Associations between low HDL, sex and cardiovascular risk markers are substantially different in sub-Saharan Africa and the UK: analysis of four population studies.
Associations between low HDL, sex and cardiovascular risk markers are substantially different in sub-Saharan Africa and the UK: analysis of four population studies.
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DOI：
10.1136/bmjgh-2021-005222
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发表时间：
2021-05
影响因子：
8.1
通讯作者：
Jones A
中科院分区：
文献类型：
--
作者：
Greiner R;Nyrienda M;Rodgers L;Asiki G;Banda L;Shields B;Hattersley A;Crampin A;Newton R;Jones A
低高密度脂蛋白（HDL）被广泛用作心血管疾病风险的标志物，尽管这种关系不是因果关系，并且可能是通过与其他危险因素的关联来介导的。高密度脂蛋白水平低在撒哈拉以南非洲人群中极为常见，这通常被解释为表明这些人群的心血管风险会增加。我们的目的是确定撒哈拉以南非洲和英国人群之间高密度脂蛋白与其他心血管危险因素之间的关联是否存在差异。我们比较了居住在乌干达和马拉维 (n=26 216) 以及英国 (n=8747) 的成年人的数据。我们检查了未调整和调整后的 HDL 水平，并应用了世界卫生组织建议的患病率估计临界值。我们使用样条和线性回归来评估 HDL 与其他心血管危险因素之间的关系。非洲人的 HDL 水平显着低于欧洲研究（几何平均值 0.9–1.2mmol/L vs 1.3–1.8mmol/L），非洲人低 HDL 患病率高达 77%。总胆固醇也显着降低（几何平均值 3.3–3.9mmol/L vs 4.6–5.4mmol/L）。与欧洲研究相比，非洲研究中HDL与肥胖（体重指数、腰臀比）之间的关系大大减弱，而与非HDL胆固醇的关系则相反：在非洲研究中，低HDL与较低的非HDL胆固醇相关。性别和 HDL 之间的关联也不同。使用世界卫生组织针对特定性别的定义，在乌干达/马拉维，低 HDL 水平在女性 (69%–77%) 中比男性 (41%–59%) 更为常见。撒哈拉以南非洲地区的 HDL 与性别、肥胖和非 HDL 胆固醇之间的关系与欧洲人群不同。在撒哈拉以南非洲地区，低 HDL 是总体胆固醇水平低的标志，并且性别差异显着减弱。因此，单独的低 HDL 不太可能表明心血管风险增加，世界卫生组织基于性别的临界值是不合适的。
Low high-density lipoprotein (HDL) is widely used as a marker of cardiovascular disease risk, although this relationship is not causal and is likely mediated through associations with other risk factors. Low HDL is extremely common in sub-Saharan African populations, and this has often been interpreted to indicate that these populations will have increased cardiovascular risk. We aimed to determine whether the association between HDL and other cardiovascular risk factors differed between populations in sub-Saharan Africa and the UK. We compared data from adults living in Uganda and Malawi (n=26 216) and in the UK (n=8747). We examined unadjusted and adjusted levels of HDL and applied the WHO recommended cut-offs for prevalence estimates. We used spline and linear regression to assess the relationship between HDL and other cardiovascular risk factors. HDL was substantially lower in the African than in the European studies (geometric mean 0.9–1.2 mmol/L vs 1.3–1.8 mmol/L), with African prevalence of low HDL as high as 77%. Total cholesterol was also substantially lower (geometric mean 3.3–3.9 mmol/L vs 4.6–5.4 mmol/L). In comparison with European studies the relationship between HDL and adiposity (body mass index, waist to hip ratio) was greatly attenuated in African studies and the relationship with non-HDL cholesterol reversed: in African studies low HDL was associated with lower non-HDL cholesterol. The association between sex and HDL was also different; using the WHO sex-specific definitions, low HDL was substantially more common among women (69%–77%) than men (41%–59%) in Uganda/Malawi. The relationship between HDL and sex, adiposity and non-HDL cholesterol in sub-Saharan Africa is different from European populations. In sub-Saharan Africans low HDL is a marker of low overall cholesterol and sex differences are markedly attenuated. Therefore low HDL in isolation is unlikely to indicate raised cardiovascular risk and the WHO sex-based cut-offs are inappropriate.