Abstract
Background
Serum lipid profile abnormalities are major predictors for coronary artery diseases. The relationship between demographic factors and dyslipidemia in Ethiopia is not completely explored. Thus, this study aimed to assess the prevalence and predictors of dyslipidemia among hypertensive patients in Lumame Primary Hospital.
Methods
A cross-sectional study was conducted from June to August 30, 2020, on the hypertensive patients in Lumame Primary Hospital. All adult hypertensive patients who visited the adult hypertensive care services during the study period were included. Interview-guided self-administered questionnaire and a chart review were used for data collection. Statistical Package for the Social Sciences (SPSS) software version 24.0 was used for data analysis.
Results
Out of 372 hypertensive patients, 190(51.1%) were females and the mean age of the study participants was 43.56 years (SD ± 4.31). The overall prevalence of dyslipidemia in this study was 48.4%. Besides the overall prevalence, the prevalence of TC, TG, LDL-c, and HDL-c was 73(19.6%), 91(24.5%), 60(16.1%), and 115(30.9%), respectively. Females were at higher risk for having high levels of TC (AOR = 2.31, 95% CI = 1.54–3.13), TG (AOR = 1.70, 95% CI = 1.34–3.79), LDL-c (AOR = 2.15, 95% CI = 1.56–2.86), and HDL-c (AOR = 2.67, 95% CI = 1.44–5.67) than males. Respondents who were from urban were at higher risk for having high levels of TC (AOR = 1.98, 95% CI = 1.04–6.83), TG (AOR = 1.78, 95% CI = 1.09–2.86), LDL-c (AOR = 3.01, 95% CI = 1.45–7.43), and HDL-c (AOR = 2.01, 95% CI = 1.94–4.55) than respondents who were from rural. Similarly, obese respondents were at higher risk for having high levels of TC (AOR = 2.03, 95% CI = 1.64–2.00), TG (AOR = 3.78, 95% CI = 1.06–6.42), LDL-c (AOR = 1.92, 95% CI = 1.66–2.12), and HDL-c (AOR = 4.23, 95% CI = 2.84–4.32) than to respondents who were underweight.
Conclusion
The prevalence of dyslipidemia among hypertensive patients was high. Independent variables such as age, gender, residence, family history of HTN, smoking, alcohol drinking, fruit diet habits, physical activity, DM, and BMI were significant determinants of dyslipidemia.
Keywords: Dyslipidemia, Risk factors, Prevalence, Hypertension, Lumame, Ethiopia
1. Background
Dyslipidemia is an increment of plasma triglycerides, cholesterol, or both, or a high low-density lipoprotein or low high-density lipoprotein levels that contributes to the development of atherosclerosis [1]. It is the most important risk factor for many chronic non-communicable diseases resulting in morbidity, and mortality, and medical costs globally [[2], [3], [4]]. With the development of the economy and improvement of living standards, more and more people suffer from atherosclerotic cardiovascular diseases which constitute the leading cause of death [5]. Elevated blood cholesterol levels are related to an increased risk of cardiovascular events like coronary heart disease, thereby serving as contributors to this process. The cholesterol abnormalities on coronary heart disease risk are raised if other risk factors such as obesity are concurrently occurred [3,6].
Increased serum lipid level was found to be a predictor for the first coronary event and predictive of recurrent events [[7], [8], [9]]. Therefore, the prevention and control of dyslipidemia particularly in adult populations have a significant role in reducing coronary events. Although the benefits of lipid-lowering therapy have been demonstrated most conclusively in persons with cardiovascular disease, lipid-lowering therapy is effective even in persons without the clinically apparent cardiovascular disease [10]. The NCEP ATP reports have been developed to provide healthcare professionals with recommendations pertinent to detecting and managing dyslipidemia [11]. The overall prevalence of dyslipidemia was 25.5% in African general adult population. The individual prevalence of TC, TG, HDL-c, and LDL-c was 25.5%, 17.0%, 19.5%, and 21.4%, respectively [12]. A study conducted in Eastern Ethiopia revealed that drinking coffee, vegetable intake, increased age, and elevated FBG were the independent predictors of dyslipidemia [13].
Patients with increased serum lipide levels have a higher-than-expected incidence of HTN, and those with HTN have a higher-than-expected incidence of raised serum lipide levels [[14], [15], [16]]. The number of cardiovascular disease cases has quickly increased worldwide. This is supposed due to various factors such as lifestyle changes, ageing, urbanization, and rapid socio-economic development [[17], [18], [19]]. The prevalence of cardiovascular disease in Saudi Arabia was found to be 5% [18]. Although cardiovascular disease risks such as dyslipidemia have been investigated in many countries, studies regarding the prevalence and risk factors of dyslipidemia in Ethiopia are still limited. For instance, even though cardiovascular disease is a common problem, there are inadequate understanding of the associated factors for dyslipidemia and cardiovascular disease risks [17,[20], [21], [22], [23]]. Thus, this study aimed to estimate the prevalence and predictors of dyslipidemia among hypertensive patients in Lumame Primary Hospital.
2. Methods
2.1. Study setting, design, and period
A cross-sectional study was conducted from June to August 30, 2020, in the hypertensive care service of Lumame Primary Hospital, located in East Gojjam zone, Ethiopia, 302 km far from Addis Ababa Lumame Primary Hospital serves more than 151,065 people of the East Gojjam zone and the people around the neighboring zones. In the referral hospital, there are different care services among which the hypertensive care services is the one serving for follow up and treatment of patients with HTN.
2.2. Study participants and sample size determination
All adult hypertensive patients (age ≥18 years) who visited the hypertension care services of Lumame Primary Hospital through the study period were included. Single population proportion formula was used with the assumption of 95% CI, 5% margin of error, the prevalence (p) of dyslipidemia among African adults (25.5%), and 10% for possible non-response to determine a final adjusted sample size of 321. However, to increase the power of the study, the sample size was extended to 372. Simple random sampling technique was used to select study participants by using adult hypertensive care services of Lumame Primary Hospital appointment list as a sampling frame.
2.3. Inclusion and exclusion criteria
Inclusion criteria were the following: adult hypertensive patients (age ≥18 years) who visited the hypertension care services of Lumame Primary Hospital through the study period, no changes in drug therapy in the previous 3 months, a full lipid profile [total cholesterol (TC), high-density lipoprotein cholesterol (HDLc), low-density lipoprotein (LDLc), and triglycerides (TG)] both performed within the previous month, and valid ambulatory BP monitoring were included in the study. However, changes in drug therapy in the previous 3 months, pregnant women, incomplete lipid profile, and participants with mental problems were excluded from the study.
2.4. Data collection quality control
For quality assurance, the principal investigator was continuously supervising the data collectors for completeness and consistency and the records were cross-checked. The training was given for data collectors and supervisors. The data collection was supervised daily and it was pretested on 10% of the sample size. Based on the findings of the pre-test, some questions were modified and some others were added. The data extracted for the pre-test was not included in the main analysis.
2.5. Data collection and measurement
The data collectors were appropriately skilled in the data collection tool before data collection. Several published articles were reviewed to prepare the data collection tool [24], [25], [26]. An interview-directed self-administered questionnaire and a chart review were used for data collection. Hypertensive patients who were unable to write and read were interviewed. The questionnaire includes socio-demographic characteristics and the clinical status of the patients. Lipid abnormalities were calculated according to NCEP ATP III [27], as TC > 200, TG > 150, LDL >130 mg/dL, and HDL<40. During data gathering, trained health professionals were recruited and supervised by the principal investigator. Finally, the completeness and fulfillment of all questions were checked by the principal investigator and data collectors.
2.6. Data analysis
Statistical Package for the Social Sciences (SPSS) software version 24.0 was used for data analysis. Descriptive statistics like, frequency, percentage, mean, standard deviation, and median were used for data presentation. Univariate and multivariate logistic regression was computed to identify associated factors with a 95% confidence interval using a p-value <0.05 as a cutoff point.
3. Results
3.1. Prevalence of dyslipidemia according to respondent's demographics
A total of 372 respondents participated in the survey. The mean age of the participants was 43.56 years (SD ± 4.31). Half 190(51.1%) of the respondents were female and 190(51.1%) of them were married. The majority of the respondents 259(69.6%), were Orthodox Christian followers and the majority of the participants were permanent residents of urban areas 208(55.9%). Concerning parents’ educational level, 120(32.3%) were Illiterate and 158(42.5%) of them were self-employed. The prevalence of dyslipidemia among hypertensive patients in the socio-demographic characteristics was reported in Table 1. The overall prevalence of all types of dyslipidemia was ranged from about 16.1% to 30.9%. Prevalence of dyslipidemia according to age, gender, marital status, residence, religion, occupation, educational level, and monthly income was found to be 73(19.6%), 91(24.5%), 60(16.1%), and 115(30.9%), respectively for TC, TG, LDL-c, and HDL-c Table 1.
Table 1.
Prevalence of dyslipidemia by participant's demographics (n = 372).
| Variable | Frequency (%) | TC ≥ 240 mg/dL (6.21 mmol/) | TG ≥ 200 mg/dL (2.26 mmol/) | LDL-C ≥ 160 mg/dL (4.14 mmol/) | HDL-C < 40 mg/dL (1.03 mmol/L) | |
|---|---|---|---|---|---|---|
| Age | <30 | 41(11.0) | 10(24.4) | 9(21.9) | 4(9.8) | 16(39.0) |
| 31–45 | 128(34.4) | 19(14.8) | 26(20.3) | 18(14.1) | 33(25.8) | |
| >45 | 203(54.6) | 44(21.7) | 56(27.6) | 38(18.7) | 66(32.5) | |
| Total | 372(100) | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| Sex | Male | 182(48.9) | 22(12.1) | 25(13.7) | 19(10.4) | 43(23.6) |
| Female | 190(51.1) | 51(26.8) | 66(34.7) | 41(21.6) | 72(37.9) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| Religion | Orthodox | 259(69.6) | 51(19.7) | 75(28.9) | 41(15.8) | 99(38.2) |
| Muslim | 81(21.8) | 16(19.8) | 12(14.8) | 14(17.3) | 10(12.3) | |
| Protestant | 32(8.6) | 6(18.8) | 4(12.5) | 5(15.6) | 6(18.8) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| Marital status | Single | 116(31.2) | 20(17.2) | 22(18.9) | 14(12.1) | 33(28.4) |
| Married | 202(54.3) | 46(22.8) | 56(27.7) | 32(15.8) | 69(34.2) | |
| Divorced | 32(8.6) | 5(15.6) | 8(25) | 11(34.4) | 6(18.8) | |
| Widowed | 22(5.9) | 2(9.1) | 5(22.7) | 3(13.6) | 7(31.8) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| Residence | Urban | 208(55.9) | 52(25) | 61(29.3) | 50(24) | 75(36.1) |
| Rural | 164(44.1) | 21(12.8) | 30(18.3) | 10(6.1) | 40(24.4) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| Occupations | Government | 85(22.8) | 22(25.9) | 26(30.6) | 20(23.5) | 30(35.3) |
| Nongovernment | 44(11.8) | 12(27.3) | 17(38.6) | 7(15.9) | 20(45.5) | |
| Self employed | 158(42.5) | 23(14.6) | 34(21.5) | 23(14.6) | 43(27.2) | |
| Farmer | 73(19.6) | 15(20.5) | 12(16.4) | 9(12.3) | 19(26.0) | |
| Student | 12(3.2) | 1(8.3) | 2(16.7) | 1(8.3) | 3(25) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| Educational level | Illiterate | 120(32.3) | 26(21.7) | 31(25.8) | 17(14.2) | 48(40) |
| Elementary school | 76(20.4) | 17(22.4) | 23(30.3) | 12(15.8) | 26(34.2) | |
| Secondary school | 72(19.4) | 18(25) | 20(27.8) | 16(22.2) | 21(29.2) | |
| High school diploma | 65(17.5) | 9(13.8) | 15(23.1) | 11(16.9) | 17(26.2) | |
| Higher education | 39(10.5) | 3(7.7) | 2(5.1) | 4(10.3) | 3(7.7) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| Monthly income | <1000 ETB | 174(46.8) | 31(17.8) | 41(23.6) | 25(14.4) | 46(26.4) |
| 1000-2000 ETB | 88(23.7) | 20(22.7) | 26(29.5) | 10(11.4) | 35(39.8) | |
| 2001-3000 ETB | 62(16.7) | 15(24.2) | 19(30.6) | 18(29.0) | 28(45.2) | |
| >3000 ETB | 48(12.9) | 7(14.6) | 5(10.4) | 7(14.6) | 6(12.5) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
Prevalence of dyslipidemia according to comorbidity with hypertension, diabetes, and medical profiles of patients.
Table 2 shows the prevalence of dyslipidemia by type of hypertension, duration of hypertension, diabetes mellitus, BMI, and family history of dyslipidemia. Among respondents with DM, the prevalence of TC, TG, LDL-c, and HDL-c was 44.8%, 47.1%, 33.3%, and 48.3%), respectively. Nevertheless, the prevalence of dyslipidemia among non-diabetic respondents was 11.9%, 17.5%, 10.9%, and 25.6%, respectively. Prevalence of TC, TG, LDL-c, and HDL-c was 5.6%, 11.1%, 5.6%, and 13.9%), respectively among respondents who were underweight. However, the prevalence of TC, TG, LDL-c, and HDL-c was 38.7%, 45.2%, 32.3%, and 56.9%), respectively among respondents who were obese. Prevalence of TC, TG, LDL-c, and HDL-c was 29.4%, 53.9%, 37.3%, and 50.9%), respectively for participants who had a family history of HTN. But, the Prevalence of TC, TG, LDL-c, and HDL-c was 15.9%, 13.3%, 8.1%, and 23.3%), respectively for respondents with a family history of HTN (Table 2).
Table 2.
Dyslipidemia by comorbidity with hypertension, diabetes, and medical profiles of patients (n = 372).
| Variable | Frequency (%) | TC ≥ 240 mg/dL (6.21 mmol/) | TG ≥ 200 mg/dL (2.26 mmol/) | LDL-C ≥ 160 mg/dL (4.14 mmol/) | HDL-C < 40 mg/dL (1.03 mmol/L) | |
|---|---|---|---|---|---|---|
| Classifications of Hypertensive patients | Normal | 69(18.5) | 4(5.8) | 3(4.3) | 2(2.9) | 5(7.2) |
| Stage 1 | 77(20.7) | 9(11,7) | 18(23.4) | 7(9.1) | 25(32.5) | |
| Stage 2 | 127(34.1) | 35(27.6) | 41(32.3) | 25(19.7) | 49(38.6) | |
| Stage 3 | 99(26.6) | 25(25.3) | 29(29.3) | 26(26.3) | 36(36.4) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| Duration of hypertension | <5 | 84(22.6) | 10(11.9) | 16(19.0) | 8(9.5) | 21(25) |
| 5–9 | 73(19.6) | 11(15.1) | 15(20.5) | 11(15.1) | 18(24.7) | |
| 10–14 | 56(15.1) | 6(10.7) | 12(21.4) | 6(10.7) | 17(30.4) | |
| 15–20 | 68(18.3) | 16(23.5) | 18(26.5) | 20(29.4) | 29(42.6) | |
| >20 | 91(24.5) | 30(32.9) | 30(32.9) | 15(27.5) | 30(32.9) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| Diabetes mellitus | Yes | 87(23.4) | 39(44.8) | 41(47.1) | 29(33.3) | 42(48.3) |
| No | 285(76.6) | 34(11.9) | 50(17.5) | 31(10.9) | 73(25.6) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| BMI | Underweight | 36(9.7) | 2(5.6) | 4(11.1) | 2(5.6) | 5(13.9) |
| Normal | 122(32.8) | 8(6.6) | 11(9.0) | 6(4.9) | 18(14.8) | |
| Overweight | 121(32.5) | 27(22.3) | 34(28.1) | 22(18.2) | 39(32.2) | |
| Obesity | 93(25.0) | 36(38.7) | 42(45.2) | 30(32.3) | 53(56.9) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| Family history of lipid | Yes | 102(27.4) | 30(29.4) | 55(53.9) | 38(37.3) | 52(50.9) |
| No | 270(72.6) | 43(15.9) | 36(13.3) | 22(8.1) | 63(23.3) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| Overall prevalence of Dyslipidemia | Yes | 180(48.4) | ||||
| No | 192(51.6) | |||||
3.2. Prevalence of dyslipidemia according to lifestyle practices of participants
The prevalence of dyslipidemia in participants with sedentary physical activity was 31.0%, 37.2%, 25.5%, and 47.6%, respectively for TC, TG, LDL-c, and HDL-c. However, the prevalence of dyslipidemia in participants with vigorous physical activity was 6.9%, 9.2%, 5.7%, and 9.2%, respectively for TC, TG, LDL-c, and HDL-c. Prevalence of TC, TG, LDL-c, and HDL-c was 7.3%, 9.4%, 7.3%, and 12.5%), respectively among respondents who had a habit of fruit in their diet. But, the prevalence of TC, TG, LDL-c, and HDL-c was 23.9%, 29.7%, 19.2%, and 37.3%), respectively for respondents who hadn't habit of fruit in their diet. Likewise, the prevalence of TC, TG, LDL-c, and HDL-c was 30.7%, 35.4%, 22.0%, and 47.2%), respectively for those who were alcohol drinkers. Nevertheless, the prevalence of TC, TG, LDL-c, and HDL-c was 13.9%, 18.8%, 13.1%, and 22.4%), respectively for those who weren't alcohol drinkers Table 3.
Table 3.
Prevalence of dyslipidemia by life style practices (n = 372).
| Variable | Frequency (%) | TC ≥ 240 mg/dL (6.21 mmol/) | TG ≥ 200 mg/dL (2.26 mmol/) | LDL-C ≥ 160 mg/dL (4.14 mmol/) | HDL-C < 40 mg/dL (1.03 mmol/L) | |
|---|---|---|---|---|---|---|
| Physical activity | Sedentary | 145(39.0) | 45(31.0) | 54(37.2) | 37(25.5) | 69(47.6) |
| Moderate | 140(37.6) | 22(15.7) | 29(20.7) | 18(12.9) | 38(27.1) | |
| Vigorous | 87(23.4) | 6(6.9) | 8(9.2) | 5(5.7) | 8(9.2) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| Fruits/vegetables consumption | Yes | 96(25.8) | 7(7.3) | 9(9.4) | 7(7.3) | 12(12.5) |
| No | 276(74.2) | 66(23.9) | 82(29.7) | 53(19.2) | 103(37.3) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| Smoking | Yes | 49(13.2) | 25(51.0) | 29(59.2) | 20(40.8) | 32(65.3) |
| No | 323(86.8) | 48(14.9) | 62(19.2) | 40(12.4) | 83(25.7) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
| Alcohol | Yes | 127(34.1) | 39(30.7) | 45(35.4) | 28(22.0) | 60(47.2) |
| No | 245(65.9) | 34(13.9) | 46(18.8) | 32(13.1) | 55(22.4) | |
| Total | 372 | 73(19.6) | 91(24.5) | 60(16.1) | 115(30.9) | |
3.3. Determinants of dyslipidemia among participants
Respondents whose age >45 were at higher risk for having high levels of TC (AOR = 1.36, 95% CI = 1.13–3.97), and low level of HDL-c (AOR = 1.54, 95% CI = 1.25–3.18) than respondents who were below 30 years of age. Females were at higher risk for having high levels of TC (AOR = 2.31, 95% CI = 1.54–3.13), TG (AOR = 1.70, 95% CI = 1.34–3.79), LDL-c (AOR = 2.15, 95% CI = 1.56–2.86), and HDL-c (AOR = 2.67, 95% CI = 1.44–5.67) than males. Respondents who were from urban were at higher risk for having high levels of TC (AOR = 1.98, 95% CI = 1.04–6.83), TG (AOR = 1.78, 95% CI = 1.09–2.86), LDL-c (AOR = 3.01, 95% CI = 1.45–7.43), and HDL-c (AOR = 2.01, 95% CI = 1.94–4.55) than respondents who were from rural. Participants who had a family history of HTN were at higher risk for having high levels of TC (AOR = 1.66, 95% CI = 1.04–2.33), TG (AOR = 1.92, 95% CI = 1.21–4.32), LDL-c (AOR = 1.54, 95% CI = 1.02–3.32), and HDL-c (AOR = 1.49, 95% CI = 1.04–3.13) than respondents who had not HTN. Participants who had sedentary physical activity were at higher risk for having high levels of TC (AOR = 2.33, 95% CI = 1.13–3.97), TG (AOR = 1.76, 95% CI = 1.23–1.98), LDL-c (AOR = 1.83, 95% CI = 1.36–2.48), and HDL-c (AOR = 1.53, 95% CI = 1.25–2.18) than participants who had vigorous physical activity. Similarly, obese respondents were at higher risk for having high levels of TC (AOR = 2.03, 95% CI = 1.64–2.00), TG (AOR = 3.78, 95% CI = 1.06–6.42), LDL-c (AOR = 1.92, 95% CI = 1.66–2.12), and HDL-c (AOR = 4.23, 95% CI = 2.84–4.32) than to respondents who were underweight Table 4.
Table 4.
Association of different factors with dyslipidemia (n = 372).
| Variable | TC ≥ 240 mg/dL (6.21 mmol/L) AOR (95% CI) | TG ≥ 200 mg/dL (2.26 mmol/L) AOR (95% CI) | LDL-C ≥ 160 mg/dL (4.14 mmol/L) AOR (95% CI) | HDL-C < 40 mg/dL (1.03 mmol/L) AOR (95% CI) | |
|---|---|---|---|---|---|
| Age | <30 | 1 | 1 | 1 | 1 |
| 31–45 | 0.57(0.20–1.60) | 0.62(0.26–1.48) | 0.83(0.33–2.12) | 0.97(0.16–0.82) | |
| >45 | 1.36(1.13–3.97) | 1.53(0.23–5.20) | 0.86(0.36–2.08) | 1.54(1.25–3.18) | |
| Sex | Male | 1 | 1 | 1 | 1 |
| Female | 2.31(1.54–3.13) | 1.70(1.34–3.79) | 2.15(1.56–2.86) | 2.67(1.44–5.67) | |
| Residence | Urban | 1.98(0.84–6.83) | 1.78(1.09–2.86) | 3.01(1.45–7.43) | 2.01(1.94–4.55) |
| Rural | 1 | 1 | 1 | 1 | |
| Family history of HTN | Yes | 1.66(1.04–2.33) | 1.92(1.21–4.32) | 1.54(1.02–3.32) | 1.49(1.04–3.13) |
| No | 1 | 1 | 1 | 1 | |
| Smoking | Yes | 1.77(1.19–2.98) | 1.89(2.56–3.55) | 1.66(1.36–2.89) | 1.53(1.34–4.32) |
| No | 1 | 1 | 1 | ||
| Alcohol | Yes | 0.76(0.23–4.87) | 1.45(0.45–5.43) | 0.77(0.15–7.45) | 1.93(1.45–3.78) |
| No | 1 | 1 | 1 | 1 | |
| Physical activity | Sedentary | 2.33(1.13–3.97) | 1.76(1.23–1.98) | 1.83(1.36–2.48) | 1.53(1.25–2.18) |
| Moderate | 1.26(0.13–1.97) | 0.53(0.43–1.27) | 0.96(0.74–2.01) | 1.34(1.03–2.91) | |
| Vigorous | 1 | 1 | 1 | 1 | |
| BMI | Underweight | 1 | 1 | 1 | 1 |
| Normal | 1.43(0.74–1.31) | 0.72(0.03–2.32) | 1.54(1.03–1.92) | 0.72(0.01–2.13) | |
| Overweight | 1.87(1.13–1.89) | 2.12(1.21–4.93) | 1.51(1.66–2.34) | 2.34(1.73–3.91) | |
| Obesity | 2.03(1.64–2.00) | 3.78(1.06–6.42) | 1.92(1.66–2.12) | 4.23(2.84–7.32) | |
| Fruits | Yes | 1 | 1 | 1 | 1 |
| No | 2.21(1.23–2.66) | 2.01(2.65–3.45) | 1.87(1.03–3.79) | 2.34(1.02–4.87) | |
| DM | Yes | 1.71(1.21–2.91) | 1.34(1.03–2.62) | 1.01(1.00–1.83) | 1.51(1.03–2.71) |
| No | 1 | 1 | 1 | 1 | |
| Duration of HTN | <5 | 1 | 1 | 1 | 1 |
| 5–9 | 1.32(0.23–1.62) | 1.67(0.34–2.11) | 0.82(0.65–1.45) | 1.69(0.51–2.01) | |
| 10–14 | 1.51(0.65–1.32) | 0.91(0.77–1.94) | 1.58(0.81–2.36) | 0.74(0.52–3.76) | |
| 15–20 | 0.73(0.23–1.63) | 1.33(0.80–2.18) | 0.81(0.62–1.55) | 1.71(0.29–2.90) | |
| >20 | 1.49(0.61–2.10) | 0.92(0.34–1.64) | 1.57(0.90–2.04) | 1.52(0.59–1.84) | |
4. Discussion
In the present study, a high prevalence of dyslipidemia (48.39%) was found among hypertensive patients in Lumame Primary Hospital. The high prevalence of dyslipidemia in this study could be due to sedentary physical activity, better socioeconomic status, alteration in the intensity of work, speedy urbanization, and alteration in dietary habits. This finding is in agreement with previous studies conducted in India (50.7%) [24]. However, this finding is lower than the previous similar studies conducted in Poland (77.2%) [28], Lithuania (89.7%) [29], Palestine (66.4%) [30], South Africa (67.3%) [31], India (78.4%) [32], Uganda (63.3%) [33], South Africa (85.0%) [34]. In contrast, the current finding is higher than previous studies done in China (32.2%) [35], Ethiopia (34.8%) [13], and Iran (30.0%) [36]. This difference could be because of differences in the study period, lifestyles of respondents, stage of urbanization, cutoffs, and socioeconomic status. In the previous studies, the prevalence of dyslipidemia ranges from 2.7% to 51.9% [[37], [38], [39], [40], [41], [42]].
In this study, the prevalence of dyslipidemia (individual serum lipide level) among hypertensive patients ranges from 16.1% to 30.9%. Prevalence of dyslipidemia according to age, gender, marital status, residence, religion, occupation, educational level, and monthly income was found to be 73(19.6%), 91(24.5%), 60(16.1%), and 115(30.9%), respectively for TC, TG, LDL-c, and HDL-c, which is in agreement with previously published similar studies [[43], [44], [45], [46]]. Low HDL-c was the most prevalent (30.9%) component of dyslipidemia followed by high TG (24.5%), which is in agreement with previous studies [[43], [44], [45], [46]]. This might be due to high saturated fat intake, and high carbohydrates intake related to speedy urbanization. The prevalence of high TG was (24.5%), which lower than previous studies conducted in Uganda (42.1%) [47], Jordan (41.9%) [48], (56.1%) [49], South Africa (59.3%) [49], Senegal (7.1%) [50], Malawi (28.7%) [51], Thailand (49.9%) [6], and Brazil (65.3%) [52]. However, this finding is higher than previous studies done in Nigeria (9.9%) [53]. and Ethiopia (21.0%) [54]. The prevalence of high TC was (19.6%), which is lower than previous findings conducted in Ethiopia (33.7%) [13]. Iran (29.6%) [36], and Ethiopia (30.8%) [55]. The prevalence of high LDL-c was (16.1%), which is lower than previous similar studies conducted in Thailand (56.5%) [6]. Jordan (75.9%) [48]. Ghana (61.0%) [56]. India (47.8%) [32], Senegal (66.3%) [57], Iran (50.0%) [58], and Uganda (60.9%) [47]. However, the current finding is higher than previous similar studies done in Ethiopia (14.1%) [54]. The difference in the prevalence of dyslipidemia may be due to differences in study populations, methodologies, genetic races, and socioeconomic status.
Females were at higher risk for having high levels of TC (AOR = 2.31, 95% CI = 1.54–3.13), TG (AOR = 1.70, 95% CI = 1.34–3.79), LDL-c (AOR = 2.15, 95% CI = 1.56–2.86), and HDL-c (AOR = 2.67, 95% CI = 1.44–5.67) than males. This finding is similar to a study conducted in Thailand [6]. In contrast, studies showed that the prevalence of dyslipidemia was high among male respondents [59,60]. Older age was also risk factors of dyslipidemia, respondents whose age >45 were at higher risk for having high levels of TC (AOR = 1.36, 95% CI = 1.13–3.97), and low level of HDL-c (AOR = 1.54, 95% CI = 1.25–3.18) than respondents who were below 30 years of age. This finding is consistent with previous studies [61,62].
Physical exercise influences the lipid profile by increasing the level of HDL-c on account of increased HDL2 subfractions trailer and reduce the level of masculine triglyceride. Several studies have verified that physical exercise (walking about 5 miles a week without strain) accompanied by music helps increase energy, and optimizing body [63,64]. In the present study, intensive physical activity was associated with favorable lipid profiles. Likewise, a previous intervention studies have demonstrated improvements in lipid profile with increases in exercise [[65], [66], [67]], as physical activity mainly results in a reduction in triglyceride levels and an increase in HDL-c [68]. In the present study, participants who had sedentary physical activity were at higher risk for having high levels of TC (AOR = 2.33, 95% CI = 1.13–3.97), TG (AOR = 1.76, 95% CI = 1.23–1.98), LDL-c (AOR = 1.83, 95% CI = 1.36–2.48), and HDL-c (AOR = 1.53, 95% CI = 1.25–2.18) than participants who had vigorous physical activity. Physical activity helps to reduce the risk of dyslipidemia and had been recommended as lifestyle therapy for dyslipidemia [69].
In this study, there is a significant association between smoking status and TC, TG, LDL-c, and HDL-c. This finding is consistent with a study conducted in Tunisia, it revealed that a significant association between smoking status and hypercholesterolemia, hyperlipoproteinemia, hypertriglyceridemia, low c-HDL, and hyper-LDL concentration, before and after adjustment for potential confounder's factors; this result confirm the association of smoking with the risk of dyslipidemia [70]. Although the mechanisms by which cigarette smoking changes lipoprotein and serum lipid levels are not fully understood, possible explanations have been proposed. The nicotine stimulates the secretion of catecholamines as well as other hormones such as growth hormones and cortisol, leading to an increased serum concentration of free fatty acids which stimulates hepatic secretion of triglycerides and very low density lipoprotein [71]. Consistent with the previous study, current smoking and drinking increase the risk of dyslipidemia in hypertensive population [61]. In contrast, a previous study revealed that current drinking might protect hypertensives from low HDL-c (alcohol drinkers had a higher HDL-cholesterol level than non-drinkers) [72].
As the previous study had confirmed diabetes and overweight/obesity increased the risk of dyslipidemia [73,74]. In this study, dyslipidemia was significantly associated with obesity and diabetes. Hypertensive patients with diabetes mellitus were at higher risk for having high levels of TC (AOR = 1.71, 95% CI = 1.21–2.91), TG (AOR = 1.34, 95% CI = 1.03–2.62), LDL-c (AOR = 1.01, 95% CI = 1.00–1.83), and HDL-c (AOR = 1.51, 95% CI = 1.03–2.71) when compared to patients who had not diabetes mellitus. Similarly, participants who had a family history of HTN were at higher risk for having high levels of TC (AOR = 1.66, 95% CI = 1.04–2.33), TG (AOR = 1.92, 95% CI = 1.21–4.32), LDL-c (AOR = 1.54, 95% CI = 1.02–3.32), and HDL-c (AOR = 1.49, 95% CI = 1.04–3.13) than respondents who had not HTN. Likewise, obese respondents were at higher risk for having high levels of TC (AOR = 2.03, 95% CI = 1.64–2.00), TG (AOR = 3.78, 95% CI = 1.06–6.42), LDL-c (AOR = 1.92, 95% CI = 1.66–2.12), and HDL-c (AOR = 4.23, 95% CI = 2.84–4.32) than to respondents who were underweight. This could be attributed to the high tendency of increasing the concentration of serum lipide levels as increased weight. The current finding is consistent with previous studies that obesity was significantly associated with dyslipidemia [40,43,45,46,66,68,75,76]. As a limitation, minor imprecisions may occur since a single laboratory measurement was applied to assess the prevalence of dyslipidemia. As cross-sectional study designs, confines causal relationships between dyslipidemia and its independent predictors.
5. Conclusion
In summary, the different forms of dyslipidemia were prevalent among hypertensive patients, with hypo-HDL-c as the most common among the participants. This study revealed that age, gender, residence, family history of HTN, smoking, alcohol drinking, fruit diet habits, physical activity, diabetes mellites, and BMI were significant determinants of dyslipidemia. Thus, education, communication, and information programs based on lifestyle modifications like healthy diet habits, weight reduction, physical activity, smoking, and cessation should be given.
CRediT authorship contribution statement
Zemene Demelash Kifle: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. Agumas Alemu Alehegn: Conceptualization, Data curation. Meaza Adugna: Formal analysis, Funding acquisition, Investigation. Biruk Bayleyegn: Methodology, Project administration, Resources.
Declaration of competing interest
The author declares that they have no competing interests.
Acknowledgment
We would like to acknowledge Lumame Primary Hospital for material supports.
Abbreviations
- TC
total cholesterol
- TG
triglycerides
- VLDL
very-low-density lipoprotein
- HDL
high-density lipoprotein
- LDL
low-density lipoprotein
- HTN
hypertension
- SPSS
statistical package for the social sciences
- AOR
adjusted odds ratio
- WHO
world health organization
Ethics approval and consent to participate
This study was approved by the ethical committee of Lumame Primary Hospital with a reference number of LPH/274/2020. Informed verbal, as well as written consent, was obtained from study participants before data collection, and the purpose of the study was explained to the respondents in advance. The information collected from respondents was kept confidential.
Availability of data and materials
Most of the data is included in the manuscript. Additional can be found from the corresponding author based on reasonable request.
Funding
Not applicable.
References
- 1.Qi L. Prevalence and risk factors associated with dyslipidemia in Chongqing, China. Int J Environ Res Publ Health. 2015;12(10):13455–13465. doi: 10.3390/ijerph121013455. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Organization W.H. 2002. Quantifying selected major risks to health. The World Health Report. Reducing risks, promoting healthy life, 2002. [Google Scholar]
- 3.Smith G. Epidemiology of dyslipidemia and economic burden on the healthcare system. Am J Manag Care. 2007;13(3):S68. [PubMed] [Google Scholar]
- 4.Stamler J. Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. Jama. 2000;284(3):311–318. doi: 10.1001/jama.284.3.311. [DOI] [PubMed] [Google Scholar]
- 5.Alvarenga M.E., Byrne D.G. Springer; 2016. Handbook of psychocardiology. [Google Scholar]
- 6.Narindrarangkura P. Prevalence of dyslipidemia associated with complications in diabetic patients: a nationwide study in Thailand. Lipids Health Dis. 2019;18(1):90. doi: 10.1186/s12944-019-1034-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Jun-Ren Z. Chinese guidelines for the management of dyslipidemia in adults. Journal of Geriatric Cardiology. 2016;15(1):1–29. doi: 10.11909/j.issn.1671-5411.2018.01.011. 2018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.McGill H.C., Jr. Effects of serum lipoproteins and smoking on atherosclerosis in young men and women. Arterioscler Thromb Vasc Biol. 1997;17(1):95–106. doi: 10.1161/01.atv.17.1.95. [DOI] [PubMed] [Google Scholar]
- 9.Miller M. Triglycerides and cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2011;123(20):2292–2333. doi: 10.1161/CIR.0b013e3182160726. [DOI] [PubMed] [Google Scholar]
- 10.Grundy S.M. Implications of recent clinical trials for the national cholesterol education program adult treatment panel III guidelines. J Am Coll Cardiol. 2004;44(3):720–732. doi: 10.1016/j.jacc.2004.07.001. [DOI] [PubMed] [Google Scholar]
- 11.Grundy S.M. Third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) final report. Circulation. 2002;106:3143–3421. [PubMed] [Google Scholar]
- 12.Noubiap J.J. Prevalence of dyslipidaemia among adults in Africa: a systematic review and meta-analysis. The Lancet Global Health. 2018;6(9):e998–e1007. doi: 10.1016/S2214-109X(18)30275-4. [DOI] [PubMed] [Google Scholar]
- 13.Sufa B., Abebe G., Cheneke W. Dyslipidemia and associated factors among women using hormonal contraceptives in Harar town, Eastern Ethiopia. BMC Res Notes. 2019;12(1):1–7. doi: 10.1186/s13104-019-4148-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Eaton C.B. Prevalence of hypertension, dyslipidemia, and dyslipidemic hypertension. J Fam Pract. 1994;38(1):17–24. [PubMed] [Google Scholar]
- 15.Thomas F. Cardiovascular mortality in hypertensive men according to presence of associated risk factors. Hypertension. 2001;37(5):1256–1261. doi: 10.1161/01.hyp.37.5.1256. [DOI] [PubMed] [Google Scholar]
- 16.O'Meara J.G. Ethnic and sex differences in the prevalence, treatment, and control of dyslipidemia among hypertensive adults in the GENOA study. Arch Intern Med. 2004;164(12):1313–1318. doi: 10.1001/archinte.164.12.1313. [DOI] [PubMed] [Google Scholar]
- 17.Al-Nozha M.M. Hypertension in Saudi Arabia. Saudi Med J. 2007;28(1):77. [PubMed] [Google Scholar]
- 18.Al-Dahi S. Assessment of Framingham cardiovascular disease risk among militaries in the Kingdom of Saudi Arabia. Mil Med. 2013;178(3):299–305. doi: 10.7205/MILMED-D-12-00079. [DOI] [PubMed] [Google Scholar]
- 19.Alwan A. Cardiovascular diseases in the eastern Mediterranean region. World health statistics quarterly. Rapp Trimest Stat Sanit Mond. 1993;46(2):97–100. [PubMed] [Google Scholar]
- 20.Al-Omran M. Atherosclerotic disease and risk factor modification in Saudi Arabia: a call to action. Vasc Health Risk Manag. 2012;8:349. doi: 10.2147/VHRM.S32783. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Regitz-Zagrosek V., Kararigas G. Mechanistic pathways of sex differences in cardiovascular disease. Physiol Rev. 2017;97(1):1–37. doi: 10.1152/physrev.00021.2015. [DOI] [PubMed] [Google Scholar]
- 22.Ibrahim N.K. Risk factors of coronary heart disease among medical students in King Abdulaziz University, Jeddah, Saudi Arabia. BMC Publ Health. 2014;14(1):1–9. doi: 10.1186/1471-2458-14-411. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Mendelsohn M.E., Karas R.H. Molecular and cellular basis of cardiovascular gender differences. Science. 2005;308(5728):1583–1587. doi: 10.1126/science.1112062. [DOI] [PubMed] [Google Scholar]
- 24.Wankhade P.S. Prevalence and risk factors of dyslipidemia among male industrial workers in India. International Journal of Community Medicine and Public Health. Int J Community Med Public Health. 2018;5(4):1458–1465. [Google Scholar]
- 25.Al-Kaabba A.F. 2012. Prevalence and correlates of dyslipidemia among adults in Saudi Arabia: results from a national survey. [Google Scholar]
- 26.Al-Hassan Y.T. Prevalence and determinants of dyslipidemia: data from a Saudi University Clinic. Open Publ Health J. 2018;11(1) [Google Scholar]
- 27.Pasternak RC. Report of the Adult Treatment Panel III: the 2001 National Cholesterol Education Program guidelines on the detection, evaluation and treatment of elevated cholesterol in adults. Cardiology clinics. 2003;21(3):393–398. doi: 10.1016/s0733-8651(03)00080-8. [DOI] [PubMed] [Google Scholar]
- 28.Pająk A. Changes in the prevalence, management and treatment of hypercholesterolemia and other dyslipidemias over 10 years in Poland. The WOBASZ study. Pol Arch Med Wewn. 2016;126(9) doi: 10.20452/pamw.3464. [DOI] [PubMed] [Google Scholar]
- 29.Rinkūnienė E. The prevalence of dislipidemia and its relation to other risk factors: a nationwide survey of Lithuania. Clin Lipidol. 2015;10(3):219–225. [Google Scholar]
- 30.Ali I. Prevalence of dyslipidemia in undiagnosed Palestinian men: a cross-sectional study. Journal of lipids. 2019;2019 doi: 10.1155/2019/3473042. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Reiger S. Awareness, treatment, and control of dyslipidemia in rural South Africa: the haalsi (health and aging in Africa: a longitudinal study of an indepth community in South Africa) study. PloS One. 2017;12(10) doi: 10.1371/journal.pone.0187347. e0187347. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Banerjee R. Dyslipidemia and its relationship with cardiovascular risk factors in a selected population of siliguri city, West Bengal, India. Asian J Med Sci. 2014;5(1):1–8. [Google Scholar]
- 33.Bakesiima R. Dyslipidaemias in women using hormonal contraceptives: a cross sectional study in Mulago Hospital Family Planning Clinic, Kampala, Uganda. BMJ open. 2018;8(10) doi: 10.1136/bmjopen-2018-022338. e022338. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Dave J.A. Anti-retroviral therapy increases the prevalence of dyslipidemia in South African HIV-infected patients. PloS One. 2016;11(3) doi: 10.1371/journal.pone.0151911. e0151911. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 35.Wootton S.H. Enhancing pathogen identification in patients with meningitis and a negative Gram stain using the BioFire FilmArray® Meningitis/Encephalitis panel. Ann Clin Microbiol Antimicrob. 2016;15(1):1–4. doi: 10.1186/s12941-016-0137-1. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Najafipour H. Prevalence of dyslipidemia and its association with other coronary artery disease risk factors among urban population in Southeast of Iran: results of the Kerman coronary artery disease risk factors study (KERCADRS) J Diabetes Metab Disord. 2016;15(1):1–8. doi: 10.1186/s40200-016-0268-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Saadi H. Prevalence of diabetes mellitus and its complications in a population-based sample in Al Ain, United Arab Emirates. Diabetes Res Clin Pract. 2007;78(3):369–377. doi: 10.1016/j.diabres.2007.04.008. [DOI] [PubMed] [Google Scholar]
- 38.Jackson R. Multiple coronary risk factors in healthy older Kuwaiti males. Eur J Clin Nutr. 2002;56(8):709–714. doi: 10.1038/sj.ejcn.1601379. [DOI] [PubMed] [Google Scholar]
- 39.Al-Moosa S. Diabetes and urbanization in the Omani population: an analysis of national survey data. Popul Health Metrics. 2006;4(1):1–8. doi: 10.1186/1478-7954-4-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 40.Bener A. Prevalence of diagnosed and undiagnosed diabetes mellitus and its risk factors in a population-based study of Qatar. Diabetes Res Clin Pract. 2009;84(1):99–106. doi: 10.1016/j.diabres.2009.02.003. [DOI] [PubMed] [Google Scholar]
- 41.Mahley R.W. Turkish Heart Study: lipids, lipoproteins, and apolipoproteins. J Lipid Res. 1995;36(4):839–859. [PubMed] [Google Scholar]
- 42.Grabauskas V. Prevalence of dyslipidemias among Lithuanian rural population (CINDI program) Medicina. 2003;39(12):1215–1222. [PubMed] [Google Scholar]
- 43.Al-Nozha M.M. Hyperlipidemia in Saudi arabia. Saudi Med J. 2008;29(2):282. [PubMed] [Google Scholar]
- 44.Ogbeide D.O. Population based study of serum lipid levels in Al-Kharj Health Center, Saudi Arabia. Saudi Med J. 2004;25(12):1855–1857. [PubMed] [Google Scholar]
- 45.Al-Shehri S.N. Prevalence of hyperlipidemia among Saudi school children in Riyadh. Ann Saudi Med. 2004;24(1):6–8. doi: 10.5144/0256-4947.2004.6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 46.Abalkhail B.A. Hypercholesterolemia and 5-year risk of development of coronary heart disease among university and school workers in Jeddah, Saudi Arabia. Prev Med. 2000;31(4):390–395. doi: 10.1006/pmed.2000.0713. [DOI] [PubMed] [Google Scholar]
- 47.Lumu W. Dyslipidaemia in a Black African diabetic population: burden, pattern and predictors. BMC Res Notes. 2017;10(1):1–7. doi: 10.1186/s13104-017-2916-y. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 48.Abujbara M. The prevalence of dyslipidemia among Jordanians. Journal of lipids. 2018;2018 doi: 10.1155/2018/6298739. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 49.Pandya H. 2012. The prevalence and pattern of dyslipidemia among type 2 diabetic patients at rural based hospital in Gujarat. India. [Google Scholar]
- 50.Doupa D. Dyslipidemia, obesity and other cardiovascular risk factors in the adult population in Senegal. The Pan African Medical Journal. 2014;19 doi: 10.11604/pamj.2014.19.181.4872. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 51.Amberbir A. Dyslipidemia among rural and urban HIV patients in south-east Malawi. PloS One. 2018;13(5) doi: 10.1371/journal.pone.0197728. e0197728. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 52.Feitosa A.C.R. Impact of the use of different diagnostic criteria in the prevalence of dyslipidemia in pregnant women. Arq Bras Cardiol. 2017;109(1):30–38. doi: 10.5935/abc.20170070. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 53.Anyabolu E.N. Dyslipidemia in people living with HIV-AIDS in a tertiary hospital in South-East Nigeria. Pan African Medical Journal. 2017;28(1) doi: 10.11604/pamj.2017.28.204.13505. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 54.Gebreyes Y.F. Prevalence of high bloodpressure, hyperglycemia, dyslipidemia, metabolic syndrome and their determinants in Ethiopia: evidences from the National NCDs STEPS Survey. PloS One. 2015;13(5) doi: 10.1371/journal.pone.0194819. e0194819. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 55.Gebreegziabiher G. Prevalence of dyslipidemia and associated risk factors among adult residents of Mekelle City, Northern Ethiopia. PloS One. 2021;16(2) doi: 10.1371/journal.pone.0243103. e0243103. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 56.Micah F., Nkum B. Lipid disorders in hospital attendants in Kumasi, Ghana. Ghana Med J. 2012;46(1) [PMC free article] [PubMed] [Google Scholar]
- 57.Doupa D. Lipid profile frequency and the prevalence of dyslipidaemia from biochemical tests at Saint Louis University Hospital in Senegal. Pan African Medical Journal. 2014;17(1) doi: 10.11604/pamj.2014.17.75.3577. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 58.Azizi F. Prevalence of metabolic syndrome in an urban population: tehran lipid and glucose study. Diabetes Res Clin Pract. 2003;61(1):29–37. doi: 10.1016/s0168-8227(03)00066-4. [DOI] [PubMed] [Google Scholar]
- 59.Grover S.A. Evaluating the benefits of treating dyslipidemia: the importance of diabetes as a risk factor. Am J Med. 2003;115(2):122–128. doi: 10.1016/s0002-9343(03)00303-6. [DOI] [PubMed] [Google Scholar]
- 60.Dasti M.A. Dyslipidemia in patients with essential hypertension. Indo american journal of pharmaceutical sciences. 2017;4(3):511–515. [Google Scholar]
- 61.Yu S. Prevalence of dyslipidemia and associated factors among the hypertensive population from rural Northeast China. BMC Publ Health. 2015;15(1):1–9. doi: 10.1186/s12889-015-2486-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 62.Zhang X. Prevalence of dyslipidemia and associated factors among the hypertensive rural Chinese population. Arch Med Res. 2007;38(4):432–439. doi: 10.1016/j.arcmed.2006.12.005. [DOI] [PubMed] [Google Scholar]
- 63.Lira F. The relationship between inflammation, dyslipidemia and physical exercise: from the epidemiological to molecular approach. Curr Diabetes Rev. 2014;10(6):391–396. doi: 10.2174/1573399810666141122210135. [DOI] [PubMed] [Google Scholar]
- 64.Biteli P. Dyslipidemia influences the effect of physical exercise on inflammatory markers on obese women in post-menopause: a randomized clinical trial. Exp Gerontol. 2021;150:111355. doi: 10.1016/j.exger.2021.111355. [DOI] [PubMed] [Google Scholar]
- 65.Zhao W.-H. Blood lipid profile and prevalence of dyslipidemia in Chinese adults. Biomed Environ Sci: BES (Biomed Environ Sci) 2007;20(4):329–335. [PubMed] [Google Scholar]
- 66.Kang W.-m. Prevalence of abnormity of blood lipid and associated factors in health examination population in Beijing. Chin Med Sci J. 2009;24(3):142–146. doi: 10.1016/s1001-9294(09)60078-x. [DOI] [PubMed] [Google Scholar]
- 67.Erem C. Prevalence of dyslipidemia and associated risk factors among Turkish adults: trabzon lipid study. Endocrine. 2008;34(1):36–51. doi: 10.1007/s12020-008-9100-z. [DOI] [PubMed] [Google Scholar]
- 68.Polychronopoulos E., Panagiotakos D.B., Polystipioti A. Diet, lifestyle factors and hypercholesterolemia in elderly men and women from Cyprus. Lipids Health Dis. 2005;4(1):1–7. doi: 10.1186/1476-511X-4-17. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 69.Montesi L. Physical activity for the prevention and treatment of metabolic disorders. Internal and emergency medicine. 2013;8(8):655–666. doi: 10.1007/s11739-013-0953-7. [DOI] [PubMed] [Google Scholar]
- 70.Mouhamed D.H. Association between cigarette smoking and dyslipidemia. Immuno-Anal Biol Specialisee. 2013;28(4):195–200. [Google Scholar]
- 71.Silva H. Tobacco use and periodontal disease—the role of microvascular dysfunction. Biology. 2021;10(5):441. doi: 10.3390/biology10050441. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 72.Choudhury S.R. Alcohol intake and serum lipids in a Japanese population. Int J Epidemiol. 1994;23(5):940–947. doi: 10.1093/ije/23.5.940. [DOI] [PubMed] [Google Scholar]
- 73.Cai L. Prevalence, awareness, treatment, and control of dyslipidemia among adults in Beijing, China. J Atherosclerosis Thromb. 2011 doi: 10.5551/jat.10116. 1110310428-1110310428. [DOI] [PubMed] [Google Scholar]
- 74.Jeenduang N. The prevalence of dyslipidemia among a rural Thai population in the Nakhon Si Thammarat province. Journal of the Medical Association of Thailand= Chotmaihet Thangphaet. 2013;96(8):992–1000. [PubMed] [Google Scholar]
- 75.Wang S. Prevalence and associated factors of dyslipidemia in the adult Chinese population. PloS One. 2011;6(3) doi: 10.1371/journal.pone.0017326. e17326. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 76.Pradeepa R. Socioeconomic status and dyslipidaemia in a south Indian population: the Chennai urban population study (CUPS 11) Natl Med J India. 2003;16(2):73–78. [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Most of the data is included in the manuscript. Additional can be found from the corresponding author based on reasonable request.