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Epidemiology of Blood Lipids and Lipoproteins

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Dyslipidemias

Part of the book series: Contemporary Endocrinology ((COE))

Abstract

Cholesterol levels in adults are related to several lifestyle factors, including obesity, cigarette smoking, ethanol intake, and physical activity. Higher levels generally confer greater risk for cardiovascular disease (CVD) events. The key determinants for higher levels of atherogenic lipids measured as low-density lipoprotein cholesterol (LDL-C) include high dietary saturated fat, high dietary cholesterol, and low dietary polyunsaturated fat. The key determinants of low high-density lipoprotein cholesterol (HDL-C), which is associated with greater CVD risk, include male sex, androgen use, progestin use, estrogen deficiency, adiposity, cigarette use, low alcohol intake, diabetes mellitus, and low dietary saturated fat. Mean cholesterol levels have generally risen in the past several decades in regions around the world where the economy is developing. On the other hand, in the developed regions of the world such as the USA and Western Europe, mean cholesterol levels in adults have generally stayed the same or declined modestly.

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References

  1. Kannel WB, McGee DL. Diabetes and cardiovascular risk factors: the Framingham Study. Circulation. 1979;59:8–13.

    Article  CAS  PubMed  Google Scholar 

  2. Neaton JD, Blackburn H, Jacobs D, Kuller L, Lee DJ, Sherwin R, Shih J, Stamler J, Wentworth D. Serum cholesterol level and mortality findings for men screened in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Arch Intern Med. 1992;152:1490–500.

    Article  CAS  PubMed  Google Scholar 

  3. Stamler J, Wentworth DN, Neaton JD. Is the relationship between serum cholesterol and risk of death from coronary heart disease continuous and graded? Findings on the 356,222 primary screenees of the Multiple Risk Factor Interventional Trial (MRFIT). JAMA. 1986;256:2823–8.

    Article  CAS  PubMed  Google Scholar 

  4. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993;16(2):434–44.

    Article  CAS  PubMed  Google Scholar 

  5. Dyer AR, Stamler J, Paul O, Shekelle RB, Schoenberger JA, Berkson DM, Lepper M, Collette P, Shekelle S, Lindberg HA. Serum cholesterol and risk of death from cancer and other causes in three Chicago epidemiological studies. J Chronic Dis. 1981;34:249.

    Article  CAS  PubMed  Google Scholar 

  6. Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J III. Factors of risk in the development of coronary heart disease—six year follow-up experience. The Framingham Study. Ann Intern Med. 1961;55:33–50.

    Article  CAS  PubMed  Google Scholar 

  7. Shekelle RB, Stamler J, Paul O, Shyrock AM, Liu S, Lepper M. Dietary lipids and serum cholesterol level: Change in diet confounds the cross-sectional association. Am J Epidemiol. 1982;115:506–14.

    CAS  PubMed  Google Scholar 

  8. Verschuren WM, Jacobs DR, Bloemberg BP, Kromhout D, Menotti A, Aravanis C, Blackburn H, Buzina R, Dontas AS, Fidanza F. Serum total cholesterol and long-term coronary heart disease mortality in different cultures. Twenty-five-year follow-up of the seven countries study. JAMA. 1995;274:131–6.

    Article  CAS  PubMed  Google Scholar 

  9. Lloyd-Jones DM, Wilson PW, Larson MG, Leip E, Beiser A, D’Agostino RB, Cleeman JI, Levy D. Lifetime risk of coronary heart disease by cholesterol levels at selected ages. Arch Intern Med. 2003;163(16):1966–72.

    Article  PubMed  Google Scholar 

  10. Berry JD, Dyer A, Cai X, Garside DB, Ning H, Thomas A, Greenland P, Van Horn L, Tracy RP, Lloyd-Jones DM. Lifetime risks of cardiovascular disease. N Engl J Med. 2012;366(4):321–9. (PMCID:PMC3336876).

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Fredrickson DS, Levy RI, Lees RS. Fat transport in lipoproteins—an integrated approach to mechanisms and disorders. N Engl J Med. 1967;276:94–103.

    Article  CAS  PubMed  Google Scholar 

  12. Heiss G, Tamir I, Davis CE, Tyroler HA, Rifkind BM, Schonfeld G, Jacobs DR Jr, Frantz ID Jr. Lipoprotein-cholesterol distributions in selected North American populations: the Lipid Research Clinics Program Prevalence Study. Circulation. 1980;61:302–15.

    Article  CAS  PubMed  Google Scholar 

  13. Brensike JF, Levy RI, Kelsey SF, Passamani ER, Richardson JM, Loh IK, Stone NJ, Aldrich RF, Battaglini JW, Moriarty DJ, et al. Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of the NHLBI Type II coronary intervention study. Circulation. 1984;69:313–24.

    Article  CAS  PubMed  Google Scholar 

  14. Gordon T, Castelli WP, Hjortland MC, Kannel WB, Dawber TR. High density lipoprotein as a protective factor against coronary heart disease: the Framingham Study. Am J Med. 1977;62:707–14.

    Article  CAS  PubMed  Google Scholar 

  15. Miller GJ, Miller NE. Plasma high density lipoprotein concentration and development of ischemic heart disease. Lancet. 1975;1:16–9.

    Article  CAS  PubMed  Google Scholar 

  16. Castelli WP, Garrison RJ, Wilson PWF, Abbott RD, Kalousdian S, Kannel WB. Coronary heart disease incidence and lipoprotein cholesterol levels: the Framingham Study. JAMA. 1986;256:2835–8.

    Article  CAS  PubMed  Google Scholar 

  17. Wilson PWF, Abbott RD, Kannel WB, Castelli WP. High density lipoprotein cholesterol and mortality: The Framingham Study. Arteriosclerosis. 1988;8:737–41.

    Article  CAS  PubMed  Google Scholar 

  18. Abbott RD, Wilson PW, Kannel WB, Castelli WP. High density lipoprotein cholesterol, total cholesterol screening, and myocardial infarction. The Framingham Study. Arteriosclerosis. 1988;8(3):207–11.

    Article  CAS  PubMed  Google Scholar 

  19. Keys A, Anderson JT, Grande F. Serum cholesterol response to changes in the diet. II. The effect of cholesterol in the diet. Metabolism. 1965;14:749–65.

    Article  Google Scholar 

  20. Gardner CD, Kraemer HC. Monounsaturated versus polyunsaturated dietary fat and serum lipids. A meta-analysis. Arterioscler Thromb Vasc Biol. 1995;15(11):1917–27.

    Article  CAS  PubMed  Google Scholar 

  21. Rader DJ, Cohen J, Hobbs HH. Monogenic hypercholesterolemia: new insights in pathogenesis and treatment. J Clin Invest. 2003;111(12):1795–803.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Steyn K, Fourie JM, Shepherd J. Detection and measurement of hypercholesterolaemia in South Africans attending general practitioners in private practice—the cholesterol monitor. S Afr Med J. 1998;88(12):1569–74.

    CAS  PubMed  Google Scholar 

  23. Knopp RH. Cardiovascular effects of endogenous and exogenous sex hormones over a woman’s lifetime. Am J Obstet Gynecol. 1988;158:1630–43.

    Article  CAS  PubMed  Google Scholar 

  24. Vaziri SM, Evans JC, Larson MG, Wilson PWF. The impact of female hormone usage on the lipid profile: the Framingham Offspring Study. Arch Intern Med. 1993;153:2200–6.

    Article  CAS  PubMed  Google Scholar 

  25. Garrison RJ, Wilson PW, Castelli WP, Feinleib M, Kannel WB, McNamara PM. Obesity and lipoprotein cholesterol in the Framingham offspring study. Metabolism. 1980;29(11):1053–60.

    Article  CAS  PubMed  Google Scholar 

  26. Lamon-Fava S, Jimenez D, Fabsitz RR, Reed T, Carmelli D, Castelli WP, Ordovas JM, Wilson PWF, Schaefer EJ. The NHLBI Twin Study: heritability of apolipoprotein A-I, B, and low density lipoprotein subclasses and condordance for lipoprotein (a). Atherosclerosis. 1991;91:97–106.

    Article  CAS  PubMed  Google Scholar 

  27. Anderson KM, Wilson PWF, Garrison RJ, Castelli WP. Longitudinal and secular trends in lipoprotein cholesterol measurements in a general population sample: the Framingham Offspring Study. Atherosclerosis. 1987;68:59–66.

    Article  CAS  PubMed  Google Scholar 

  28. Campos H, Wilson PWF, Jimenez D, McNamara JR, Ordovas J, Schaefer EJ. Differences in apolipoproteins and low-density lipoprotein subfractions in postmenopausal women on and off estrogen therapy: results from the Framingham Offspring Study. Metabolism. 1990;39:1033–8.

    Article  CAS  PubMed  Google Scholar 

  29. Dannenberg AL, Keller JB, Wilson PWF, Castelli WP. Leisure time physical activity in the Framingham Offspring Study. Description, seasonal variation, and risk factor correlates. Am J Epidemiol. 1989;129:76–87.

    CAS  PubMed  Google Scholar 

  30. Williams PT, Haskell WL, Vranizan KM, Krauss RM. The associations of high-density lipoprotein subclasses with insulin and glucose levels, physical activity, resting heart rate, and regional adiposity in men with coronary artery disease: the Stanford Coronary Risk Intervention Project baseline survey. Metabolism. 1995;44(1):106–14.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  31. Wood PD, Stefanick ML, Williams PT, Haskell WL. The effects on plasma lipoproteins of a prudent weight-reducing diet, with or without exercise, in overweight men and women. N Engl J Med. 1991;325:461–6.

    Article  CAS  PubMed  Google Scholar 

  32. Kraus WE, Houmard JA, Duscha BD, Knetzger KJ, Wharton MB, McCartney JS, Bales CW, Henes S, Samsa GP, Otvos JD, et al. Effects of the amount and intensity of exercise on plasma lipoproteins. N Engl J Med. 2002;347(19):1483–92.

    Article  CAS  PubMed  Google Scholar 

  33. Durrington P. Dyslipidaemia. Lancet. 2003;362(9385):717–31.

    Article  CAS  PubMed  Google Scholar 

  34. Brunzell JD, Schrott HG, Motulsky AG, et al. Myocardial infarction in the familial forms of hypertriglyceridemia. Metabolism. 1976;25:313–20.

    Article  CAS  PubMed  Google Scholar 

  35. Siegel RD, Cupples A, Schaefer EJ, Wilson PW. Lipoproteins, apolipoproteins, and low-density lipoprotein size among diabetics in the Framingham offspring study. Metabolism. 1996;45(10):1267–72.

    Article  CAS  PubMed  Google Scholar 

  36. Garrison RJ, Kannel WB, Feinleib M, Castelli WP, McNamara PM, Padgett SJ. Cigarette smoking and HDL cholesterol: the Framingham offspring study. Atherosclerosis. 1978;30(1):17–25.

    Article  CAS  PubMed  Google Scholar 

  37. Mukamal KJ, Jadhav PP, D’Agostino RB, Massaro JM, Mittleman MA, Lipinska I, Sutherland PA, Matheney T, Levy D, Wilson PW, et al. Alcohol consumption and hemostatic factors: analysis of the Framingham Offspring cohort. Circulation. 2001;104(12):1367–73.

    Article  CAS  PubMed  Google Scholar 

  38. Ingelsson E, Schaefer EJ, Contois JH, McNamara JR, Sullivan L, Keyes MJ, Pencina MJ, Schoonmaker C, Wilson PW, D’Agostino RB, et al. Clinical utility of different lipid measures for prediction of coronary heart disease in men and women. JAMA. 2007;298(7):776–85.

    Article  CAS  PubMed  Google Scholar 

  39. Freedman DS, Otvos JD, Jeyarajah EJ, Shalaurova I, Cupples LA, Parise H, D’Agostino RB, Wilson PW, Schaefer EJ. Sex and age differences in lipoprotein subclasses measured by nuclear magnetic resonance spectroscopy: the Framingham Study. Clin Chem. 2004;50(7):1189–200.

    Article  CAS  PubMed  Google Scholar 

  40. Wilson PW, Myers RH, Larson MG, Ordovas JM, Wolf PA, Schaefer EJ. Apolipoprotein E alleles, dyslipidemia, and coronary heart disease. The Framingham Offspring Study. JAMA. 1994;272(21):1666–71.

    Article  CAS  PubMed  Google Scholar 

  41. Cromwell W, Otvos JD, Keyes MJ, Pencina MJ, Sullivan L, Wilson PWF, D’Agostino RB Sr. LDL particle number and risk of future cardiovascular disease in the Framingham Offspring Study–Implications for LDL management. J Clin Lipidol. 2007;1:583–92.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Wilson PW, D’Agostino RB, Parise H, Sullivan L, Meigs JB. Metabolic syndrome as a precursor of cardiovascular disease and type 2 diabetes mellitus. Circulation. 2005;112(20):3066–72.

    Article  CAS  PubMed  Google Scholar 

  43. Meigs JB, Rutter MK, Sullivan LM, Fox CS, D’Agostino RB Sr, Wilson PW. Impact of insulin resistance on risk of type 2 diabetes and cardiovascular disease in people with metabolic syndrome. Diabetes Care. 2007;30(5):1219–25.

    Article  CAS  PubMed  Google Scholar 

  44. McNamara JR, Campos H, Ordovas JM, Peterson J, Wilson PWF, Schaefer EJ. Effect of gender, age, and lipid status on low density lipoprotein subfraction distribution: results from the Framingham Offspring Study. Arteriosclerosis. 1987;7:483–90.

    Article  CAS  PubMed  Google Scholar 

  45. Campos H, McNamara JR, Wilson PWF, Ordovas JM, Schaefer EJ. Differences in low density lipoprotein subfractions and apolipoproteins in premenopausal and postmenopausal women. J Clin Endo Metab. 1988;67:30–5.

    Article  CAS  Google Scholar 

  46. Meigs JB, Mittleman MA, Nathan DM, Tofler GH, Singer DE, Murphy-Sheehy PM, Lipinska I, D’Agostino RB, Wilson PW. Hyperinsulinemia, hyperglycemia, and impaired hemostasis: the Framingham Offspring Study. JAMA. 2000;283(2):221–8..

    Google Scholar 

  47. Meigs JB, Jacques PF, Selhub J, Singer DE, Nathan DM, Rifai N, D–Agostino RB, Wilson PW. Fasting plasma homocysteine levels in the insulin resistance syndrome: the Framingham offspring study. Diabetes Care. 2001;24(8):1403–10.

    Google Scholar 

  48. Hivert MF, Sullivan LM, Fox CS, Nathan DM, D’Agostino RB Sr, Wilson PW, Meigs JB. Associations of adiponectin, resistin, and tumor necrosis factor-alpha with insulin resistance. J Clin Endocrinol Metab. 2008;93(8):3165–72. (PMCID:PMC2515087).

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  49. Bostom AG, Gagnon DR, Cupples LA, Wilson PWF, Jenner JL, Ordovas JM, Schaefer EJ, Castelli WP. A prospective investigation of elevated lipoprotein (a) detected by electrophoresis and cardiovascular disease in women: the Framingham Heart Study. Circulation. 1994;90:1688–95.

    Article  CAS  PubMed  Google Scholar 

  50. Bostom AG, Cupples LA, Jenner JL, Ordovas JM, Seman LJ, Wilson PWF, Schaefer EJ, Castelli WP. Elevated plasma lipoprotein (a) and coronary heart disease in men aged 55 years and younger: a prospective study. JAMA. 1996;276:544–8.

    Article  CAS  PubMed  Google Scholar 

  51. Walldius G, Jungner I, Holme I, Aastveit AH, Kolar W, Steiner E. High apolipoprotein B, low apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. Lancet. 2001;358(9298):2026–33.

    Article  CAS  PubMed  Google Scholar 

  52. Barter PJ, Ballantyne CM, Carmena R, Castro CM, Chapman MJ, Couture P, de Graaf J, Durrington PN, Faergeman O, Frohlich J, et al. Apo B versus cholesterol in estimating cardiovascular risk and in guiding therapy: report of the thirty-person/ten-country panel. J Intern Med. 2006;259(3):247–58.

    Article  CAS  PubMed  Google Scholar 

  53. Scanu AM, Scandiani L. Lipoprotein(a): structure, biology and clinical relevance. Adv Intern Med. 1991;36:249–70.

    CAS  PubMed  Google Scholar 

  54. Austin MA, Hokanson JE, Brunzell JD. Characterization of low-density lipoprotein subclasses: methodologic approaches and clinical relevance. Curr Opinion Lipid. 1994;5(6):395–403.

    Article  CAS  Google Scholar 

  55. Myers RH, Schaefer EJ, Wilson PWF, D’Agostino RB, Bachman DL, Ordovas JM, Au R, Cobb JL, Wolf PA. Apolipoprotein E allele 4 is associated with dementia in the Framingham Study. In: Iqbal K, Mortimer JA, Winblad B, et al., editors. Research advances in Alzheimer’s disease and related disorders. 1st ed. Wiley; 1995. pp. 63–70.

    Google Scholar 

  56. Myers RH, Schaefer EJ, Wilson PWF, D’Agostino RB, Ordovas JM, Espino A, Au R, White RF, Knoefel JE, Cobb JL, et al. Apolipoprotein E allele 4 is asociated with dementia in a population based study: the Framingham Study. Neurology. 1996;46:673–7.

    Article  CAS  PubMed  Google Scholar 

  57. Kathiresan S, Melander O, Anevski D, Guiducci C, Burtt NP, Roos C, Hirschhorn JN, Berglund G, Hedblad B, Groop L, et al. Polymorphisms associated with cholesterol and risk of cardiovascular events. N Engl J Med. 2008;358(12):1240–9.

    Article  CAS  PubMed  Google Scholar 

  58. Kathiresan S, Musunuru K, Orho-Melander M. Defining the spectrum of alleles that contribute to blood lipid concentrations in humans. Curr Opin Lipidol. 2008;19(2):122–7.

    Article  CAS  PubMed  Google Scholar 

  59. Kathiresan S, Melander O, Guiducci C, Surti A, Burtt NP, Rieder MJ, Cooper GM, Roos C, Voight BF, Havulinna AS, et al. Six new loci associated with blood low-density lipoprotein cholesterol, high-density lipoprotein cholesterol or triglycerides in humans. Nat Genet. 2008;40(2):189–97.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  60. Cupples LA, Arruda HT, Benjamin EJ, D’Agostino RB Sr, Demissie S, DeStefano AL, Dupuis J, Falls KM, Fox CS, Gottlieb DJ, et al. The Framingham Heart Study 100K SNP genome-wide association study resource: overview of 17 phenotype working group reports. BMC Med Genet. 2007;8(Suppl 1):S1.

    Google Scholar 

  61. Humphries SE, Norbury G, Leigh S, Hadfield SG, Nair D. What is the clinical utility of DNA testing in patients with familial hypercholesterolaemia? Curr Opin Lipidol. 2008;19(4):362–8.

    Article  CAS  PubMed  Google Scholar 

  62. Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97(18):1837–47.

    Article  CAS  PubMed  Google Scholar 

  63. Anderson KM, Wilson PWF, Odell PM, Kannel WB. An updated coronary risk profile. A statement for health professionals. Circulation. 1991;83:357–63.

    Google Scholar 

  64. Anderson KM, Odell PM, Wilson PWF, Kannel WB. Cardiovascular disease risk profiles. Am Heart J. 1991;121:293–8.

    Article  CAS  PubMed  Google Scholar 

  65. Ueshima H, Sekikawa A, Miura K, Turin TC, Takashima N, Kita Y, Watanabe M, Kadota A, Okuda N, Kadowaki T, et al. Cardiovascular disease and risk factors in Asia: a selected review. Circulation. 2008;118(25):2702–9.

    Article  PubMed Central  PubMed  Google Scholar 

  66. McQueen MJ, Hawken S, Wang X, Ounpuu S, Sniderman A, Probstfield J, Steyn K, Sanderson JE, Hasani M, Volkova E, et al. Lipids, lipoproteins, and apolipoproteins as risk markers of myocardial infarction in 52 countries (the INTERHEART study): a case-control study. Lancet. 2008;372(9634):224–33.

    Article  CAS  PubMed  Google Scholar 

  67. Wolf PA, D’Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: a risk profile from the Framingham Study. Stroke. 1991;3:312–8.

    Article  Google Scholar 

  68. Wilson PWF, Hoeg JM, D’Agostino RB, Silbershatz H, Belanger AM, Poehlmann H, O’Leary D, Wolf PA. Cumulative effects of high cholesterol levels, high blood pressure, and cigarette smoking on carotid stenosis. N Engl J Med. 1997;337(8):516–22.

    Article  CAS  PubMed  Google Scholar 

  69. Lamon-Fava S, Wilson PW, Schaefer EJ. Impact of body mass index on coronary heart disease risk factors in men and women. The Framingham Offspring Study. Arterioscler Thromb Vasc Biol. 1996;16(12):1509–15.

    Article  CAS  PubMed  Google Scholar 

  70. Meigs JB, D’Agostino RB, Wilson PWF, Cupples LA, Nathan DM, Singer DE. Risk variable clustering in the insulin resistance syndrome. Diabetes. 1997;46:1594–600.

    Article  CAS  PubMed  Google Scholar 

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  1. Medicine and Public Health, Emory University, 1462 Clifton Road, 30322, Atlanta, GA, USA

    Peter W.F. Wilson MD

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  1. Professor of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA

    Abhimanyu Garg

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Wilson, P. (2015). Epidemiology of Blood Lipids and Lipoproteins. In: Garg, A. (eds) Dyslipidemias. Contemporary Endocrinology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-60761-424-1_2

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