Indian Journal of Clinical Biochemistry

, Volume 24, Issue 4, pp 343–355 | Cite as

Reference intervals for serum total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, Lp (a), apolipoprotein A-I, A-II, B, C-II, C-III, and E in healthy South Indians from Andhra Pradesh

Original Article

Abstract

The incidence of cardiovascular and cerebrovascular disease is steadily increasing in South East Asian countries including Indian sub continent. Many lipids, apolipoproteins and Lp (a) except HDL-C and apo A-I, A-II are implicated as risk factors for coronary artery disease and cerebrovascular disease. There is great need to have national guidelines for each country like the ATP III guidelines recommended for U.S. population. For recommending appropriate medical decision limits, it is mandatory that each country establishes reference intervals pertaining to their population due to dietary, genetic and environmental diversity. In the present study, reference intervals for serum lipids, apolipoproteins and Lp (a) were established in a total of 1923 healthy Indian reference individuals comprising 1161 healthy men and 762 healthy women from Andhra Pradesh. For each analyte viz., serum total cholesterol, HDL-C, LDL-C, triglycerides, Lp (a), Apo A-I, Apo A-II, B, C-II, C-III and E, mean, two SD, median, confidence limits of mean, different percentile values are presented. The study also includes decade wise changes in each analyte and comparison of lipids, lipoproteins and Lp (a) among few populations covering U.S., India, Japan, Sweden, Finland and China. Reference Intervals for all lipid and lipoprotein parameters will immensely help in assessing associated risk for cardiovascular and cerebrovascular diseases in India. Additionally, the results will be beneficial in formulating our own guidelines pertaining to Indian population.

Key Words

Blood Lipids Cholesterol Triglycerides Apolipoproteins Reference Intervals South Indian Population 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Tunstall-Pedoe H, Kuulsmaa K, Amouyel P, Arveiler D, Rajakangas AM, Pajak A. Myocardial infraction and coronary deaths in the world Health Organization MONICA Project: Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 1994; 90: 583–612.PubMedGoogle Scholar
  2. 2.
    O’Flaherty, Ford E, Allender S, Scarborough P, Capewell S. Coronary heart disease trends in England and Wales from 1984 to 2004: concealed leveling of mortality rates among young adults. Heart 2008; 94: 178–181.CrossRefPubMedGoogle Scholar
  3. 3.
    Marmot MG, Syme SL, Kagar A, Kato H, Cohen JB, Belsky J. Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: Prevalence of coronary and hypertensive heart disease and associated risk factors. Am J Epidemiol 1975; 102: 514–525.PubMedGoogle Scholar
  4. 4.
    Howard BV, Lee ET, Cowan LD, Fabsitz RR, Howard WJ, Oopik AJ, Robbins DC, Savage PJ, Yeh JL, Welty TK. Coronary heart disease prevalence and its relation to risk factors in American Indians: the strong heart study. Am J Cardiol 1996; 78: 1400–1405.CrossRefPubMedGoogle Scholar
  5. 5.
    Bhopal R, Unwin N, White M, Yallop J, Walker L, Alberti KGMM, et al. Heterogeneity of coronary heart disease risk factors in Indian Pakistani, Bangladeshi and European origin populations: cross sectional study. Brit Med J 1999; 319: 215–220.PubMedGoogle Scholar
  6. 6.
    British Heart Foundation. Coronary heart disease statistics. London: British Heart Foundation, 2007Google Scholar
  7. 7.
    Berenson GS, Srinivasan SR, Bao W, Newman WP III, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Eng J Med 1998; 338: 1650–1656.CrossRefGoogle Scholar
  8. 8.
    Mc Gill HC Jr, Mc Mahan CA, Malcolm GT, Oilman MC, Strong JP. Effects of serum lipoprotein and smoking on arthrosclerosis in young men and women. Arterioscleroses Thromb Vasc Biol 1997; 17: 95–106.Google Scholar
  9. 9.
    Stamler J, Daviglus ML, Garside DB, Dyer AR, Greenland P, Neaton JA. Relationship of baseline serum cholesterol levels in three large cohorts of younger men to coronary, cardiovascular and all cause mortality and to longevity. JAMA 2000; 284: 311–318.CrossRefPubMedGoogle Scholar
  10. 10.
    Strong JP, Malcom GT, Mc Mahan CA, Tracy RE, Newman WP III, Hedrick EE, Cornhill JF. Prevalence and extent of atherosclerosis in adolescents and young adults’ implications for prevention from pathobiological determinants of atherosclerosis in youth study. JAMA 1999 281: 727–735.CrossRefPubMedGoogle Scholar
  11. 11.
    Austin MA, McKnight B, Edwards KL, Bradley CM, McNeely MJ, Psaty BM, Brunzell JD, Motulsky AC. Cardiovascular disease mortality in familial forms of hypertriglyceridemia: a 20 year prospective study. Circulation 2000; 101: 2777–2782.PubMedGoogle Scholar
  12. 12.
    Ingelsson E, Schaefer EJ, Contois JH, McNamara JR, Sullivan L, Keyes MJ, Pencina MJ, Schoonmaker C, Wilson PW, D’Agostino RB, Vasan RS. Lipid measures for prediction of coronary heart disease in men and women. JAMA 2007; 298: 776–785.CrossRefPubMedGoogle Scholar
  13. 13.
    Cutri BA, Hime NJ, Nicholls SJ. High-density lipoproteins: an emerging target in the prevention of cardiovascular disease. Cell research 2006; 16: 799–808.CrossRefPubMedGoogle Scholar
  14. 14.
    Chien KL, Hsu HC, Su TC, Sung FC, Chen MF, Lee YT. Lipoprotein (a) and Cardiovascular Disease in Ethnic Chinese: The Chin-Shan Community Cardiovascular Cohort Study. Clin Chem 2008; 54: 285–291.CrossRefPubMedGoogle Scholar
  15. 15.
    Chopra V, Wasir HS. Implications of lipoprotein abnormalities in Indian patients. J Assoc Physicians India 1998; 46: 814–818.PubMedGoogle Scholar
  16. 16.
    Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Minhas R, Sheikh A, Brindle P. Predicting Cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. Brit Med J 2008; 336: 1475–1482.CrossRefPubMedGoogle Scholar
  17. 17.
    Grundy SM, Parternak R, Greenland P, Smith S Jr, Fustex V. Assessment of cardiovascular risk by use of multiple risk factor assessment equation: a statement for health care professional from the American Heart Association and the American College of Cardiology. Circulation 1999; 100: 1481–1492.PubMedGoogle Scholar
  18. 18.
    Misra A, Luthra K, Vikram NK. Dyslipidemia in Asian Indians: determinants and significance. JAPI 2004; 52: 137–142.PubMedGoogle Scholar
  19. 19.
    O’Connor PJ, Gary RJ, Maciosek MV, Fillbrandt KM, DeFor TA, Alexander CM, Weiss TW, Teutsch SM. Cholesterol Levels and Statin Use in Patients with Coronary Heart Disease treated in Primary Care settings (CDC Original research document), Preventing Chronic Disease, Public Health Research, Practice and policy 2005; 2: 1–17.Google Scholar
  20. 20.
    Rifai N, Warnick GR. Lipids, lipoproteins, Apolipoproteins, and other cardiovascular risk factors. In Burtis CA Ashwood ER Bruns DE eds. Tietz Textbook of clinical Chemistry and Molecular Diagnostics 4th Ed 2006; 903–981. Elsevier Saunders.Google Scholar
  21. 21.
    Bennet AM, Angelantonio ED, Ye Z, Wensley F, Dahlin A, Ahlbom A, Keavney B, Collins R, Wiman B, Faire de U, Danesh J. Association of apolipoprotein E genotypes with lipid levels and coronary risk. JAMA 2007; 298: 1300–1311.CrossRefPubMedGoogle Scholar
  22. 22.
    Kottke BA, Zinsmeister AR, Holmes DR, Kneller RW, Hallaway BJ, Mao SJT. Apolipoproteins and Coronary Artery Disease, Mayo Clinic proceedings 1986; 61: 313–320.PubMedGoogle Scholar
  23. 23.
    Lamarche B, Moorjani S, Lupien PJ, Cantin B, Bernard PM, Dagenais GR, Despres JP. Apolipoprotein A1 and B levels and the risk of ischemic heart disease during a five year follow up of men in Quebec cardiovascular study. Circulation 1996; 94: 273–278.PubMedGoogle Scholar
  24. 24.
    Suzuki M, Wada H, Maeda S, Saito K, Minatoguchi S, Saito K, Seishima M. Increased Plasma Lipid-Poor Apolipoprotein A-I in Patients with Coronary Artery Disease. Clin Chem 2005; 51: 132–137.CrossRefPubMedGoogle Scholar
  25. 25.
    Tilly P, Sass C, Vincent-Viry M, Aguillon D, Siest G, Visvikis S. Biological and genetic determinants of serum Apo C-III concentration: reference limits from the Stanislas cohort. J Lipid Res 2003; 44: 430–436.CrossRefPubMedGoogle Scholar
  26. 26.
    Walldius G, Jungner I, Holme I, Aastveit A H, Kolar W, Steiner E. High Apolipoprotein B, low Apolipoprotein A-I, and improvement in the prediction of fatal myocardial infarction (AMORIS study): a prospective study. Lancet 2001; 358: 2026–2033.CrossRefPubMedGoogle Scholar
  27. 27.
    Rahmani M, Raiszadeh F, Allahverdian S, Kiaii S, Navab M, Azizi F. Coronary artery disease is associated with the ratio of apolipoprotein A-I/B and serum concentration of apolipoprotein B, but not with paraoxonase enzyme activity in Iranian subjects. Atherosclerosis 2002; 162: 381–389.CrossRefPubMedGoogle Scholar
  28. 28.
    Fulwood R, Kalsbeek W, Rifkind B. National Center for Health Statistics, Total serum cholesterol levels of adults 20–74 years of age; United States, 1976–80 Vital and Health Statistics. Series11. no. 236 DHHS Pub No (PHS) 86-1686 Public Health Service, Washington U.S. Government Printing Office, May 1986;pp 59.Google Scholar
  29. 29.
    Kronmal RA, Cain RC, Ye Z, Omenn GS. Total serum Cholesterol levels and mortality risk as a function of age. Arch Intern Med 1993; 153: 1065–1073.CrossRefPubMedGoogle Scholar
  30. 30.
    Kastelein JJP, Akim F, Stroes ESG. Effect of the Combination of Ezetimibe and Simvastatin versus Monotherapy Simvastatin on Arterial Intima-Media Thickness in Familial Hypercholesterolemia (ENHANCE): a randomized controlled trial. N Engl J Med 2008; 358: 1431–1443.CrossRefPubMedGoogle Scholar
  31. 31.
    Pekkanen J, Lenn S, Heiss G, Suchindran CM, Leon A, Rifkind BM, Tyroler HA. Ten year mortality from cardiovascular in relation to cholesterol level among men with and without preexisting cardiovascular disease. N Engl J Med 1990; 322: 1700–1707.PubMedCrossRefGoogle Scholar
  32. 32.
    Saddlemire AE, Denny CH, Greenlund KJ, Coolidge JN, Fan AZ, Croft JB. Trends in Cholesterol Screening and Awareness of High Blood Cholesterol — United States, 1991–2003. CDC Mortality and Morbidity weekly report 2005; 54: 865–870.Google Scholar
  33. 33.
    Bansal S, Buring JE, Rafai N, Samia M, Sacks FM, Ridker PM. Fasting compared with nonfasting Triglycerides and risk of Cardiovascular events in women. JAMA 2007; 298: 309–316.CrossRefPubMedGoogle Scholar
  34. 34.
    Iso H, Naito Y, Sato S, Kitamura A, Okamura T, Sankai T. Serum triglycerides and risk of coronary heart disease among Japanese men and women. Am J Epidemiol 2001; 153: 490–499.CrossRefPubMedGoogle Scholar
  35. 35.
    McBride PR. Triglycerides and risk for coronary heart disease. JAMA 2007; 298: 336–338.CrossRefPubMedGoogle Scholar
  36. 36.
    Warnick RG, Nakajima K. Fasting versus Nonfasting Triglycerides: Implications for Laboratory Measurements. Clin Chem 2008; 54: 14–16.CrossRefPubMedGoogle Scholar
  37. 37.
    Sacks FM, Alaupovic P, Moye LA, Cole TG, Sussex B, Stampfer MJ, Pfeffer, Braunwald E. VLDL, Apolipoprotein B, CIII and E. Risk of recurrent coronary events in the cholesterol and recurrent events (CARE) trial. Circulation 2000; 102: 1886–1892.PubMedGoogle Scholar
  38. 38.
    Bennet AM, Angelantonio E Di, Erqou S, Eiriksdottir G (Gudny), Sigurdsson G, Woodward M, Rumley A, Lowe GD, Danesh J, Gudnason V. Lipoprotein(a) Levels and Risk of Future Coronary Heart Disease: Large-Scale Prospective Data. Arch Intern Med 2008; 168: 598–608.CrossRefPubMedGoogle Scholar
  39. 39.
    Gaw A, Murray HM, Brown EA, the PROSPER study group. Plasma lipoprotein (a) [Lp (a)] concentrations and cardiovascular events in the elderly: evidence from the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER). Atherosclerosis 2005180: 381–388.CrossRefPubMedGoogle Scholar
  40. 40.
    Ohira T, Schreiner PJ, Morrisett JD, Chambless LE, Rosamond WD, Folsom AR. Lipoprotein (a) and incident ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) study. Stroke 2006; 37: 1407–1412.CrossRefPubMedGoogle Scholar
  41. 41.
    Smolders B, Lemmens R, Thijs V. Lipoprotein (a) and Stroke A Meta-Analysis of Observational Studies. Stroke 2007; 38: 1959–1966.CrossRefPubMedGoogle Scholar
  42. 42.
    Singh IM, Shishehbor MH, Ansell BJ. High-density lipoprotein as a therapeutic target: a systematic review: JAMA 2007; 298: 786–798.CrossRefPubMedGoogle Scholar
  43. 43.
    Frohlich J, Fodor G, McPherson R, Genest J, Langner N. Dyslipidemia working group of health Canada. Rationale for and outline of the recommendations of the working group on hypercholesterolemia and other dyslipidemias. Interim report. Can J Cardiol 1998; 14(suppl): 17A–21A.PubMedGoogle Scholar
  44. 44.
    Hata Y, Mabuchi H, Saito Y, Itakura H, Egusa G, Ito H, Teramoto T, Tsushima M, Tada N, Oikawa S, Yamada N, Yamashita S, Sakuma N, Sasaki J. Report of the Japan Atherosclerosis Society (JAS) Guideline for Diagnosis and Treatment of Hyperlipidemia in Japanese Adults. J Atherosclerosis and Thrombosis 1998; 9: 1–27.Google Scholar
  45. 45.
    O’Connor PJ. Public health research, practice and policy cent. Preventing Chronic Diseases. CDC document 2005; 2: 3–13.Google Scholar
  46. 46.
    Prevention of coronary heart disease: Scientific background and new clinical guidelines. Recommendations of the European Atherosclerosis Society prepared by the International Task Fore for Prevention of Coronary Heart disease. Nutr Metab Cardiovas Dis 1992; 2: 113–156.Google Scholar
  47. 47.
    The Expert Panel report of the National Cholesterol Education Programme, Expert Panel on detection, Evaluation and Treatment of high blood cholesterol in adults. Arch Intern Med 1988; 148: 36–39.CrossRefGoogle Scholar
  48. 48.
    National Cholesterol Education Program Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II). JAMA 1993; 269: 3015–3023.CrossRefGoogle Scholar
  49. 49.
    National Cholesterol Education Program Second Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood cholesterol in Adults (Adult treatment Panel II). Circulation 1994; 89: 1333–1445.Google Scholar
  50. 50.
    Bachorik PS, Ross JW, for the national Cholesterol Education Program Working Group on Lipoprotein Measurement. National Cholesterol Education Program recommendations for measurement of low-density lipoprotein cholesterol: executive summary. Clin Chem 1995; 41: 1414–1420.PubMedGoogle Scholar
  51. 51.
    Warnick RG, Wood PD, for the National Cholesterol Education Program Working Group on Lipoprotein Measurement. National cholesterol Education Program recommendations for measurement of High density lipoprotein cholesterol: executive summary. Clin Chem 1995; 41: 1427–1433.PubMedGoogle Scholar
  52. 52.
    Stein EA, for the National Cholesterol Education Program Working Group on Lipoprotein Measurement. National Cholesterol Education Program recommendations for Triglycerides measurement: executive summary. Clin Chem 1995; 41: 1421–1426.PubMedGoogle Scholar
  53. 53.
    National Cholesterol Education Program Expert Panel, Executive summary of the third report of the NCEP expert panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486–2497 and NIM publication, Bethesda; MD: National Heart, Lung and Blood Institute, 2001.CrossRefGoogle Scholar
  54. 54.
    Warnick GR, Myers GL, Cooper GR, Rifai N. Impact of the Third Cholesterol Report from the Adult Treatment Panel of the National Cholesterol Education Program on the Clinical Laboratory. Clin Chem 2002; 48: 11–17.PubMedGoogle Scholar
  55. 55.
    Patel K, Bhopal R. The epidemic of coronary heart disease in South Asian populations: causes and consequences. Birmingham: South Asian Health Foundation 2004;164.Google Scholar
  56. 56.
    D’Agostino RB Sr. Vasan RS, Pencina MJ, Wolf PA, Cobain M, Massaro JM, et al. General cardiovascular risk profile for use in primary care: the Framingham heart study. Circulation 2008; 117: 743–753.CrossRefPubMedGoogle Scholar
  57. 57.
    Ashavaid TF, Kondkar AA, Todur SP, Dherai AJ, Morey J, Raghavan R. Lipids, lipoporteins, Apolipoprotein and Lipoprotein (a) levels: reference intervals in a Healthy Indian Population. J Atheroscl Thromb 2005; 12: 251–259.Google Scholar
  58. 58.
    Reddy KS, Prabhakaran D, Chaturvedi V, Jeemon P, Thankappan KR, Ramakrishnan L, et al. Methods for establishing a surveillance system for cardiovascular diseases in Indian industrial populations. Bulletin of the World Health Organization 2006; 84: 461–467.CrossRefPubMedGoogle Scholar
  59. 59.
    Carroll M, Sempos C, Briefel R. Serum lipids of adults 20-74 years, United States, 1976–80, National Center for health Statistics. Vital Health Stat 1993; 11(2242).Google Scholar
  60. 60.
    Li J, Wang J, Li P, Niu Q, Wang S, Jiang L. The investigation of serum lipids and lipoproteins in Beijing (Chinese). Chin Med J 1988; 68: 327–331.Google Scholar
  61. 61.
    Li Z, Yang R, Xu G, Xia T. Serum Lipid Concentrations and Prevalence of Dyslipidemia in a Large Professional Population in Beijing. Clin Chem 2005; 51(1): 144–150.CrossRefPubMedGoogle Scholar
  62. 62.
    Noma A, Hata Y, Goto Y. Quantitation of serum Apolipoprotein A-1, A-II, B, C-II, C-III and E in healthy Japanese by turbidimetric immunoassay: reference values and age — and sex related differences. Clin Chim Acta 1991; 199: 147–158.CrossRefPubMedGoogle Scholar
  63. 63.
    Sakurabayashi I, Saito Y, Kita T, Matsuzawa Y, Goto Y. Reference intervals for serum apolipoproteins A-I, A-II, B, C-II, C-III, and E in healthy Japanese determined with a commercial immunoturbidimetric assay and effects of sex, age, smoking, drinking, and Lp(a) level. Clin Chim Acta 2001; 312: 87–95.CrossRefPubMedGoogle Scholar
  64. 64.
    Sekimoto H, Goto Y, Goto Y, Naito C, Yasugi T, Okido M, et al. Changes of serum total cholesterol and triglyceride levels in normal subjects in Japan in the past twenty years. Jpn Circ J 1983; 47: 1351–1358.PubMedGoogle Scholar
  65. 65.
    Wang S, Man Y, Li H, Dong J, Tang W, Guo H. Changes in serum total cholesterol levels of Beijing professional population during 1981–2001 (Chinese). Chin J Arterioscler 2003; 11: 435–438.Google Scholar
  66. 66.
    Pajak A, Williams OD, Broda G, Baczynska E, Rywik S, Davis CE, et al. Changes over time in blood lipids and their correlates in Polish rural and urban populations: the Poland-United States Collaborative Study in cardiopulmonary disease epidemiology. Ann Epidemiol 1997; 7: 115–124.CrossRefPubMedGoogle Scholar
  67. 67.
    Ichihara K, Itoh Y, Lam CWK, Poon PMK, Kim JH, Kyono H, Chandrawening N, Muliaty D. Sources of variation for commonly measured serum analytes among 6 Asian cities and consideration of common reference intervals. (Science committee for the Asian Pacific Federation of Clinical Biochemistry). Clin Chem 2008; 54: 356–365.CrossRefPubMedGoogle Scholar
  68. 68.
    Okayama A, Ueshima H, Marmot MG, Elliott P, Yamakawa M, Kita Y. Different trends in serum cholesterol levels among rural and urban populations aged 40–59 in Japan from 1960 to 1990. J Clin Epidemiol 1995; 48: 329–337.CrossRefPubMedGoogle Scholar
  69. 69.
    Contois JH, McNamara JR, Lammi-Keefe CJ, Wilson PW, Masov T, Schaefer EJ. Reference intervals for plasma Apolipoprotein A-I determined with a standardized commercial immunoturbidimetric assay: results from the Framingham Offspring Study. Clin Chem 1996; 42: 507–514.PubMedGoogle Scholar
  70. 70.
    Contois JH, McNamara JR, Lammi-Keefe CJ, Wilson PW, Masov T, Schaefer EJ. Reference intervals for plasma Apolipoprotein B determined with a standardized commercial immunoturbidimetric assay: results from the Framingham Offspring Study. Clin Chem 1996; 42: 515–523.PubMedGoogle Scholar
  71. 71.
    Leino A, Impivaara O, Kaitsaari M, Jarvisalo J. Serum concentrations of apolipoprotein A-I, apolipoprotein B, and lipoprotein (a) in a population sample. Clin Chem 1995; 41: 1633–1636.PubMedGoogle Scholar
  72. 72.
    Jungner I, Marcovina SM, Walldius G, Holme I, Kolar W, Steiner E. Apolipoprotein B and A-I values in 147,576 Swedish males and females, standardized according to the World Health Organization-International Federation of Clinical Chemistry First International Reference Materials. Clin Chem 1998; 44: 164.Google Scholar

Copyright information

© Association of Clinical Biochemists of India 2009

Authors and Affiliations

  1. 1.Department of BiochemistryNizam’s Institute of Medical SciencesHyderabadIndia
  2. 2.Department of BiochemistryNizam’s Institute of Medical SciencesPunjagutta, HyderabadIndia

Personalised recommendations