High total cholesterol | High triglycerides | Low high-density lipoprotein cholesterol | Normal to elevated low-density lipoprotein cholesterol | Small, dense low-density lipoprotein particles
The relationship of the age-adjusted prevalence of high total cholesterol, defined as 240 mg/dL (6.21 mmol/L), to BMI from NHANES III is shown in Figure 3 (2).
Figure 3. NHANES III Age-Adjusted Prevalence of High Blood Cholesterol* According To Body Mass Index
At each BMI level, the prevalence of high blood cholesterol is greater in women than in men. In a smaller sample, higher body weight is associated with higher levels of total serum cholesterol in both men (133) and women (134) at levels of BMI > 25. Several large longitudinal studies also provide evidence that overweight, obesity, and weight gain are associated with increased cholesterol levels (135-137). In women, the incidence of hypercholesterolemia also increases with increasing BMI (138). In addition, the pattern of fat distribution appears to affect cholesterol levels independently of total weight. Total cholesterol levels are usually higher in persons with predominant abdominal obesity, defined as a waist-to-hip circumference ratio of 0.8 for women and 1.0 for men (139).
The strong association of triglyceride levels with BMI has been shown in both cross-sectional and longitudinal studies, for both sexes and all age groups (133, 134, 140, 141). In three adult age groups, namely, 20 to 44 years, 45 to 59 years, and 60 to 74 years, higher levels of BMI, ranging from 21 or less to more than 30, have been associated with increasing triglyceride levels; the difference in triglycerides ranged from 61 to 65 mg/dL (0.68 to 0.74 mmol/L) in women (134) and 62 to 118 mg/dL (0.70 to 1.33 mmol/L) in men (133).
The age-adjusted prevalence of low high-density lipoprotein (HDL)-cholesterol in relation to BMI levels, based on NHANES III data, is shown in Figure 4.
HDL-cholesterol levels at all
ages and weights are lower in men than in women. Although low HDL-cholesterol
in this study was defined as < 35 mg/dL (0.91 mmol/L) in men and < 45
mg/dL (1.16 mmol/L) in women (2), the panel accepts the definition of low HDL-cholesterol as
35 mg/dL for men and women used by the National Cholesterol Education Program's
Second Report of the Expert Panel on the Detection, Evaluation, and
Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel II
Report) (2). Cross-sectional studies have
reported that HDL-cholesterol levels are lower in men and women with higher BMI
Longitudinal studies have found that changes in BMI are associated with changes
in HDL-cholesterol. A BMI change of 1 unit is associated with an
HDL-cholesterol change of 1.1 mg/dL for young adult men and an HDL-cholesterol
change of 0.69 mg/dL for young adult women (145).
Figure 4. NHANES III Age-Adjusted Prevalence of Low HDL-Cholesterol* According To Body Mass Index
The link between total serum cholesterol and CHD is largely due to low-density lipoprotein (LDL). A high-risk LDL-cholesterol is defined as a serum concentration of 160 mg/dL. This lipoprotein is the predominant atherogenic lipoprotein and is therefore the primary target of cholesterol-lowering therapy. Cross-sectional data suggest that LDL-cholesterol levels are higher by 10 to 20 mg/dL in relation to a 10- unit difference in BMI, from levels of 20 to 30 kg/m2(133, 134). According to extensive epidemiological data, a 10 mg/dL rise in LDL-cholesterol corresponds to approximately a 10 percent increase in CHD risk over a period of 5 to 10 years (146).
Few large-scale epidemiological data are available on small, dense LDL particles (147-149). Clinical studies have shown that small, dense LDL particles are particularly atherogenic and tend to be present in greater proportion in hypertriglyceridemic patients with insulin resistance syndrome associated with abdominal obesity (148-152).