153.81 ± 40.2
0.00
LDL Cholesterol
1
532
116.45 ± 34.6
3
522
89.53 ± 13.3
0.00
Triglyceride
1
532
145.85 ± 32.3
3
521
123.36 ±15.2
0.00
HDL Cholesterol
1
532
36.85 ± 9.5
3
522
37.82 ± 11.0
0.123
statistically significant p value is ≤ 0.05
Difference in mean Group-1 age <40 Years & Group-3 age > 60 Years
DISCUSSION
Assessment of Lipid profile includes TG, TC,
HDL-C and LDL-C allows an estimation of risk of
cardiovascular diseases. Many recent studies indicates
that high concentrations of total cholesterol,
triglycerides, low-density lipoprotein and decreased
high-density lipoprotein increases the risk of
atherosclerotic plaques [11-13].
In present study we observed the prevalence of
high LDL(>130mg/dl), hypercholesterolemia (>
200mg/dl), were observed in age group between <40yrs
and hypertriglyceridemia (>150mg/dl) was observed in
age group between 41 to 60 yrs. Lower high-density
lipoprotein < 40 mg/dl was observed in age group < 60
years.
Total cholesterol and low-density lipoprotein
levels increases in age of young or middle-aged
population studied cross-sectionally. However, cross-
sectional studies of participants who are ≥65 years of
age have reported that total cholesterol and low-density
lipoprotein levels decrease with age. Although High
Density Lipoprotein levels does not change with age in
majority of the cross-sectional studies, levels decreased
with age in both male and female in most of the
prospective studies [14-19] is in accordance to this
study.
The former study suggested that reduced
capacity of the liver indicates that low density
lipoprotein increase with age and also there is
secondary to reduced hepatic low density lipoprotein
receptor expression &/or cholesterol intestinal
immersion increase. Over-mentioned studies show that
cholesterol situations on the effect of age provided
mixed results. The importance of negative correlation
between total cholesterol and that low density
lipoprotein with age demonstrated by senior Japanese-
American men of Honolulu Heart Program. There is a
positive correlation between LDL-cholesterol and age
explained by Framingham Offspring Study. In each
study indicate result difference can incompletely
explained by the age range of the participants. Honolulu
Heart Program study age varies between 71 & 93 times
while <60 years of age population are mostly seen in
the periods of those studied in the Framingham
Offspring Study [21-24]. Our study included age group
of more than 60 years to appraise the outline of change
in lipid profile estimation in elderly population and to
evaluate if these changes would deviate them towards
the risk of cardiovascular diseases [25].
High density lipoprotein levels vary with age
not suggested by majority of cross-sectional studies [16,
26] but a recent research from the Cardiovascular
Health Study [27] suggested that High density
lipoprotein levels appeared to increase with age in male
but not in female, which is almost similar to the results
of this study which indicted increased High density
lipoprotein in > 60 years age in contrast to other age
groups population.
There is a difference between plasma lipid
level in rural and urban population found in Sabir, A. A,
et al., study and Hausa-Fulani found dyslipidemia in
North-Western Nigeria population, demonstrated that
the mean serum Total cholesterol was remarkably
elevated in rural and urban population. Mean serum
Triglycerides and low density lipoprotein
concentrations were elevated in the urban than rural
population but the difference was not statistically
significant. Abnormally low high density lipoprotein-
Cholesterol was the most frequent dyslipidemia found
in the urban participants than in rural participants [28].
Study Limitations
Primary limitation of this study was that it is
cross-sectional observational in nature. The present
study was not able to include an involvement of diet,
physical activity, genetic profiling and other factors that
might affect with the blood lipid levels in the
participants studied. More possible factors and larger
population groups are needed to verify our result in
Future studies.

Sharique Ahmad et al; Saudi J Pathol Microbiol, Jun, 2022; 7(6): 240-244
© 2022 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 243
CONCLUSIONS
Our study concluded that dyslipidemia was
highest among population with age group less than 60
years. The most important sedentary lifestyle factors
which affect the serum Cholesterol are physical
inactivity, saturated fat full diet, and high body mass
index . Efforts to motivate the population to do more
physical work, exercise and eat healthy food which will
lead to reduce the risk of cardio-vascular diseases, not
just physical activity but screening the population, by
the early detection and intervention we can prevent
young population by morbidity and mortality which
caused by coronary artery disease.
Conflict of Interest: The authors declare that there are
no conflicts of interest.
Funding Source: Nil
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