Retrospective analysis of the cholesterol levels in a European mid-latitude population between 2007 and 2018: controversies and therapeutic implications

Main Article Content

Davide Ferrari
Andrea Motta
Marta Strollo
Massimo Locatelli

Keywords

cholesterol, low-density lipoproteins, Friedewald equation, coronary heart disease

Abstract

Background and aim of the work: Coronary heart disease is the leading cause of morbidity and mortality in developed countries and its association with LDL-cholesterol has been well established. During the last decades statin therapy, and an healthy lifestyle, has proven highly effective in reducing cardiovascular event rates. Yet, there is still controversy among national guidelines and clinical practice with regard to LDL-cholesterol measurements. The aim of this study was to verify whether significant changes in cholesterol levels were observed over a relatively long (12 years) period. We also compared the Friedewald-calculated with directly-measured LDL cholesterol in order to verify whether the two methods were equivalent.


Methods: We retrospectively analyzed 288000 data (total cholesterol, HDL, LDL both directly-measured and Friedewald-calculated, and triglycerides), from 57600 individuals, collected at the San Raffaele Hospital in Milan between 2007 and 2018. Data were statistically analyzed using a linear regression over the 12 years long period of time.


Results: We observed a general decreasing trend in total cholesterol (and an increasing trend in HDL) and a decrease in triglycerides only in the male group. Directly-measured  LDL did not correlate well with calculated LDL.


Conclusion: The total cholesterol decrease and the corresponding increment in HDL was attributed to either an increased use of statin and/or an improvement of the general population dietary habits. The latter was further confirmed by the decrease in triglycerides observed in the male group. Based on our data, an alternative method for assessing atherogenics lipoproteins level has been proposed.

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References

1. Syed S. Mahmooda. The Framingham Heart Study and the Epidemiology of Cardiovascular Diseases: A Historical Perspective. 2014;383(9921):1933–45.
2. Ridker PM. LDL cholesterol: Controversies and future therapeutic directions. Lancet [Internet]. 2014;384(9943):607–17. Available from: http://dx.doi.org/10.1016/S0140-6736(14)61009-6
3. MacMahon S, Duffy S, Rodgers et al. A. Blood cholesterol and vascular mortality by age, sex, and blood pressure: A meta-analysis of individual data from 61 prospective studies with 55 000 vascular deaths. Lancet. 2007;370(9602):1829–39.
4. Ference BA, Yoo W, Alesh I, Mahajan N, Mirowska KK, Mewada A, et al. Effect of Long-Term Exposure to Lower Low-Density Lipoprotein Cholesterol Beginning Early in Life on the Risk of Coronary Heart Disease. J Am Coll Cardiol. 2012;60(25):2631–9.
5. Sacks FM, Pfeffer M a, Moye L a, Rouleau JL, Rutherford JD, Cole TG, et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. N Engl J Med [Internet]. 1996;335(14):1001–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/8801446
6. Frick MH, Elo O, Haapa K, Heinonen OP, Heinsalmi P, Helo P, et al. Helsinki Heart Study: primary-prevention trial with gemfibrozil in middle-aged men with dyslipidemia. Safety of treatment, changes in risk factors, and incidence of coronary heart disease. N Engl J Med [Internet]. 1987;317:1237–45. Available from: http://www.ncbi.nlm.nih.gov/pubmed/3313041
7. Ference BA, Yoo W, Alesh I, Mahajan N, Mirowska KK, Mewada A, et al. Effect of long-term exposure to lower low-density lipoprotein cholesterol beginning early in life on the risk of coronary heart disease: A Mendelian randomization analysis. Ration Pharmacother Cardiol. 2013;9(1):90–8.
8. Mihaylova B, Emberson J, Blackwell et al. L. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: Meta-analysis of individual data from 27 randomised trials. Lancet. 2012;380(9841):581–90.
9. Peter P. Toth MB. Statins: Then and Now. Methodist Debakey Cardiovasc J. 2019;15(1):23–31.
10. Vancheri F, Backlund L, Strender LE, Godman B, Wettermark B. Time trends in statin utilisation and coronary mortality in Western European countries. BMJ Open. 2016;6(3).
11. Rifai N, Warnick GR, McNamara JR, Belcher JD, Grinstead GF, Frantz ID. Measurement of low-density-lipoprotein cholesterol in serum: A status report. Clin Chem. 1992;38(1):150–60.
12. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem [Internet]. 1972;18(6):499–502. Available from: http://www.ncbi.nlm.nih.gov/pubmed/4337382
13. Martin SS, Blaha MJ, Elshazly MB, Brinton EA, Toth PP, McEvoy JW, et al. Friedewald-estimated versus directly measured low-density lipoprotein cholesterol and treatment implications. J Am Coll Cardiol. 2013;62(8):732–9.
14. Cordova CMM De, Schneider CR, Juttel ID, Cordova MM De. Comparison of LDL-cholesterol direct measurement with the estimate using the Friedewald formula in a sample of 10,664 patients. Arq Bras Cardiol [Internet]. 2004;83(6):482-7-81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15654445
15. Martin SS, Blaha MJ, Elshazly MB, Toth PP, Kwiterovich PO, Blumenthal RS, et al. Comparison of a novel method vs the Friedewald equation for estimating low-density lipoprotein cholesterol levels from the standard lipid profile. JAMA - J Am Med Assoc. 2013;310(19):2061–8.
16. Miller WG, Myers GL, Sakurabayashi I, Bachmann LM, Caudill SP, Dziekonski A, et al. Seven direct methods for measuring HDL and LDL cholesterol compared with ultracentrifugation reference measurement procedures. Clin Chem. 2010;56(6):977–86.
17. Fawwad A, Sabir R, Riaz M, Moin H. Measured versus calculated LDL-cholesterol in subjects with type 2 diabetes. Pakistan J Med Sci. 2016;32(4):955–60.
18. Nauck M, Warnick GR, Rifai N. Methods for measurement of LDL-cholesterol: a critical assessment of direct measurement by homogeneous assays versus calculation. Clin Chem [Internet]. 2002;48(2):236–54. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11805004
19. Evans SR, Fichtenbaum CJ, Aberg JA. Comparison of Direct and Indirect Measurement of LDL-C in HIV-Infected Individuals: ACTG 5087. HIV Clin Trials. 2007;8(1):45–52.
20. Mora S, Rifai N, Buring JE, Ridker PM. Comparison of LDL cholesterol concentrations by Friedewald calculation and direct measurement in relation to cardiovascular events in 27 331 women. Clin Chem. 2009;55(5):888–94.
21. Ferrari D, Manca M, Banfi G, Locatelli M. Alcohol and illicit drugs in drivers involved in road traffic crashes in the Milan area. A comparison with normal traffic reveals the possible inadequacy of current cut-off limits. Forensic Sci Int. 2018;282:127–32.
22. Ferrari D, Manca M, Premaschi S, Banfi G, Locatelli M. Toxicological investigation in blood samples from suspected impaired driving cases in the Milan area : Possible loss of evidence due to late blood sampling. Forensic Sci Int. 2018;288:211–7.
23. Martin S. Surprise! Women eat healthier than men. C Can Med Assoc J = J l"Association medicale Can. 2002;167(8):913.
24. Kant AK, Graubard BI. Within-person comparison of eating behaviors, time of eating, and dietary intake on days with and without breakfast: NHANES 2005-20101-3. Vol. 102, American Journal of Clinical Nutrition. 2015. p. 661–70.
25. Boekholdt MS, Arsenault BJ, Mora S, Nestel PJ, Simes RJ, Durrington P, et al. Association of LDL Cholesterol , Non – HDL Cholesterol , and Apolipoprotein B Levels With Risk of Cardiovascular Events. J Am Med Assoc. 2012;307(12):1302–9.

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