Transcript low HDL-cholesterol

Low level of high density lipoprotein cholesterol
in children of patients
with premature coronary heart disease.
Relation to own and parental characteristics.
M.V.Konnov*, L.M.Dobordzhginidze, A.D.Deev, N.A.Gratsiansky**
Center for Atherosclerosis,
Institute Of Physico-Chemical Medicine,
Moscow, Russian Federation
*[email protected], **[email protected]
http://athero.ru
Background
Low level of high density lipoprotein (HDL) cholesterol
can be a critical contributor to elevated risk
of coronary heart disease (CHD)
in children of patients with premature CHD (PCHD).
Purpose
To elucidate associations between low HDL-cholesterol
in children of patients with PCHD
(onset <55 years, men; <60 years, women)
with their own and parental characteristics.
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Material
In the framework of the study of risk factors
in families of patients with PCHD
we examined members of 285 families:
- 268 proband-parents (patients with PCHD)
aged 32-67 years,70.6% men, 75.7% after MI;
- 198 their consorts
aged 28-67 years, 18.8% men, 3.7% with overt CHD;
- 371 children of proband-parents
aged 5-38 years, 56.9% men, without overt CHD.
Konnov MV et al, 2011
Parameters registered
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alcohol consumption;
tobacco smoking;
oral contraceptive use;
weight; height;
body mass index (BMI);
waist circumference;
heart rate;
systolic/diastolic blood pressure (BP);
arterial prehypertension (PreHT) and hypertension (HT);
total, HDL and low density lipoprotein (LDL) cholesterol;
triglycerides;
basal serum glucose;
impaired glucose tolerance;
diabetes mellitus;
(in adults) education level and presence of menstruation;
metabolic syndrome.
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Methods
BMI was calculated as follows: (body mass [kg] / height [m2])
LDL-cholesterol - calculated with Friedwald‘s formula
High BP was defined as arterial prehypertension
or hypertension according to criteria of:
- 4-th Report of National High BP Education Program Working
Group on High BP in children and adolescents criteria (USA)
(in persons aged 5-17 years);
- 7-th Report of Joint National Committee criteria (USA)
(in persons aged ≥18 years).
For diagnosis of impaired glucose tolerance and diabetes mellitus
were used oral glucose tolerance test (1.75 g of glucose per kg
body weight up to a total of 75 g for children/adolescents, 75 g for
adults, WHO recommendations, 1998), and ADA criteria (2010).
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Definition of Metaabolic Syndrome
(*Joint Interim Statement 2009 criteria)
1. Δelevated waist circumference (population and country specific);
2. elevated triglycerides (≥ 1.7 mmol/l)
or drug treatment for this lipid abnormality;
3. reduced HDL-cholesterol (< 1.0 mmol/l, men; < 1.3 mmol/l,
women) or drug treatment for this lipid abnormality;
4. elevated BP (systolic BP ≥ 130 mm Hg
and/or diastolic BP ≥ 85 mm Hg) or antihypertensive drug
treatment of previously diagnosed arterial hypertension;
5. elevated fasting plasma glucose (≥ 5.55 mmol/l)
or drug treatment of elevated glucose.
*clinical identification (diagnosis) of MS – any 3 of 5 criteria.
Δ for
people of Europid origin (e.g. participants of this study) IDF cut points
can be used – waist: ≥ 94 cm (men), ≥ 80 cm (women)
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Statistical methods
• Predictors (factors associated with low HDL in children)
were selected by logistical regression analysis
with adjustment for age and sex.
• Before logistical regression for reduction of variability
of continuous coronary risk factors and to suppress
possible outliers symmetric censoring of 1% of their values
was carried out;
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Results
Factors associated with low HDL-cholesterol
were elucidated separately in young (age 5-17, n=148)
and adult (age 18-38 years, n=223) children.
Low HDL cholesterol was found
in 47 of 148 (31.8%) children aged 5-17 years
and
in 81 of 223 (36.3%) children aged 18-38 years.
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Table 1. Children aged 5-17 years (n=148):
Characteristics related to low HDL-cholesterol
(n=47, 31.8%) with p<0.1.
Results of univariate analysis
Characteristics related (with p<0.1) to
low HDL-cholesterol (47/148 [31.8%])
OR
95% CI
P
own age, years
0.90
0.81 to 1.01
0.064
own sex, girls vs boys
0.69
0.33 to 1.46
0.333
own triglycerides, mmol/l
2.98
1.28 to 6.94
0.011
own BMI, kg/m2
1.14
1.03 to 1.27
0.015
own waist circumference, cm
1.04
1.00 to 1.09
0.034
own alcohol consumption, yes vs no
0.39
0.14 to 1.09
0.071
low HDL-cholesterol of proband, yes vs no
1.12
0.52 to 2.43
0.773
low HDL-cholesterol of consort, yes vs no
2.46
1.07 to 5.64
0.034
in children aged 5-17 years
OR, CI, P – odds ratio, confidence interval and P-level,, respectively
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Table 2. Independent predictors of low HDL-cholesterol
in children aged 5-17 years.
Results of multivariate analysis
Independent predictors (with p<0.05) of
low HDL-cholesterol (47/148 [31.8%)
OR
95% CI
P
own BMI, tertile 2 (<20.95 kg/m2) vs tertile 1
(≤17.54 kg/m2)
2.43
0.90 to 6.58
0.080
own BMI, tertile 3 (≥20.95 kg/m2) vs tertile 1
(≤17.54 kg/m2)
3.35
1.18 to 9.52
0.023
low HDL-cholesterol of consort, yes vs no
2.46
1.07 to 5.64
0.034
in children aged 5-17 years
OR, CI, P – odds ratio, confidence interval and P-level,, respectively
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Table 3a. Children aged 18-38 years (n=223):
Characteristics related to low HDL-cholesterol
(n=81, 36.3%) with p<0.1
Results of univariate analysis (1)
Characteristics
OR
95% CI
P
own age, years
0.99
0.93 to 1.05
0.751
own sex, girls vs boys
2.52
1.44 to 4.40
0.001
own waist circumference, cm
1.04
1.02 to 1.07
0.0018
own triglycerides, mmol/l
1.83
1.23 to 2.71
0.0029
low HDL-cholesterol of proband, yes vs no
2.25
2.23 to 4.14
0.0088
low HDL-cholesterol of consort, yes vs no
4.92
2.13 to 11.4
0.0002
metabolic syndrome of consort, yes vs no
3.51
1.61 to 7.65
0.0016
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Table 3b. Children aged 18-38 years (n=223):
Characteristics related to low HDL-cholesterol
(n=81, 36.3%) with p<0.1
Results of univariate analysis (2)
Characteristics
OR
95% CI
P
BMI of consort, kg/m2
1.13
1.04 to 1.22
0.0023
waist circumference of consort, cm
1.04
1.01 to 1.08
0.0061
systolic BP of consort, mm Hg
1.02
1.01 to 1.04
0.0062
*heart rate of consort, beats pro minute
1.02
1.01 to 1.04
0.0062
basal serum glucose of consort, mmol/l
2.02
1.14 to 3.61
0.014
diastolic BP of consort, mm Hg
1.04
1.00 to 1.07
0.034
arterial PreHT/HT of consort, yes vs no
1.58
0.97 to 2.55
0.065
*additional adjustment for beta-blockers use
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Table 4. Independent predictors of low HDL-cholesterol
in children aged 18-38 years.
Results of multivariate analysis
Independent predictors (with p<0.05) of
low HDL-cholesterol (81/223 [36.3%)
in children aged 18-38 years
OR
95% CI
P
own waist circumference, tertile 2 (<83 cm)
vs tertile 1 (≤73 cm)
2.73
1.27 to 5.84
0.0098
own waist circumference, tertile 3 (≥83 cm)
vs tertile 1 (≤73 cm)
4.68
2.01 to 10.9
0.0003
own triglycerides, mmol/l
1.56
1.03 to 2.35
0.036
low HDL-cholesterol of proband, yes vs no
2.11
1.16 to 3.83
0.014
metabolic syndrome of consort, yes vs no
4.67
2.02 to 10.8
0.0003
*heart rate of consort, beats pro minute
0.93
0.88 to 0.97
0.0021
*additional adjustment for beta-blockers usie
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Conclusions
Low HDL cholesterol was highly prevalent
in this group of different age people
with parental premature CHD.
Independent predictors of low HDL-cholesterol
in this sample of children of patients with premature CHD
were mostly metabolic factors
both own (body mass index, waist circumference, triglycerides)
and parental (low HDL-cholesterol, metabolic syndrome).
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Abstract
OBJECTIVE. To elucidate associations between low HDL-C in children of patients with PCHD (onset <55, men; <60
years, women) and their own and parental characteristics.
METHODS. We examined members of 285 families: 268 probands (70.6% men, age 32-67 years), their 198 consorts
(18.8% men, 28-67 years, 3.7% overt CHD) and 371 their children (56.9% men, age 5-38 years, no overt CHD). We
registered alcohol consumption, smoking, oral contraceptive use, height, body mass index (BMI), waist circumference
(WC), heart rate (HR), systolic/diastolic BP, total/low density lipoprotein cholesterol, HDL-C, triglycerides (TG), serum
glucose, impaired glucose tolerance, diabetes, arterial pre-/hypertension (NHBPEP-4 or JNC-7 criteria depending on
age) and (in adults) education, menstruation status, metabolic syndrome (MS, JIS criteria). Low HDL-C was defined
as ≤25 percentile (Lipid Research Clinics, 5-17 years), or <1.0 (men), <1.3 (women) mmol/l (adults). Predictors of low
HDL-C were selected by sex, age adjusted logistic regression in 2 age groups: 5-17, 18-38 years.
RESULTS. Low HDL-C was found in 47/148 (31.8%) children aged 5-17 years. Its independent predictors were own
BMI and low HDL-C of consort. Low HDL-C was found in 81/223 (36.3%) adult children. Its predictors were WC and
TG of children, low HDL-C of proband, MS and HR of consort (table).
Independent predictors of low HDL-cholesterol
Children aged 5-17 years
OR
95% CI
p
own BMI, tertile 3 (≥20.95 kg/m2) vs tertile 1 (≤17.54 kg/m2)
4.68
2.01 to 10.9
0.0003
low HDL-cholesterol of consort, yes vs no
2.46
1.07 to 5.64
0.034
own waist circumference, tertile 3 (≥83 cm) vs tertile 1 (≤73 cm)
4.68
2.01 to 10.9
0.0003
own triglycerides, mmol/l
1.56
1.03 to 2.35
0.036
low HDL-cholesterol of proband, yes vs no
2.11
1.16 to 3.83
0.014
metabolic syndrome of consort, yes vs no
4.67
2.02 to 10.8
0.0003
heart rate of consort, beats pro minute
0.93
0.88 to 0.97
0.0021
Children aged 18-38 years
CONCLUSION. In this group of different age people with parental premature CHD independent predictors of low
HDL-cholesterol were mostly own (body mass index, waist circumference, triglycerides) and parental (low HDLcholesterol, metabolic syndrome) metabolic factors.
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