Plasma lipid abnormalities in Pakistani population: trends, associated factors, and clinical implications

Abstract

Previous studies have reported increased prevalence of coronary heart disease (CHD) in Indians and South Asian settlers in North America. This increased burden of CHD among South Asians is mainly caused by dyslipidemia. To the best of our knowledge, none of the previous works has studied the patterns and prevalence of dyslipidemia in the Pakistani population. The present work aimed to study the plasma lipid trends and abnormalities in a population-based sample of urban and rural Pakistanis. The study included 238 participants (108 males,130 females). Plasma lipid profiles of the participants were determined using standard protocols. We observed that 63% of the study population displayed irregularities in at least one major lipid-fraction including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), or triglycerides (TG). The most common form of isolated-dyslipidemia was low HDL-C (17.3%) followed by high TG (11.2%). Several overlaps between high TC, LDL-C, TG and low HDL-C were also noted. Gender, urbanization, and occupational class were all observed to have an impact on lipid profiles. Briefly, male, urban, and blue-collar participants displayed higher prevalence of dyslipidemia compared to female, rural, and white-collar participants, respectively. In comparison to normal subjects, dyslipidemic subjects displayed significantly higher values for different anthropometric variables including body mass index (BMI), body fat percentage, and waist circumference. The present work provides a comprehensive estimation of the prevalence of dyslipidemia and CHD risk in the Pakistani population. This information will be helpful for better healthcare planning and resource allocation in Pakistan.

Figure 1.. Pie charts displaying the percentage distribution of the study population into various sub-groups according to the plasma levels of A: total cholesterol; B: low density lipoprotein cholesterol; C: triglycerides; D: high-density lipoprotein cholesterol. The increasing color intensity within each pie chart signifies increasing coronary heart disease risk.

Figure 2.. Effect of different confounding factors on stratification of the study population into plasma lipoprotein-based coronary heart disease risk categories according to the ATP-III guidelines. Statistical significance was determined by z-test for two population proportions. *P<0.05. The following comparisons were made: male vs female; urban vs rural; blue-collar vs white-collar; urban blue-collar vs urban white-collar. LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol.

Figure 3.. Stratification of the study population into CHD-risk categories according to Framingham Risk Scoring (10-year CHD risk). Comparisons were made between A: Males and females; B: Different age groups in years (G1: 14–22, G2: 23–31, G3: 32–40, G4:41–49, G5: 50–58, and G5: ≥59); C: Urban and rural; D: Blue-collar and white-collar; E: Urban blue-collar vs urban white-collar. Statistical significance was determined by the z-test for two population proportions. *P<0.05, comparison of high-risk groups.

Figure 4.. Prevalence of isolated- and mixed-dyslipidemias in the study population. A, Venn-Diagram displays overlaps between prevalence of high TC, LDL-C, TG and low HDL-C levels in the study population. B, Venn-Diagram displays overlaps between prevalence of high LDL-C, TG and low HDL-C levels in the study population.TC: total cholesterol; TG: triglycerides; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol.