Atherosclerosis
Volume 246, 2016, Pages 36-43

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

Lazo-Porras M. , Bernabe-Ortiz A. , Málaga G. , Gilman R.H. , Acuña-Villaorduña A. , Cardenas-Montero D. , Smeeth L. , Miranda J.J.*
  • a CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
  • b CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
  • c CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru, Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru, Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
  • d Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States, Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru
  • e Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
  • f Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru
  • g Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • h CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru, Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru

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. © 2015 The Authors.

Author Keywords

HDL Human migration Stroke Cholesterol Mortality Myocardial infarction

Index Keywords

urban area rural area lifestyle longitudinal study Life Style cardiovascular risk Myocardial Infarction Stroke cerebrovascular accident heart infarction sex ratio human risk assessment comorbidity middle aged Odds Ratio Longitudinal Studies obesity Biomarkers time factor priority journal Time Factors rural health Urban Health Cross-Sectional Studies cross-sectional study migrant Humans male female risk factor Risk Factors Multivariate Analysis prevalence Article blood major clinical study adult gender migration down regulation biological marker Down-Regulation Dyslipidemias high density lipoprotein cholesterol Cholesterol, HDL Sex Distribution dyslipidemia age distribution outcome assessment Transients and Migrants Peru mortality
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-84952802677&doi=10.1016%2fj.atherosclerosis.2015.12.039&partnerID=40&md5=e5214f10f1c48399c977d669463bb020
DOI: 10.1016/j.atherosclerosis.2015.12.039
ISSN: 00219150
Cited by: 16
Original Language: English