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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
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INTRODUCTION:
This research was conducted to investigate
serum lipid levels of Tehranian people.
MATERIAL 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
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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.
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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.
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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