Serum Lipids and Cardiovascular Disease Mortality in Iranian Population: Joint Modeling of Longitudinal and Survival Data in Tehran Lipid and Glucose Study (TLGS) Cohort
DOI:
https://doi.org/10.31661/gmj.v8i.1516Keywords:
Cardiovascular Diseases High-Density Lipoprotein, Low-Density Lipoprotein, Survival Analysis, Longitudinal StudiesAbstract
Background: Lipid abnormalities are major risk factors of death from cardiovascular disease (CVD). As well as, lipid markers are time-dependent covariates that change with aging. Previous cohort studies have only investigated baseline measurements of lipid markers on CVD mortality. Materials and Methods: The study sample consisted of 4,148 individuals aged over 40 years. Total cholesterol (TC), LDL-cholesterol (LDL-C), and HDL-cholesterol (HDL-C) were measured in five phases. A joint model analysis was used to investigate the association between each longitudinal lipid markers and CVD mortality in men, women and pooled sample. All analysis was performed using the survival and joint modeling packages in R 3.3.3. Results: Totally, 233 CVD deaths occurred during a median follow-up of 12.4 years. For men, CVD mortality increased by 28% (confidence interval [CI]: 14%,44%) for a 10% increased in TC. For women, CVD mortality increased by 43% (CI: 22%, 68%) and 21% (CI:7%, 37%) for 10 % increase in TC and LDL-C and decreased by ‌18% (CI:7%, 27%) for a 10% increase in HDL-C. Conclusion: Association of lipid ‎markers with CVD mortality is different in men and women, such that high levels of TC ‎and ‎LDL-C and low levels of HDL-C are risk factors of CVD mortality in women, but only TC is a risk ‎factor of CVD mortality in men. [GMJ.2019;8:e1516]
References
http://ghdx.healthdata.org/gbd-results-tool Chirovsky DR, Fedirko V, Cui Y, Sazonov V, Barter P. Prospective studies on the relationship between high-density lipoprotein cholesterol and cardiovascular risk: a systematic review. European Journal of Cardiovascular Prevention & Rehabilitation. 2009;16(4):404-23. https://doi.org/10.1097/HJR.0b013e32832c8891PMid:19465856 Collaboration ERF. Major Lipids, Apolipoproteins, and Risk of Vascular Disease. Journal of Vascular Surgery. 2010;52(2):518-9. https://doi.org/10.1016/j.jvs.2010.06.085 Upmeier E, Lavonius S, Heinonen P, Viitanen M, Isoaho H, Arve S et al. Longitudinal changes in serum lipids in older people the Turku elderly study 1991-2006. Age and ageing. 2011;40(2):280-3. https://doi.org/10.1093/ageing/afq180PMid:21252037 Ghasemzadeh Z, Abdi H, Asgari S, Tohidi M, Khalili D, Valizadeh M et al. Divergent pathway of lipid profile components for cardiovascular disease and mortality events: Results of over a decade follow-up among Iranian population. Nutrition & metabolism. 2016;13(1):43. https://doi.org/10.1186/s12986-016-0102-1PMid:27346994 PMCid:PMC4919865 Kheirandish M, Asgari S, Lotfaliany M, Bozorgmanesh M, Saadat N, Tohidi M et al. Secular trends in serum lipid levels of a Middle Eastern adult population; 10 years follow up in Tehran lipid and glucose study. Lipids in health and disease. 2014;13(1):20. https://doi.org/10.1186/1476-511X-13-20PMid:24456699 PMCid:PMC3912503 Nazari SSH, Shakiba M, Khalili D, Hadaegh F, Tohidi M, Azizi F. High-density lipoprotein cholesterol, a protective or a risk factor for developing coronary heart disease? Tehran lipid and glucose study. Journal of clinical lipidology. 2015;9(4):553-8. https://doi.org/10.1016/j.jacl.2015.04.001PMid:26228673 Tohidi M, Hatami M, Hadaegh F, Safarkhani M, Harati H, Azizi F. Lipid measures for prediction of incident cardiovascular disease in diabetic and non-diabetic adults: results of the 8.6 years follow-up of a population based cohort study. Lipids in health and disease. 2010;9(1):6. https://doi.org/10.1186/1476-511X-9-6PMid:20096127 PMCid:PMC2835707 Hadaegh F, Harati H, Ghanbarian A, Azizi F. Association of total cholesterol versus other serum lipid parameters with the short-term prediction of cardiovascular outcomes: Tehran Lipid and Glucose Study. European Journal of Cardiovascular Prevention & Rehabilitation. 2006;13(4):571-7. https://doi.org/10.1097/01.hjr.0000216552.81882.caPMid:16874147 Hadaegh F, Khalili D, Ghasemi A, Tohidi M, Sheikholeslami F, Azizi F. Triglyceride/HDL-cholesterol ratio is an independent predictor for coronary heart disease in a population of Iranian men. Nutrition, Metabolism and Cardiovascular Diseases. 2009;19(6):401-8. https://doi.org/10.1016/j.numecd.2008.09.003PMid:19091534 Tohidi M, Mohebi R, Cheraghi L, Hajsheikholeslami F, Aref S, Nouri S et al. Lipid profile components and incident cerebrovascular events versus coronary heart disease; the result of 9 years follow-up in Tehran Lipid and Glucose Study. Clinical biochemistry. 2013;46(9):716-21. https://doi.org/10.1016/j.clinbiochem.2013.03.012PMid:23531403 Nejat A, Mirbolouk M, Mohebi R, Hasheminia M, Tohidi M, Saadat N et al. Changes in lipid measures and incident coronary heart disease: Tehran Lipid & Glucose Study. Clinical biochemistry. 2014;47(13-14):1239-44. https://doi.org/10.1016/j.clinbiochem.2014.03.004PMid:24657509 Christen A, Efstathiadou Z, Laspa E, Johnston DG, Godsland IF. Rate of change and instability in body mass index, insulin resistance, and lipid metabolism as predictors of atherosclerotic vascular disease. The Journal of Clinical Endocrinology & Metabolism. 2007;92(10):3780-7. https://doi.org/10.1210/jc.2006-2267PMid:17666474 Koro CE, Bowlin SJ, Stump TE, Sprecher DL, Tierney WM. The independent correlation between high-density lipoprotein cholesterol and subsequent major adverse coronary events. American heart journal. 2006;151(3):755. e1-. e6. https://doi.org/10.1016/j.ahj.2005.12.007PMid:16504648 Kreger BE, Odell PM, D'Agostino RB, Wilson PF. Long-term intraindividual cholesterol variability: natural course and adverse impact on morbidity and mortality-the Framingham Study. American heart journal. 1994;127(6):1607-14. https://doi.org/10.1016/0002-8703(94)90393-X Laitinen DL, Manthena S. Impact of change in high-density lipoprotein cholesterol from baseline on risk for major cardiovascular events. Advances in therapy. 2010;27(4):233-44. https://doi.org/10.1007/s12325-010-0019-4PMid:20437214 Azizi F, Madjid M, Rahmani M, Emami H, Mirmiran P, Hadjipour R. Tehran Lipid and Glucose Study (TLGS): rationale and design. Iranian journal of endocrinology and metabolism. 2000;2(2):77-86. Association AD. Diagnosis and classification of diabetes mellitus. Diabetes care. 2014;37(Supplement 1):S81-S90. https://doi.org/10.2337/dc14-S081PMid:24357215 Azizi F, Rahmani M, Emami H, Mirmiran P, Hajipour R, Madjid M et al. Cardiovascular risk factors in an Iranian urban population: Tehran lipid and glucose study (phase 1). Sozial-und präventivmedizin. 2002;47(6):408-26. https://doi.org/10.1007/s000380200008PMid:12643001 Ibrahim JG, Chu H, Chen LM. Basic concepts and methods for joint models of longitudinal and survival data. Journal of Clinical Oncology. 2010;28(16):2796. https://doi.org/10.1200/JCO.2009.25.0654PMid:20439643 PMCid:PMC4503792 Rizopoulos D. Joint models for longitudinal and time-to-event data: With applications in R. CRC Press; 2012. https://doi.org/10.1201/b12208 Rizopoulos D. JM: Shared Parameter Models for the Joint Modelling of Longitudinal and Time-to-Event Data. R package version 1.2-0. 2012. https://doi.org/10.1201/b12208 Tirosh A, Rudich A, Shochat T, Tekes-Manova D, Israeli E, Henkin Y et al. Changes in triglyceride levels and risk for coronary heart disease in young men. Annals of Internal Medicine. 2007;147(6):377-85. https://doi.org/10.7326/0003-4819-147-6-200709180-00007PMid:17876021 Cai J, Pajak A, Li Y, Shestov D, Davis CE, Rywik S et al. Total cholesterol and mortality in China, Poland, Russia, and the US. Ann Epidemiol. 2004;14(6):399-408. https://doi.org/10.1016/j.annepidem.2003.10.012PMid:15246328 Bae J-M, Yang Y-J, Li Z-M, Ahn Y-O. Low cholesterol is associated with mortality from cardiovascular diseases: a dynamic cohort study in Korean adults. J Korean Med Sci. 2012;27(1):58-63. https://doi.org/10.3346/jkms.2012.27.1.58PMid:22219615 PMCid:PMC3247776 Tanamas SK, Saulnier P-J, Hanson RL, Nelson RG, Hsueh W-C, Sievers ML et al. Serum lipids and mortality in an American Indian population: A longitudinal study. J Diabetes Complications. 2018;32(1):18-26. https://doi.org/10.1016/j.jdiacomp.2017.09.015PMid:29103893 Shestov DB, Deev AD, Klimov AN, Davis CE, Tyroler HA. Increased risk of coronary heart disease death in men with low total and low-density lipoprotein cholesterol in the Russian Lipid Research Clinics Prevalence Follow-up Study. Circulation. 1993;88(3):846-53. https://doi.org/10.1161/01.CIR.88.3.846PMid:8353914 Jacobs Jr DR, Mebane IL, Bangdiwala SI, Criqui MH, Tyroler HA, PROGRAM LRC. High density lipoprotein cholesterol as a predictor of cardiovascular disease mortality in men and women: the follow-up study of the Lipid Research Clinics Prevalence Study. Am J Epidemiol. 1990;131(1):32-47. https://doi.org/10.1093/oxfordjournals.aje.a115483PMid:2293751 Ravnskov U, Diamond DM, Hama R, Hamazaki T, Hammarskjöld B, Hynes N et al. Lack of an association or an inverse association between low-density-lipoprotein cholesterol and mortality in the elderly: a systematic review. BMJ open. 2016;6(6):e010401. https://doi.org/10.1136/bmjopen-2015-010401PMid:27292972 PMCid:PMC4908872 Masudi S, Yavari P, Mehrabi Y, Azizi F, Khalili D, Hadaegh F. Underestimating the effect of lipids on cardiovascular events: regression dilution bias in the population-based cohort of Tehran lipid and glucose study. International journal of endocrinology and metabolism. 2015;13(4). https://doi.org/10.5812/ijem.27528PMid:26587030 PMCid:PMC4648128 Uusitupa M, Niskanen L, Siitonen O, Voutilainen E, Pyörälä K. Ten-year cardiovascular mortality in relation to risk factors and abnormalities in lipoprotein composition in type 2 (non-insulin-dependent) diabetic and non-diabetic subjects. Diabetologia. 1993;36(11):1175-84. https://doi.org/10.1007/BF00401063PMid:8270133 Gordon DJ, Probstfield JL, Garrison RJ, Neaton JD, Castelli WP, Knoke JD et al. High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies. Circulation. 1989;79(1):8-15. https://doi.org/10.1161/01.CIR.79.1.8PMid:2642759