Prevalence of plasma lipid abnormalities and associated risk factors among Iranian adults based on the findings from STEPs survey 2021

Abstract

The study aimed to estimate the prevalence of lipid abnormalities in Iranian adults by demographic characterization, geographical distribution, and associated risk factors using national and sub-national representative samples of the STEPs 2021 survey in Iran. In this population-based household survey, a total of 18,119 individuals aged over 25 years provided blood samples for biochemical analysis. Dyslipidemia was defined by the presence of at least one of the lipid abnormalities of hypertriglyceridemia (≥ 150 mg/dL), hypercholesterolemia (≥ 200 mg/dL), high LDL-C (≥ 130 mg/dL), and low HDL-C (< 50 mg/dL in women, < 40 mg/dL in men), or self-reported use of lipid-lowering medications. Mixed dyslipidemia was characterized as the coexistence of high LDL-C with at least one of the hypertriglyceridemia and low HDL-C. The prevalence of each lipid abnormality was determined by each population strata, and the determinants of abnormal lipid levels were identified using a multiple logistic regression model. The prevalence was 39.7% for hypertriglyceridemia, 21.2% for hypercholesterolemia, 16.4% for high LDL-C, 68.4% for low HDL-C, and 81.0% for dyslipidemia. Hypercholesterolemia and low HDL-C were more prevalent in women, and hypertriglyceridemia was more prevalent in men. The prevalence of dyslipidemia was higher in women (OR = 1.8), obese (OR = 2.8) and overweight (OR = 2.3) persons, those residents in urban areas (OR = 1.1), those with inappropriate physical activity (OR = 1.2), patients with diabetes (OR = 2.7) and hypertension (OR = 1.9), and participants with a history (OR = 1.6) or familial history of CVDs (OR = 1.2). Mixed dyslipidemia prevalence was 13.6% in women and 11.4% in men (P < 0.05). The prevalence of lipid abnormalities was highly heterogeneous among provinces, and East Azarbaijan with 85.3% (81.5–89.1) and Golestan with 68.5% (64.8–72.2) had the highest and lowest prevalence of dyslipidemia, respectively. Although the prevalence of high cholesterol and LDL-C had a descending trend in the 2016–2021 period, the prevalence of dyslipidemia remained unchanged. There are modifiable risk factors associated with dyslipidemia that can be targeted by the primary healthcare system. To modify these risk factors and promote metabolic health in the country, action plans should come to action through a multi-sectoral and collaborative approach.

Epidemiology and Prevalence of Dyslipidemia Among Adult Population of Tehran: The Tehran Cohort Study

“…The WHO STEPS national survey results in 2021 concluded that 81.0% of the Iranian population (aged ≥ 25 years) had dyslipidemia. 8 Their finding indicated that low HDL-C (68.4%) was the most prevalent lipid abnormality, followed by hypertriglyceridemia (39.7%), hypercholesterolemia (21.2%), and high LDL-C (16.4%). Meanwhile, a meta-analysis of population-based studies from 1994 to 2015 estimated the prevalence of hypercholesterolemia at 42%, high LDL-C at 40%, and low HDL-C at 42%.…”

“… 21 Therefore, Tehran has a higher prevalence of dyslipidemia which can be possibly attributed to air pollution, a sedentary lifestyle, and unhealthy dietary habits compared to less populated provinces such as Golestan (68.5%), Kerman (74.1%), Mazandaran (76.6%), and Semnan (76.8%). 8 However, more studies are warranted to find evidence between the following risk factors and dyslipidemia. 22 , 23 A previous study has demonstrated a favorable trend in reducing TC and non-HDL-C from 1999 to 2011 in Tehran; however, it was limited due to the small sample size and single-district sampling.…”

“…Our results showed that one out of three adult residents of Tehran has hypertriglyceridemia, which is higher than the rest of the country. 8 , 25 Nonetheless, the latest WHO STEPS survey showed a high prevalence of hypertriglyceridemia in men who live in Tehran, while the prevalence was higher in women who lived in other cities. 8 Similarly, we have observed a significantly higher prevalence of hypertriglyceridemia in men; this difference has more than doubled in individuals aged 35-44 and decreased with advancing age.…”

“… 8 , 25 Nonetheless, the latest WHO STEPS survey showed a high prevalence of hypertriglyceridemia in men who live in Tehran, while the prevalence was higher in women who lived in other cities. 8 Similarly, we have observed a significantly higher prevalence of hypertriglyceridemia in men; this difference has more than doubled in individuals aged 35-44 and decreased with advancing age. Previous studies have reported a steady trend in the prevalence of hypertriglyceridemia from 1999 to 2011 in Tehran, but now it has diminished by 9.6% since 2011, considering the same cut-off value.…”

“…7 A nationwide survey in 2021 found that about 81% of the Iranian adult population had at least one lipid abnormality, and several studies have reported different rates of dyslipidemia across various regions of the country. [8][9][10][11] Previous epidemiological studies in Tehran were limited by district-level samplings, and small sample sizes, with uncertainties regarding the current prevalence of dyslipidemia rates in Tehran. [12][13][14] Nevertheless, the current understanding of dyslipidemia prevalence in Tehran remains limited, particularly across its diverse districts and among different age and sex groups.…”