Longitudinal changes in serum cholesterol in man: An epidemiologic search for an etiology

doi:10.1016/0021-9681(82)90111-4

Journal of Chronic Diseases

Volume 35, Issue 2, 1982, Pages 101-114

Journal of Chronic D...

https://doi.org/10.1016/0021-9681(82)90111-4 Get rights and content

Abstract

Serum cholesterol levels were determined in 1011 male participants of the Baltimore Longitudinal Study of Aging. This study presents the longitudinal changes in serum cholesterol from 1 July 1963 to 30 June 1977. Serum cholesterol values dropped 6% between 1970 and 1972. The span of this study was divided into two eras, one preceding and one following the drop. The effects of obesity, selected dietary constituents and physical activity were examined in an attempt to explain the secular change in serum cholesterol. Serum cholesterol levels were not significantly correlated to levels of weight or body mass index. Changes in weight were significantly positively correlated with changes in serum cholesterol. Overall, however, the study population did not experience a significant drop in weight and therefore, this relationship could not explain the observed drop in serum cholesterol. There were virtually no significant correlations between the absolute value of any of the dietary variables examined and the absolute level of serum cholesterol. There were significant but small changes in most dietary constituents; however, only changes in caloric intake were significantly positively correlated with changes in serum cholesterol. Because the overall change in caloric intake was small, it could explain less than 1 mg/dl of the 11 mg/dl drop. There was no overall change in physical activity. No significant correlations were found between either the level or change in physical activity and the level or change in serum cholesterol. It is concluded that neither weight nor physical activity could account for the observed changes in serum cholesterol. Changes in dietary constituents were significant and in a direction which would predict a lower serum cholesterol. However, for the group, dietary changes could not fully explain the drop in serum cholesterol. For individuals, the changes in diet poorly predicted changes in serum cholesterol. It is suggested that the observed secular drop in serum cholesterol may be due to factor(s) other than those studied.

References (30)

LL Abell et al.
A simplified method for the estimation of total cholesterol in serum and demonstration of its specificity
J Biol Chem
(1952)
G Kessler
Automated techniques in lipid chemistry
Adv Clin Chem
(1967)
LE Hollister et al.
Relationship of obesity to serum triglycerides, cholesterol, and uric acid, and to plasma-glucose levels
Am J Clin Nutr
(1967)
WJ Walker et al.
Effect of weight reduction and caloric balance on serum lipoprotein and cholesterol levels
Am J Med
(1953)
HJ Montoye et al.
The effects of exercise on blood cholesterol in middleaged men
Am J Clin Nutr
(1959)
FW Ashley et al.
Relation of weight change to changes in atherogenic traits: the Framingham Study
J Chron Dis
(1974)
DM Hegsted et al.
Quantitative effects of dietary fat on serum cholesterol in man
Am J Clin Nutr
(1965)
SC Stulb et al.
The relationship of nutrient intake and exercise to serum cholesterol levels in white males in Evans County, Georgia
Am J Clin Nutr
(1965)
AB Nichols et al.
Dietary nutritional intake and serum lipid levels. The Tecumseh Study
Am J Clin Nutr
(1976)
HJ Montoye et al.
Habitual physical activity and serum lipids: males 16–64 in a total community
J Chron Dis
(1976)

United States Department of Health, Education and Welfare, National Heart, Blood Vessel, Lung and Blood Program

Fourth Report of the Director of the National Heart, Lung, and Blood Institute

WJ Walker

Coronary mortality: what is going on?

J Am Med Assoc

(1974)

MP Stern

The recent decline in ischemic heart disease mortality

Ann Intern Med

(1979)

S Abraham

Total serum cholesterol levels of adults, 18–74 years, United States, 1971–1974

Cited by (76)

Higher than predicted resting energy expenditure and lower physical activity in healthy underweight Chinese adults
2022, Cell Metabolism
Falling cholesterol trend at acute coronary syndrome presentation is strongly related to statin use for secondary prevention
2016, International Journal of Cardiology
Citation Excerpt :
After adjustment for age and sex, LLT use explained 79% of the fall in TC in the group with a history of CHD (R2 = 0.79, p < 0.001) but accounted for only 27% of the fall in those without a history of CHD of borderline statistical significance (R2 = 0.27, p = 0.06). Population studies indicate that serum TC levels have been declining from 1960 to the first decade of the millennium [8–32], and LLT use in the general population has increased from 1980 to 2006 [33–36]. The fall in TC and increase in LLT in the general population from the world literature has been superimposed on the GRACE and CONCORDANCE data in Fig. 4.
Lifestyle changes are believed responsible for temporal trends of reduced population total cholesterol (TC), but it is uncertain whether this applies to patients with known coronary heart disease (CHD) often prescribed lipid lowering therapy (LLT). We studied temporal TC trends at presentation with acute coronary syndrome (ACS) to determine the contribution of LLT given for secondary prevention.
TC and LLT were obtained in 5592 patients in annual surveys of ACS admissions in Australia between 1999 and 2013, and annual mean trends analysed by linear and segmented regression.
TC declined from 5.13 ± 1.1 to 4.53 ± 1.2 mmol/L (p < 0.001) and LLT (96% statin) use at presentation increased from 37.4% to 47.5% (p = 0.005). TC decline was greater in those on LLT vs. those not on therapy, with LLT contributing to 57% of the TC decline. The decline in TC and increase in LLT use was non-linear and much steeper in those with, than without CHD history, and LLT contributed substantially more to the TC decline (79%, p < 0.001 vs. 27%, p = 0.06 respectively). The rapid decline in TC and increase in LLT, plateauing after 2005 in those with CHD history differed markedly from trends in recent population studies, while TC trend for those without CHD history was slower, linear and consistent with population trends.
Declining TC level at presentation for ACS was strongly associated with increasing LLT use in those with a history of CHD, indicating that increasing uptake of LLT for secondary prevention has impacted TC changes in the new millennium.
Aging and dyslipidemia: A review of potential mechanisms
2015, Ageing Research Reviews
Citation Excerpt :
In women, the TG concentrations increase throughout their life, and are higher in those using estrogens all the time (Gobal and Mehta, 2010). Nevertheless, in a few studies including older persons, TC in the elderly has been reported to decrease with age (Table 1) (Gillum et al., 1982; Hershcopf et al., 1982). Most investigators consider that the decrease of TC as age increases may represent cohort, period, and/or survivorship effects rather than a true decline (Newschaffer et al., 1992).
Elderly adults constitute a rapidly growing part of the global population, thus resulting in an increase in morbidity and mortality related to cardiovascular disease (CVD), which remains the major cause of death in elderly population, including men and women. Dyslipidemia is a well-established risk factor for CVD and is estimated to account for more than half of the worldwide cases of coronary artery disease (CAD). Many studies have shown a strong correlation between serum cholesterol levels and risk of developing CAD. In this paper, we review the changes of plasma lipids that occur in men and women during aging and the potential mechanisms of age-related disorders of lipoprotein metabolism covering humans and/or animals, in which changes of the liver sinusoidal endothelium, postprandial lipemia, insulin resistance induced by free fatty acid (FFA), growth hormone (GH), androgen (only for men) and expression and activity of peroxisome proliferator-activated receptor α (PPARα) are mainly focused.
Predictors of falling cholesterol levels in older adults: The cardiovascular health study
2004, Annals of Epidemiology
To estimate 4-year change in serum total cholesterol levels in a population-based sample of older adults and identify independent predictors of cholesterol decline.
Prospective study of 2837 adults aged 65 years and older with serum cholesterol measured in 1992–1993 and 1996–1997.
Mean serum cholesterol levels declined 6.3 mg/dl between the two examinations. Declines were greater in white (−7.3 mg/dl) than black (−1.4 mg/dl) participants and in those in good/excellent health (−0.9 mg/dl) vs. fair/poor health (−3.1 mg/dl; both p < 0.01). Factors associated with greater decline on multivariate analysis included age, male gender, and higher white cell count, albumin, and baseline cholesterol. Cholesterol levels declined 2.0 mg/dl per 6 year increment in baseline age and 6.8 mg/dl more in men than women after adjustment for other factors. C-reactive protein levels were unrelated to cholesterol change.
Declining cholesterol levels were associated with male gender, advanced age, weight loss, and white blood cell count but not with C-reactive protein levels. The role of declining cholesterol synthesis, due to as yet undefined age-related changes or to cytokine-mediated reductions related to illness, should be examined to help clarify the mechanisms of the sometimes marked declines in cholesterol levels observed at advanced ages.
Age-related changes in risk factor effects on the incidence of thromboembolic and hemorrhagic stroke
2003, Journal of Clinical Epidemiology
We examined the changes in risk factor effects on the incidence of thromboembolic and hemorrhagic stroke as they may occur with age. Findings were based on repeated risk factor measurements at four examinations over a 26-year period in 7589 men in the Honolulu Heart Program. After each examination, 6 years of follow-up were available to assess risk factor effects on the incidence of stroke over a broad range of ages (45–93 years). As compared with normotensive men, the risk of thromboembolic stroke in the presence of hypertension declined from a 7-fold excess in men aged 45 to 54 years to a 1.4-fold excess in men aged ⩾75 (P<.001). Adverse effects of diabetes and atrial fibrillation seemed to be equally important across all ages, whereas a protective effect of physical activity increased with age. Except for men with atrial fibrillation, the incidence of thromboembolic stroke increased significantly with age regardless of risk factor status, including men with normal blood pressure (P<.001). Although hemorrhagic events were less common, positive relations with cigarette smoking seemed to strengthen with age, whereas those with hypertension tended to decline. Our findings suggest that strategies for the prevention of stroke may need to account for changes in risk factor effects as they occur with age. Control of diabetes and the encouragement of active lifestyles in the elderly seem to be especially important.
Exercise considerations in hypertension, obesity, and dyslipidemia
2003, Clinics in Sports Medicine

View all citing articles on Scopus

¹: Present address: The Rockefeller University, New York, NY 10021.

²: Present address: Scarsdale Medical Center, 259 Heathcote Road, Scarsdale, NY 16583.

³: Present address: University of South Florida College of Medicine, Tampa, FL 33612.

View full text

Original articleLongitudinal changes in serum cholesterol in man: An epidemiologic search for an etiology

Abstract

J Biol Chem

Adv Clin Chem

Am J Clin Nutr

Am J Med

Am J Clin Nutr

J Chron Dis

Am J Clin Nutr

Am J Clin Nutr

Am J Clin Nutr

J Chron Dis

Fourth Report of the Director of the National Heart, Lung, and Blood Institute

Coronary mortality: what is going on?

J Am Med Assoc

The recent decline in ischemic heart disease mortality

Ann Intern Med

Total serum cholesterol levels of adults, 18–74 years, United States, 1971–1974

Original article
Longitudinal changes in serum cholesterol in man: An epidemiologic search for an etiology