Associations of lifestyle and dietary habits with hyperlipidemia in Lebanon

Abstract

Aim: This study was designed to evaluate the effects of dietary and lifestyle habits on several blood lipid parameters in the Lebanese population.

Methods: This was a cross-sectional study for 2,000 individuals, of whom 1,003 completed the survey about their dietary and lifestyle habits. Anthropometric measurements and blood tests were performed and recorded.

Results: Up to 53.2% of the population was hypercholesterolemic. Gender and age contributed to the prevalence of high levels of low density lipoprotein cholesterol (LDL-C) or triglycerides. Prevalence of hypercholesterolemia, hypertriglyceridemia and high LDL-C levels was higher in smokers, physically inactive or those who consume fatty meat or eggs. Prevalence of hypercholesterolemia was not affected by consumption of whole milk, skimmed milk or fruits and vegetables. However, the prevalence of hypertriglyceridemia and high LDL-levels was higher in individuals who consumed whole milk, and lower in those who consumed skimmed or fruits and vegetables.

Conclusion: Hyperlipidemia affects more than half of the Lebanese population. The finding that the majority of the individuals were unaware of their lipid profile mandates warrant efforts for both patient and public education.

Keywords

Lipidemia / cardiovascular disease / diet / Lebanon

References

[1] World Health Organization.Cardiovascular diseases (CVDs)..2017;In: Fact SheetsWorld Health Organization

[2] Wilson P,Levy D,Silbershatz H.Prediction of coronary heart disease using risk factor categories..Circulation1998;97:1837-47

[3] Chapman MJ,Amarenco P,Borén J,Descamps OS,Kovanen PT,Lesnik P,Nordestgaard BG,Reiner Z,Tokgözoglu L,Watts GF.Triglyceride-rich lipoproteins and high-density lipoprotein cholesterol in patients at high risk of cardiovascular disease: evidence and guidance for management..Eur Heart J2011;32:1345-61 PMCID:PMC3105250

[4] National Cholesterol Education Program (NCEP) Expert Panel on Detection E, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)..Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report..Circulation2002;106:3143-421

[5] Gordon D,Garrison R,Castelli W,Jacobs DJ,Tyroler H.High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies..Circulation1989;79:8-15

[6] Musunuru K.Surprises from genetic analyses of lipid risk factors for atherosclerosis..Circ Res2016;118:579-85 PMCID:PMC4762058

[7] Daugherty A,Rader DJ.Accelerating the pace of atherosclerosis research..Arterioscler Thromb Vasc Biol2015;35:11-2 PMCID:PMC4840438

[8] Melendez QM,Wooten CJ.Hypercholesterolemia: the role of PCSK9..Arch Biochem Biophys2017;625-626:39-53

[9] Go AS,Roger VL,Berry JD,Dai S,Fox CS,Fullerton HJ,Hailpern SM,Howard VJ,Judd SE,Kittner SJ,Lichtman JH,Mackey RH,Marcus GM,Matchar DB,Mohler ER3rd,Mussolino ME,Nichol G,Paynter NP,Sorlie PD,Towfighi A,Virani SS,Woo D.Heart disease and stroke statistics--2014 update: a report from the American Heart Association..Circulation2014;129:e28-e292 PMCID:PMC5408159

[10] Herrington W,Sherliker P,Lewington S.Epidemiology of atherosclerosis and the potential to reduce the global burden of atherothrombotic disease..Circ Res2016;118:535-46

[11] Saleh Al-Shehabi T,Eid AH.Anti-atherosclerotic plants which modulate the phenotype of vascular smooth muscle cells..Phytomedicine2016;23:1068-81

[12] World Health Organization. World Health Report 2002. Available from: http://www.who.int/whr/2002/en/. [Last accessed on Jul 31, 2017]

[13] Haskell WL,Fair JM,Mackey SF,Williams PT,Champagne MA.Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention Project (SCRIP)..Circulation1994;89:975-90

[14] Grundy SM,Merz CN,Clark LT,Pasternak RC,Stone NJ.Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines..J Am Coll Cardiol2004;44:720-32

[15] Downs JR,Weis S,Shapiro DR,Langendorfer A,Kruyer W.Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study..JAMA1998;279:1615-22

[16] Sacks FM,Moye LA,Rutherford JD,Brown L,Arnold JM,Davis BR.The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators..N Engl J Med1996;335:1001-9

[17] Pedersen TR,Berg K,Faergeman O,Pyörälä K,Wilhelmsen L,Wedel H.Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). 1994..Atheroscler Suppl2004;5:81-7

[18] Virmani R,Burke AP,Schwartz SM.Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions..Arterioscler Thromb Vasc Biol2000;20:1262-75

[19] Libby P.Inflammation in atherosclerosis..Nature2002;420:868-74

[20] Keys A.Seven countries : a multivariate analysis of death and coronary heart disease..1980;CambridgeHarvard Univ. Press

[21] Råstam L,Luepker RV,Murray DM.Seasonal variation in plasma cholesterol distributions: implications for screening and referral..Am J Prev Med1992;8:360-6

[22] Gupta R,Misra A.Recent trends in epidemiology of dyslipidemias in India..Indian Heart J2017;69:382-92

[23] Erem C,Deger O,Topbas M.Prevalence of dyslipidemia and associated risk factors among Turkish adults: Trabzon lipid study..Endocrine2008;34:36-51

[24] al-Nuaim A,al-Mazrou Y,al-Daghari N.Prevalence of hypercholesterolemia in Saudi Arabia, epidemiological study..Int J Cardiol1996;54:41-9

[25] Singh R,Rastogi V,Moshiri M,Janus E.Prevalence of coronary artery disease and coronary risk factors in rural and urban populations of north India..Eur Heart J1997;18:1728-35

[26] Foucan L,Koumavi Ekouévi D,Bangou-Brédent J.Lipid profile in an adult population in Guadeloupe..Diabetes Metab2000;26:473-80

[27] Primatesta P.Lipid concentrations and the use of lipid lowering drugs: evidence from a national cross sectional survey..BMJ2000;321:1322-5 PMCID:PMC27537

[28] Vartiainen E,Alfthan G,Pietinen P.Cardiovascular risk factor changes in Finland, 1972-1997..Int J Epidemiol2000;29:49-56

[29] Ford E,Pearson W,Mokdad A.Trends in hypercholesterolemia, treatment and control among United States adults..Int J Cardiol2010;140:226-35

[30] Kavanagh K,Zhang L,Register T,Rudel L.Estrogen decreases atherosclerosis in part by reducing hepatic acyl-CoA:cholesterol acyltransferase 2 (ACAT2) in monkeys..Arterioscler Thromb Vasc Biol2009;29:1471-7 PMCID:PMC2763273

[31] Godsland I.Effects of postmenopausal hormone replacement therapy on lipid, lipoprotein, and apolipoprotein (a) concentrations: analysis of studies published from 1974-2000..Fertil Steril2001;75:898-915

[32] Li H,Wu L,Shuang T,Wang R.The interaction of estrogen and CSE/H2S pathway in the development of atherosclerosis..Am J Physiol Heart Circ Physiol2017;312:H406-14

[33] Oh Y,Park Y.Synergic hypocholesterolaemic effect of n-3 PUFA and oestrogen by modulation of hepatic cholesterol metabolism in female rats..Br J Nutr2015;114:1766-73

[34] Lee J.Hypertriglyceridemia-induced pancreatitis created by oral estrogen and in vitro fertilization ovulation induction..J Clin Lipidol2008;2:63-6 PMCID:PMC2350225

[35] Phan BA.Dyslipidemia in women: etiology and management..Int J Womens Health2014;6:185-94 PMCID:PMC3923614

[36] Moorthy K,Mantha AK,Sharma D,Baquer NZ.Estradiol and progesterone treatments change the lipid profile in naturally menopausal rats from different age groups..Biogerontology2004;5:411-9

[37] Nigro M,Barthem CS,Fortunato RS,Carvalho DP.A change in liver metabolism but not in brown adipose tissue thermogenesis is an early event in ovariectomy-induced obesity in rats..Endocrinology2014;155:2881-91

[38] Zhang N,Zhang X,Wang F,Zhao M,Gao L,Guan Q.The relationship between endogenous testosterone and lipid profile in middle-aged and elderly Chinese men..Eur J Endocrinol2014;170:487-94

[39] Hatch NW,Chan HW,Tannock LR.Endogenous androgen deficiency enhances diet-induced hypercholesterolemia and atherosclerosis in low-density lipoprotein receptor-deficient mice..Gend Med2012;9:319-28 PMCID:PMC3483072

[40] Kim DE,Jang IM,Ahn MY.Associations of cigarette smoking with intracranial atherosclerosis in the patients with acute ischemic stroke..Clin Neurol Neurosurg2012;114:1243-7

[41] Popa SG,Mihaltan FD,Munteanu I,Serafinceanu C,Hancu N,Lichiardopol R,Mihai B,Roman G.Associations of smoking with cardiometabolic profile and renal function in a Romanian population-based sample from the PREDATORR cross-sectional study..Eur J Gen Pract2017;23:164-70

[42] Donahue R,Kuller L.Lipids and lipoproteins in a young adult population. The Beaver County Lipid Study..Am J Epidemiol1985;122:458-67

[43] Yang Z,Liu J,Si L,Tu P.Associations between anthropometric parameters and lipid profiles in Chinese individuals with age ≥ 40 years and BMI < 28kg/m²..Plos One2017;12:e0178343 PMCID:PMC5478121

[44] Facchini FS,Jeppesen J,Reaven GM.Insulin resistance and cigarette smoking..Lancet1992;339:1128-30

[45] Herron K,Waters D,Clark R,Fernandez M.The ABCG5 polymorphism contributes to individual responses to dietary cholesterol and carotenoids in eggs..J Nutr2006;136:1161-5

[46] Chakrabarty G,Bijlani R,Mahapatra S,Lakshmy R,Manchanda S.The effect of ingestion of egg on the serum lipid profile of healthy young Indians..Indian J Physiol Pharmacol2004;48:286-92

[47] Fernandez M.Dietary cholesterol provided by eggs and plasma lipoproteins in healthy populations..Curr Opin Clin Nutr Metab Care2006;9:8-12

[48] Chakrabarty G,Mahapatra S,Lakshmy R,Manchanda S.The effect of ingestion of egg on serum lipid profile in healthy young free-living subjects..Indian J Physiol Pharmacol2002;46:492-8

[49] Ballesteros M,Saucedo MS.Dietary cholesterol does not increase biomarkers for chronic disease in a pediatric population from northern Mexico..Am J Clin Nutr2004;80:855-61

[50] Choi Y,Lee JE,Cho J,Suh BS,Zhao D,Pastor-Barriuso R,Shin H,Guallar E.Egg consumption and coronary artery calcification in asymptomatic men and women..Atherosclerosis2015;241:305-12

[51] Hussi E,Ollus A,Ehnholm C,Huttunen J.Lack of serum cholesterol-lowering effect of skimmed milk and butter milk under controlled conditions..Atherosclerosis1981;39:267-72

[52] Estévez-González M,Betancor-León P.Reduction of serum cholesterol and low-density lipoprotein cholesterol levels in a juvenile population after isocaloric substitution of whole milk with a milk preparation (skimmed milk enriched with oleic acid)..J Pediatr1998;132:85-9

[53] Smith-Warner SA,Tharp TM,Randall B,Wood J.Increasing vegetable and fruit intake: randomized intervention and monitoring in an at-risk population..Cancer Epidemiol Biomarkers Prev2000;9:307-17

[54] Hong S,Lee KH,Lee M,Joung H.A fruit and dairy dietary pattern is associated with a reduced risk of metabolic syndrome..Metabolism2012;61:883-90

[55] Yuan C,Shin HJ,Cho E.Fruit and vegetable consumption and hypertriglyceridemia: Korean National Health and Nutrition Examination Surveys (KNHANES) 2007-2009..Eur J Clin Nutr2015;69:1193-9

[56] Broekmans W,Kluft C,Kok F.Fruit and vegetables and cardiovascular risk profile: a diet controlled intervention study..Eur J Clin Nutr2001;55:636-42

[57] Zino S,Williams S.Randomised controlled trial of effect of fruit and vegetable consumption on plasma concentrations of lipids and antioxidants..BMJ1997;314:1787-91 PMCID:PMC2126938

[58] Djuric Z,Mekhovich O,Heilbrun L.Effects of high fruit-vegetable and/or low-fat intervention on plasma micronutrient levels..J Am Coll Nutr2006;25:178-87

[59] Tokede OA,Yansane A,Djousse L.Soya products and serum lipids: a meta-analysis of randomised controlled trials..Br J Nutr2015;114:831-43

[60] Dauchet L,Dallongeville J.Fruits, vegetables and coronary heart disease..Nat Rev Cardiol2009;6:599-608

[61] Moreno DA,Garcia-Viguera C.Effects of stir-fry cooking with different edible oils on the phytochemical composition of broccoli..J Food Sci2007;72:S064-8

[62] Nordestgaard BG,Humphries SE,Masana L,Wiklund O,Raal FJ,Wiegman A,Watts GF,Hovingh GK,Boileau C,Borén J,Catapano AL,Pajukanta P,Stalenhoef AF,Taskinen MR.Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease..Eur Heart J2013;34:3478-90a PMCID:PMC3844152