Skip to main content

Advertisement

SpringerLink
Log in

Age, period and cohort analysis of high cholesterol levels in Iranian adults over a 20-year period

  • Research article
  • Published:
Journal of Diabetes & Metabolic Disorders Aims and scope Submit manuscript

Abstract

Purpose

Hypercholesterolemia is one of the most important modifiable risk factors of non-communicable diseases and data on their values in different societies and their trend of changes should be updated every couple of years. Many studies have focused on assessing the prevalence of high cholesterol. We must emphasise that most of these studies were cross-sectional and did not directly investigate the temporal trends of change for age, period and birth cohort (APC). The aim of this study is to evaluate the effect of age, period and birth cohort on the prevalence of borderline to high cholesterol levels in Iranian adult population.

Methods

The data were collected from 110,302 subjects between 25 and 69 years of age over the period of 1990–2011. Data from these subjects were collected by using five national cross-sectional surveys conducted in 1990–91, 1999, 2003, 2007 and 2011. The APC effect on the prevalence of borderline and high cholesterol levels was assessed using the Intrinsic Estimator model.

Results

The overall prevalence of borderline cholesterol level among male subjects was found to be lower than that of females (39.8% vs. 46.3%). Similarly, the prevalence of high cholesterol level in men was reported to be 13.1%, which was lower than the 18.0% calculated in women. The prevalence of borderline and high cholesterol levels increased with age in men between the ages of 45–49. Then it stayed quite steady and eventually declined. Then it stayed quite steady and eventually declined. The prevalence in women also increased with age, with its maximum rise after the ages of menopause and a slight decline at the ages of 65–69. As for the birth cohorts, the prevalence of borderline and high cholesterol levels followed a declining trend by going from earlier birth cohorts to the later ones.

Conclusion

The present study provides evidence that age, period and birth cohort affect the prevalence of borderline and high cholesterol levels. Thus, these factors should be considered when developing and implementing care plans for people with hypercholesterolemia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

APC:

Age, period and cohort

IE:

Intrinsic estimator

SSU:

Secondary sampling units

SuRFNCD:

Sixth National Surveillance of Risk Factors of Non-Communicable Disease

WHO :

World Health Organization

References

  1. Alwan A, MacLean DR, Riley LM, d'Espaignet ET, Mathers CD, Stevens GA, et al. Monitoring and surveillance of chronic non-communicable diseases: progress and capacity in high-burden countries. Lancet. 2010;376(9755):1861–8.

    Article  Google Scholar 

  2. Organization WH. Global health risks: mortality and burden of disease attributable to selected major risks: World Health Organization; 2009.

  3. Boutayeb A, Boutayeb S. The burden of non communicable diseases in developing countries. Int J Equity Health. 2005;4(1).

  4. Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet. 2006;367(9524):1747–57.

    Article  Google Scholar 

  5. Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJL. Selected major risk factors and global and regional burden of disease. Lancet. 2002;360(9343):1347–60.

    Article  Google Scholar 

  6. Gregg EW. Secular trends in cardiovascular disease risk factors according to body mass index in US adults. JAMA. 2005;293(15):1868.

    Article  CAS  Google Scholar 

  7. Forouzanfar MH, Sepanlou SG, Shahraz S, Dicker D, Naghavi P, Pourmalek F, et al. Evaluating causes of death and morbidity in Iran, global burden of diseases, injuries, and risk factors study 2010. Archives of Iranian medicine. 2014;17(5):304–20.

    PubMed  Google Scholar 

  8. Tabatabaei-Malazy O, Qorbani M, Samavat T, Sharifi F, Larijani B, Fakhrzadeh H. Prevalence of dyslipidemia in Iran: a systematic review and meta-analysis study. Int J Prev Med. 2014;5(4):373–93.

    PubMed  PubMed Central  Google Scholar 

  9. Hosseini M, Yousefifard M, Taslimi S, Sohanaki H, Nourijelyani K, Asgari F, et al. Trend of blood cholesterol level in Iran: results of four national surveys during 1991-2008. Acta Medica Iranica. 2013;51(9):642–51.

    PubMed  Google Scholar 

  10. Hickman TB, Briefel RR, Carroll MD, Rifkind BM, Cleeman JI, Maurer KR, et al. Distributions and trends of serum lipid levels among United States children and adolescents ages 4–19 years: data from the third National Health and nutrition examination survey. Prev Med. 1998;27(6):879–90.

    Article  CAS  Google Scholar 

  11. Hosseini M, Taslimi S, Yousefifard M, Asgari F, Etemad K, Heidarian Miri H, et al. Serum cholesterol level nomograms for Iranian population; suggestion for national cut-offs. Iran. J. Public Health. 2013;42(2):164–71.

    PubMed  PubMed Central  Google Scholar 

  12. Vartiainen E, Jousilahti P, Alfthan G, Sundvall J, Pietinen P, Puska P. Cardiovascular risk factor changes in Finland, 1972–1997. Int J Epidemiol. 2000;29(1):49–56.

    Article  CAS  Google Scholar 

  13. Walker ARP, Arvidsson UB. Fat intake, serum cholesterol concentration, and atherosclerosis in the south African bantu. Part I. low fat intake and the age trend of serum cholesterol concentration in the south African Bantu1. J Clin Investig. 1954;33(10):1358–65.

    Article  CAS  Google Scholar 

  14. Shimamoto T, Komachi Y, Inada H, Doi M, Iso H, Sato S, et al. Trends for coronary heart disease and stroke and their risk factors in Japan. Circulation. 1989;79(3):503–15.

    Article  CAS  Google Scholar 

  15. Szklo M. Epidemiology: beyond the basics. Am J Epidemiol. 2001;153(8):821–2.

    Article  Google Scholar 

  16. Mariotti S, Capocaccia R, Farchi G, Menotti A, Verdecchia A, Keys A. Age, period, cohort and geographical area effects on the relationship between risk factors and coronary heart disease mortality. J Chronic Dis. 1986;39(3):229–42.

    Article  CAS  Google Scholar 

  17. Yang Y. Trends in US adult chronic disease mortality, 1960–1999: age, period, and cohort variations. Demography. 2008;45(2):387–416.

    Article  Google Scholar 

  18. Yang Y, Fu WJ, Land KC. A methodological comparison of age-period-cohort models: the intrinsic estimator and conventional generalized linear models. Sociol Methodol. 2004;34(1):75–110.

    Article  Google Scholar 

  19. Gostynski M, Gutzwiller F, Kuulasmaa K, Döring A, Ferrario M, Grafnetter D, et al. Analysis of the relationship between total cholesterol, age, body mass index among males and females in the WHO MONICA project. Int J Obes. 2004;28(8):1082–90.

    Article  CAS  Google Scholar 

  20. Gertler MM, Garn SM, Bland E. Age, serum cholesterol and coronary artery disease. Circulation. 1950;2(4):517–22.

    Article  CAS  Google Scholar 

  21. Green MS, Heiss G, Rifkind BM, Cooper GR, Williams O, Tyroler H. The ratio of plasma high-density lipoprotein cholesterol to total and low-density lipoprotein cholesterol: age-related changes and race and sex differences in selected north American populations. The lipid research clinics program prevalence study. Circulation. 1985;72(1):93–104.

    Article  CAS  Google Scholar 

  22. Collaboration PS. 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.

    Article  Google Scholar 

  23. Jensen J, Nilas L, Christiansen C. Influence of menopause on serum lipids and lipoproteins. Maturitas. 1990;12(4):321–31.

    Article  CAS  Google Scholar 

  24. Stevenson JC, Crook D, Godsland IF. Influence of age and menopause on serum lipids and lipoproteins in healthy women. Atherosclerosis. 1993;98(1):83–90.

    Article  CAS  Google Scholar 

  25. Akahoshi M, Soda M, Nakashima E, Shimaoka K, Seto S, Yano K. Effects of menopause on trends of serum cholesterol, blood pressure, and body mass index. Circulation. 1996;94(1):61–6.

    Article  CAS  Google Scholar 

  26. Shadpour K. Primary health care networks in the Islamic Republic of Iran. 2000.

  27. Farzadfar F, Murray CJ, Gakidou E, Bossert T, Namdaritabar H, Alikhani S, et al. Effectiveness of diabetes and hypertension management by rural primary health-care workers (Behvarz workers) in Iran: a nationally representative observational study. Lancet. 2012;379(9810):47–54.

    Article  Google Scholar 

  28. Asadi-Lari M, Sayyari A, Akbari M, Gray D. Public health improvement in Iran—lessons from the last 20 years. Public Health. 2004;118(6):395–402.

    Article  CAS  Google Scholar 

  29. Ghassemi H, Harrison G, Mohammad K. An accelerated nutrition transition in Iran. Public Health Nutr. 2002;5(1a):149–55.

    Article  Google Scholar 

  30. Carroll MD, Kit BK, Lacher DA, Yoon S. Total and high-density lipoprotein cholesterol in adults: National Health and nutrition examination survey, 2009-2010: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2012.

  31. Morabia A, Costanza MC. The obesity epidemic as harbinger of a metabolic disorder epidemic: trends in overweight, hypercholesterolemia, and diabetes treatment in Geneva, Switzerland, 1993–2003. Am J Public Health. 2005;95(4):632–5.

    Article  Google Scholar 

  32. Estoppey D, Paccaud F, Vollenweider P, Marques-Vidal P. Trends in self-reported prevalence and management of hypertension, hypercholesterolemia and diabetes in Swiss adults, 1997-2007. BMC Public Health. 2011;11(1):114.

    Article  Google Scholar 

  33. Arnett DK, Jacobs DR, Luepker RV, Blackburn H, Armstrong C, Claas SA. Twenty-year trends in serum cholesterol, hypercholesterolemia, and cholesterol medication use. Circulation. 2005;112(25):3884–91.

    Article  Google Scholar 

Download references

Acknowledgements

We kindly appreciate Mrs. Mehrnoosh Yazdanbakhsh for her valuable help to language editing of the paper.

Funding

This research has been supported by Tehran University of Medical Sciences & health Services grant (ID number: 93–04–27-26163).

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poursina Ave, Tehran, Iran

    Mostafa Hosseini & Kazem Mohammad

  2. Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mahmoud Yousefifard

  3. Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

    Masoud Baikpour

  4. Department of Epidemiology and Biostatistics, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mohammad Fayaz & Koorosh Etemad

  5. Department of Community Medicine, Preventive medicine & Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran

    Jalil Koohpayehzadeh

  6. Center for Disease Control, Ministry of Health and Medical Education, Tehran, Iran

    Ali Rafei, Koorosh Etemad, Mohammad Mehdi Gouya & Fereshteh Asgari

Authors
  1. Mostafa Hosseini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mahmoud Yousefifard
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Masoud Baikpour
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammad Fayaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jalil Koohpayehzadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ali Rafei
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Koorosh Etemad
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mohammad Mehdi Gouya
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Fereshteh Asgari
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Kazem Mohammad
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conception or design of the work: MH; MY; KM; MMG.

Data acquisition: FA; AR; KE; JK; MB.

Analysis: MH, MY.

Interpretation of data for the work: MH; MY; KM; MY.

Drafting the work: MY; MB; MH.

Revising draft critically for important intellectual content: All authors.

Corresponding author

Correspondence to Kazem Mohammad.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and inform consent

The study designs were approved by Tehran University of Medical Sciences Ethics Committee. In this study an informed consent was given from participants.

Role of the sponsor

The Tehran University of Medical Sciences had no role in the design and conduct of the study; collection, management, and analysis of the data.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hosseini, M., Yousefifard, M., Baikpour, M. et al. Age, period and cohort analysis of high cholesterol levels in Iranian adults over a 20-year period. J Diabetes Metab Disord 18, 289–299 (2019). https://doi.org/10.1007/s40200-019-00410-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40200-019-00410-5

Keywords

Search

Navigation