TY - JOUR
T1 - Low HDL cholesterol as a cardiovascular risk factor in rural, urban, and rural-urban migrants
T2 - PERU MIGRANT cohort study
AU - Lazo-Porras, María
AU - Bernabe-Ortiz, Antonio
AU - Málaga, Germán
AU - Gilman, Robert H.
AU - Acuña-Villaorduña, Ana
AU - Cardenas-Montero, Deborah
AU - Smeeth, Liam
AU - Miranda, J. Jaime
N1 - Funding Information:
The PERU MIGRANT Study baseline assessment work was funded through by a Wellcome Trust Master Research Training Fellowship and a Wellcome Trust PhD Studentship to JJM ( GR074833MA ), and its follow up by Universidad Peruana Cayetano Heredia (Fondo Concursable No. 20205071009 ). ML, AB-O, and JJM and the CRONICAS Centre of Excellence in Chronic Diseases were supported by Federal funds from the United States National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services , under contract No. HHSN268200900033C . LS is a Wellcome Trust Senior Clinical Fellow ( 098504/Z/12/Z ), and AB-O is a Wellcome Trust Research Training Fellow in Public Health and Tropical Medicine ( 103994/Z/14/Z ).
Funding Information:
We are thankful to Renato Quispe and Katherine Sacksteder for their valuable editorial inputs to earlier versions of the manuscript.
Publisher Copyright:
© 2015 The Authors.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - 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.
AB - 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.
KW - Cholesterol
KW - HDL
KW - Human migration
KW - Mortality
KW - Myocardial infarction
KW - Stroke
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U2 - 10.1016/j.atherosclerosis.2015.12.039
DO - 10.1016/j.atherosclerosis.2015.12.039
M3 - Article
C2 - 26752691
AN - SCOPUS:84952802677
SN - 0021-9150
VL - 246
SP - 36
EP - 43
JO - Atherosclerosis
JF - Atherosclerosis
ER -
