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Samaha et al. Hyperlipidemia in Lebanon

The prevalence of hypercholesterolemia and associated mortality and morbidity in Lebanon.
triglyceridemia was significantly higher in males than Moreover, given the lack of sufficient available
females (both P < 0. 01), but prevalence of high LDL-C literature, we could not find a study that analyzed
was higher in females (P < 0.01). the effect of gender or dietary/lifestyle habits on
the prevalence of atherosclerosis in the Lebanese
Cigarette smokers have significantly higher prevalence population. This has hindered us from making a
of high cholesterol (P < 0.01), TG (P = 0.002) and meaningful conclusion on the interplay between these
LDL-C levels (P < 0.001). Likewise, sedentary parameters and atherosclerosis.
individuals exhibited higher prevalence of all the three
hyperlipidemias (P < 0.01 for cholesterol and P < 0.001 Compared with other countries, the prevalence of
for TG and LDL-C). hypercholesterolemia in Lebanon is higher than that
in Turkey, Saudi Arabia, India, Guadeloupe,
[26]
[25]
[23]
[24]
[27]
With respect to the dietary factors, consumption of but lower than that in England, and similar to that in
[28]
3 or more servings of either fatty meat or eggs was Finland, and the USA. [29]
significantly associated with higher prevalence of
the three hyperlipidemias. Consumption of whole or Gender appeared to play an important role in the
skimmed milk did not significantly affect the prevalence prevalence of the lipidemia studied. Although there
of hypercholesterolemia. However, participants who was no difference in mean cholesterol levels between
reportedly consumed 1 or more servings of skimmed males and females, more males suffered from
milk had significantly lower incidence of high TG hypercholesterolemia. In addition, prevalence of high
or LDL-C levels (P < 0.001). The exact opposite is TG was higher in males than females. This lower
noted for those who consumed 1 or more servings of prevalence in females may suggest that female sex
whole milk; these individuals had significantly higher hormones, particularly estrogen, offers a protective
prevalence of high TG and LDL-C levels (P < 0.001). effect against the elevation of cholesterol or TG
levels in the Lebanese population. Indeed, such a
The number of serving of fruits/vegetables per protective role for estrogen has been previously
[30-33]
week did not seem to contribute to the prevalence reported, but remains controversial. Interestingly,
of hypercholesterolemia. However, those who in the female population included in this study, the
consumed 3 or more servings of fruits/vegetables had levels of cholesterol and TG increased with age,
a significantly lower prevalence of high TG and LDL-C even beyond menopause. On the other hand, it is
possible that estrogen contributes to the increased
levels (P < 0.001).
levels of TG. While this would be consistent with other
reports where estrogen was shown to precipitate
DISCUSSION hypertriglyceridemia, it remains inconsistent with
[34]
other studies suggesting that menopausal women
To the best of our knowledge, this is the first study to have higher levels of LDL-C and TC compared with
determine the prevalence of hypercholesterolemia pre-menopausal women. [35,36] Moreover, estrogen
in Lebanon. In fact, it is also the largest and injection has been shown to reduce hepatic cholesterol
most comprehensive study examining a health- synthesis thereby leading to decreased blood levels of
related issue in Lebanon, a small country with a LDL-C. [36,37]
total population of around 4 million people. The
relatively large number of participants and their It is also possible that the male hormone, testosterone,
wide demographic distribution covering all parts of predisposes men for hypercholesterolemia and
Lebanon are two strengths of this study. triglyceridemia. Indeed, some reports suggest that
testosterone levels are inversely proportional to
In this study, we first determined the prevalence of TC, serum lipid levels in males. Moreover, animal
[38]
LDL-C, HDL-C and TG in the Lebanese population. studies show that testosterone-deficient male mice
We then evaluated how age, gender, some dietary exhibit higher cholesterol levels, clearly suggesting a
and lifestyle-related habits modulated the lipid favorable role for testosterone in regulating blood lipid
profile. We herein report that 53% of the Lebanese levels. However, testosterone is unlikely to explain
[39]
population is hypercholesterolemic. Alarmingly, most the higher prevalence of hypercholesterolemia in
of these subjects were unaware of their lipid profile. males, particularly because the population average of
This mandates concerted efforts to educate the public cholesterol did not differ between males and females.
about the danger of dyslipidemia as well as its relation
to various cardiovascular diseases. Unfortunately, Because it increased the prevalence of
no large-scale studies have determined the CVD- hypercholesterolemia and triglyceridemia, smoking
102 Vessel Plus ¦ Volume 1 ¦ September 26, 2017