Low HDL cholesterol as a cardiovascular risk factor in rural, urban, and rural-urban migrants: PERU MIGRANT cohort study

Atherosclerosis. 2016 Mar:246:36-43. doi: 10.1016/j.atherosclerosis.2015.12.039. Epub 2015 Dec 29.

Abstract

Introduction: Whilst the relationship between lipids and cardiovascular mortality has been well studied and appears to be controversial, very little has been explored in the context of rural-to-urban migration in low-resource settings.

Objective: Determine the profile and related factors for HDL-c patterns (isolated and non-isolated low HDL-c) in three population-based groups according to their migration status, and determine the effect of HDL-c patterns on the rates of cardiovascular outcomes (i.e. non-fatal stroke and non-fatal myocardial infarction) and mortality.

Methods: Cross-sectional and 5-year longitudinal data from the PERU MIGRANT study, designed to assess the effect of migration on cardiovascular risk profiles and mortality in Peru. Two different analyses were performed: first, we estimated prevalence and associated factors with isolated and non-isolated low HDL-c at baseline. Second, using longitudinal information, relative risk ratios (RRR) of composite outcomes of mortality, non-fatal stroke and non-fatal myocardial infarction were calculated according to HDL-c levels at baseline.

Results: Data from 988 participants, rural (n = 201), rural-to-urban migrants (n = 589), and urban (n = 199) groups, was analysed. Low HDL-c was present in 56.5% (95%CI: 53.4%-59.6%) without differences by study groups. Isolated low HDL-c was found in 36.5% (95%CI: 33.5-39.5%), with differences between study groups. In multivariable analysis, urban group (vs. rural), female gender, overweight and obesity were independently associated with isolated low HDL-c. Only female gender, overweight and obesity were associated with non-isolated low HDL-c. Longitudinal analyses showed that non-isolated low HDL-c increased the risk of negative cardiovascular outcomes (RRR = 3.46; 95%CI: 1.23-9.74).

Conclusions: Isolated low HDL-c was the most common dyslipidaemia in the study population and was more frequent in rural subjects. Non-isolated low HDL-c increased three-to fourfold the 5-year risk of cardiovascular outcomes.

Keywords: Cholesterol; HDL; Human migration; Mortality; Myocardial infarction; Stroke.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Distribution
  • Biomarkers / blood
  • Cholesterol, HDL / blood*
  • Comorbidity
  • Cross-Sectional Studies
  • Down-Regulation
  • Dyslipidemias / blood*
  • Dyslipidemias / diagnosis
  • Dyslipidemias / epidemiology*
  • Dyslipidemias / mortality
  • Female
  • Humans
  • Life Style
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / mortality
  • Odds Ratio
  • Peru / epidemiology
  • Prevalence
  • Risk Assessment
  • Risk Factors
  • Rural Health*
  • Sex Distribution
  • Stroke / diagnosis
  • Stroke / epidemiology*
  • Stroke / mortality
  • Time Factors
  • Transients and Migrants*
  • Urban Health*

Substances

  • Biomarkers
  • Cholesterol, HDL