Table of Contents    
Year : 2013  |  Volume : 4  |  Issue : 2  |  Page : 359-363  

Plasma total cholesterol level and some related factors in northern Iranian people

1 Department of Biochemistery and Nutrition, Golestan University of Medical Sciences, Gorgan, Iran
2 Deputy of Health, Golestan University of Medical Sciences, Gorgan, Iran
3 Department of Microbiology, Golestan University of Medical Sciences, Gorgan, Iran

Date of Web Publication26-Aug-2013

Correspondence Address:
Gholamreza Veghari
Ischemic Disorders Research Center, Golestan University of Medical Sciences, Gorgan
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0976-9668.117008

Rights and Permissions

Background: In middle age people, hypercholesterolemia (HC) has been included as a risk factor for cardiovascular disease. Objectives: The main objective of this study was to evaluate the prevalence of HC and some related factors in the north of Iran. Materials and Methods: This was a population-based cross-sectional study that enrolled 1995 subjects (997 males and 998 females) in 25-65 year age using stratified cluster sampling. Interviewers recorded the data using a multidimensional questionnaire including anthropometric indexes. Plasma cholesterol was measured in the morning after a 12-hour fast and determined by an auto-analyzer. HC was defined by a total plasma total cholesterol level over 200 mg/dl. The SPSS.16 software was used to analyze data. Results: The mean age of the participant was 44.2 years and mean ± SD plasma total cholesterol level in men and women was 196.7 ± 39.11 and 209.4 ± 42.9, respectively. Generally, the prevalence of HC was 50.4% with a significant differences between men (44.7%) and women (57%) ( P < 0.05). The mean plasma total cholesterol levels were significantly differenced among age groups, location area, BMI, and waist circumferences ( P < 0.001). Women gender (OR = 1.64), 55-65 years old (OR = 2.79), BMI ≥40 kg/m 2 (OR = 10.0), and abdominal obesity (OR = 2.47) were associated with increased risk of HC ( P = 0.001 and 95%CI for all). Conclusion: HC is one of the most health problems in the northern Iran and it is more common in women than in men. General and abdominal obesity are the most common risk factors for HC.

Keywords: Hypercholesterolemia, Iran, obesity, socio-demographic, total cholesterol

How to cite this article:
Veghari G, Sedaghat M, Joshghani H, Niknezad F, Angizeh A, Tazik E, Moharloei P, Banihashem S. Plasma total cholesterol level and some related factors in northern Iranian people. J Nat Sc Biol Med 2013;4:359-63

How to cite this URL:
Veghari G, Sedaghat M, Joshghani H, Niknezad F, Angizeh A, Tazik E, Moharloei P, Banihashem S. Plasma total cholesterol level and some related factors in northern Iranian people. J Nat Sc Biol Med [serial online] 2013 [cited 2020 Aug 14];4:359-63. Available from:

   Introduction Top

In middle age people, total cholesterol levels have been established as a risk factor for a cardiovascular disease (CVD) risk marker. [1] In Finland data have been shown that mortality rate from CVD among people high plasma total cholesterol level people (>300 mg/dl) is fivefold higher than other factors and reducing plasma total cholesterol level by 10% can reduce the mortality due to CVD up 30%. [2]

According to a survey in the USA, 50% of adults showed cholesterol level higher than 200 mg/dl, while 37 million people had levels higher than 240 mg/dl. [3] Framingham et al. [4] showed that the prevalence of mortality and morbidity due to CVD can be estimated by the determination of plasma cholesterol levels in young and adult people. Several other studies have shown that many factors such as lifestyle, diet, smoking, BMI, gender, physical activity, and age are correlated with mean plasma cholesterol level. [5],[6],[7]

Of 1.6 million people in Golestan province (northern Iran and south east of Caspian sea), 66.39% are 25-65 years old, whereas 43.9% and 56.1% are living in urban and rural area, respectively. [8] Agriculture is the main occupation in the rural area.

The main objective of this study was to determine the plasma total cholesterol status and some associated factors in people of urban and rural areas in northern Iran. This study may suggest the ways to decline or prevent the risk of CVD in this area.

   Materials and Methods Top

This was a population-based cross-sectional study conducted in Golastan Province (northern Iran). Regarding the previous study [3] and 95% confidence interval, 1995 subjects (997 males and 998 females) were chosen by the stratified cluster sampling method. From 11 districts, 100 clusters of 20 cases were randomly selected by family code in Primary Health Centers in rural areas and postal code in urban areas with equal proportions of genders. From each district, one team was trained to complete the questionnaire and measure anthropometric indexes. The questionnaire included demographic characteristics, residential area, educational level, and physical activity.

All family members in blocks who were in 25-65 years were included in the clusters. Pregnant women and those who were unwilling to participate in this study were excluded from the study. Weight was measured with light clothing without shoes and height was measured with standing up and head, back, and buttock on the vertical land of the height gauge.

Body mass index (BMI) was calculated as weight (kg)/height (m 2 ) and using World Health Organization classification. [9] BMI of 25.0-29.9 kg/m 2 was classified as overweight, BMI of 30.0-39.9 kg/m 2 was classified as obese, and BMI ≥40 kg/m 2 was classified as pathologic obese. Waist circumference higher than the normal range (men >102 and women >88 cm) was determined as abdominal obesity. [10]

Physical activity was categorized into five categories based on daily work and activity including no physical activities (without moving from one place to another), low physical activity (activity that requires extension of the muscular-skeletal system and moving from one place to another), moderate physical activity (activity that requires sometimes increased respiratory rate like cleanliness, gardening, building painting, etc.), high physical activity (activity that requires highly increased reparatory rate like manual labor, building labor, etc.), and very high activity (a combination of above activities). [11]

For measuring plasma total cholesterol level, blood was drowned from each subject after 12 hours fast in the morning. Plasma total cholesterol was measured with commercial kits (Pars Azmoon, Karaj, Iran) by an auto-analyzer. The plasma cholesterol level more than 200 mg/dl was diagnosed as hypercholesterolemia (HC). [12]

SPSS 16.0 software was used for the statistical analysis, the Chi-square test was used for comparing frequencies and the t-test and ANOVA were used for comparing the means. Logistic regression analysis was applied in order to estimate the odds ratio (OR) of HC considering the socio-demographic factors at 95% significant level. A P value <0.05 included significations. The reliability was assessed using Cronbach's alpha coefficient and was found to be 0.86. This study was approved by Ethical Research Committee and consent was received from all participants. Unwilling subjects and pregnant women were excluded from this study.

   Results Top

The mean and standard deviation of age was 44.2 ± 11.3 years. Of the 1995 subjects, 50%, 46.7%, 29%, and 43.3% were men, urban residence, general, and abdominal obese, respectively [Table 1].
Table 1: Characteristics of study subjects (n=1995)

Click here to view

The mean and standard deviation of plasma total cholesterol levels were 203.6 ± 40.7 mg/dl and it was 12.7 mg/dl higher in women than in men. There was a positive significant correlation between age and plasma total cholesterol level ( P = 0.001). Plasma total cholesterol level decreased with physical activity; the mean of plasma total cholesterol level in the low active group (205.1 mg/dl) was 14.9 mg/dl higher than in the very active group (190.2 mg/dl) which was statistically significant ( P = 0.019). The plasma total cholesterol level had a positive correlation with BMI P = 0.001), and in the obese group (BMI ≤40 kg/m 2 ) (255.5 mg/dl) it was 71.4 mg/dl higher than in the thin group (BMI <18.5 kg/m 2 ) (184.1 mg/dl) [Table 2].
Table 2: The mean and standard deviation of plasma total cholesterol levels based on some related factors

Click here to view

The overall prevalence of HC was 50.9% and it was up to 12.3% higher in women (57%) than in men (44.7%) ( P = 0.001). The prevalence of HC was 25.1% among 55-65 years age participants (61.5%) higher than among that observed in the 25-35 years age group (36.4%). HC was significantly common in abdominal obese subjects (63.2%) higher than in normal subjects (41%) ( P = 0.001) and in the urban area (53.1%) it was 4.1% higher than in the rural area (49%) without statistically significant difference [Table 3].
Table 3: The prevalence of hypercholesterolemia based on some related factors

Click here to view

Multiple logistic regressions were used to identify variables that contribute to HC. The risk of HC was found to be 1.64 [95% CI: 1.31-1.99] in female compared to male; 2.79 [95% CI: 2.15-3.631] in 55-65 years subjects compared to 25-35 years; 10.00 [95% CI: 3.75-26.67] in BMI ≥40 compared to BMI ≤18.5 and 2.47 [95% CI: 2.06-2.98] in abdominal obesity compare to normal people. No significant differences were found among residential area and physical activities [Table 4].
Table 4: Odds ratio and 95% CI obtained from logistic regression analysis for hypercholesterolemia

Click here to view

   Discussion Top

The results of this study show that half of adult population living in northern Iran is hypercholestrolomic. The prevalence of HC has been reported to be in Romania (70%), Northwest Mexico (52.6%), Indian rural (22.3%), Spain (24%), Western Samoa (36%), Koki (25%), and Saudi Arabia (54%). [6],[13],[14],[15],[16],[17],[18] HC prevalence in Tehran (capital of Iran) and in Arak (a capital city in central Iran) has been reported up to be 40.4% and 26.7%, respectively. [19] As like as mentioned studies [13],[14],[18] the prevalence of HC in the north of Iran is high and should be consider as the most common health problem in this area.

In our study, the prevalence of HC was seen to be higher in urban than in rural and higher in women than in men. There was a positive association between age, waist circumference, and BMI with plasma total cholesterol level.

Increasing HC in an urban population in the worldwide has been shown in some studies. [18],[20],[21] Similarly, women suffer from HC than man. [13],[21],[22],[23],[24] After menopause, estrogen has a positive role in serum cholesterol level, therefore, estrogen therapy has been recommended for the control of CVD. [22] In our study, half of the women were over 45 years, which may be used as a interfering factor for increased plasma total cholesterol level.

The correlation between plasma total cholesterol level and age, waist circumference, and BMI in our study is similar to the earlier reports. [13],[23],[25],[26],[27],[28]

The influence of physical activity on the serum cholesterol level was not similar in all studies. Although the role of physical activity in decreasing plasma total cholesterol level has been shown in many studies, [29],[30] there was not any correlation between them in another. [31] Physical activities decreased the plasma lipid profile with statistical significant differences in HDLc and ApoA1. [4],[24]

We don't know whether there is any signification between physical activity and HC, but it seems that other related factors which are not included in our study such as ethnicity and food behavior do have influence on the plasma total cholesterol level.

   Conclusion Top

Our study showed that HC is a health problem in northern Iran and it is common in half the adult population. Socio-economic status, general, and abdominal obesity are predispose factors for HC. Screening and intervention programs for the prevention of HC are necessary. Further studies are necessary to examine the related factors such as life style, food behavior, ethnic differences, and awareness with HC.

   Acknowledgments Top

The authors would like to thank the medical and administrative staff in the Primary Health Care Centers of Golestan University of Medical Sciences for their valuable assistance during the field work. This paper was created from provincial incommunicable data study and supported by Health Office of Golestan University of Medical Sciences and based on 258888 official document justifying publication.

   References Top

1.Kones R. Primary prevention of coronary heart disease: Integration of new data, evolving views, revised goals, and role of rosuvastatin in management. A comprehensive survey. Drug Des Devel Ther 2011;5:325-80.  Back to cited text no. 1
2.Ousilahti P, Serum cholesterol disease risk: Observations and predictions among middle aged population in eastern Finland. Circulation 1998;97:1087-97.  Back to cited text no. 2
3.Schaefer EJ. Hyperlipidemia and coronary artery disease. In: Becker KL, editor. Becker′s principles and practice of endocrinology and metabolism. 2 nd ed. Philadelphia: J. B Lippincott Company; 1995. p. 1378-80.  Back to cited text no. 3
4.D′Agostino RB Sr, Grundy S, Sullivan LM, Wilson P, CHD Risk Prediction Group. Validation of the Framingham coronary heart disease prediction scores: Results of a multiple ethnic groups investigation. JAMA 2001;286:180-7.  Back to cited text no. 4
5.Morikawa Y, Nakagawa H, Miura K, Soyama Y, Ishizaki M, Kido T, et al. Effect of shift work on body mass index and metabolic parameters. Scand J Work Environ Health 2007;33:45-50.  Back to cited text no. 5
6.Oancã ME, Azoicãi D, Manole A, Ivan A. Contributions to the knowledge of clinical and epidemiological features of essential arterial hypertension in Moldavia, Romania. Rev Med Chir Soc Med Nat Iasi. 2007;111:1012-6.  Back to cited text no. 6
7.Kolovou GD, Anagnostopoulou KK, Damaskos DS, Mihas C, Mavrogeni S, Hatzigeorgiou G, et al. Gender influence on postprandial lipemia in heterozygotes for familial hypercholesterolemia. Ann Clin Lab Sci 2007;37:335-42.  Back to cited text no. 7
8.Statistical Center of Iran (2006). Population and Housing Census. Available from: [Last accessed on 2011 May 23].  Back to cited text no. 8
9.World Health Organization. Obesity: Prevention and managing the global epidemic. Geneva: WHO; 2000.  Back to cited text no. 9
10.Molarius A, Seidell JC, Visscher TL, Hofman A. Misclassification of high-risk older subjects using waist action levels established for young and middle-aged adults-results from the Rotterdam Study. J Am Geriatr Soc 2000;48:1638-45.  Back to cited text no. 10
11.Ebrahimi M, Mansournia MA, Haghdoost AA, Abazari A, Alaeddini F, Mirzazadeh A, et al. Social disparities in prevalence, treatment and control of hypertension in Iran: Second national surveillance of risk factors of noncommunicable diseases 2006. J Hypertens 2010;28:1620-9.  Back to cited text no. 11
12.Costa J, Borges M, Oliveira E, Gouveia M, Carneiro AV. Incidence and prevalence of hypercholesterolemia in Portugal: A systematic review. Part 3. Rev Port Cardiol 2003;22:829-36.  Back to cited text no. 12
13.Alemán-Mateo H, Esparza-Romero J, Romero RU, García HA, Pérez Flores FA, Ochoa Chacón BV, et al. Prevalence of malnutrition and associated metabolic risk factors for cardiovascular disease in older adults from Northwest Mexico. Arch Gerontol Geriatr 2008;46:375-85.  Back to cited text no. 13
14.Gupta R. Lipoprotein tipids and the prevalence of hyperlipidemia in rural India. J Cardiovasc Risk 1994;1:179-84.  Back to cited text no. 14
15.Plans P, Pardell H, Salleras L. Epidemiology of cardiovascular disease risk factors in Catalonia (Spain). Eur J Epidemiol 1993;9:381-9.  Back to cited text no. 15
16.Hodge AM, Dowse GK, Tocluope P. The association of modernization with dyslipidemia and changes in lipid levels in the Polynesian population of western Samoa. Int J Epidemol 1997;26:297-306.  Back to cited text no. 16
17.Erasmus RT, Sinh AK, Nathniel K. Serum lipid concentrations in the Koki community a preliminary report. Med J 1993;36:306-10.  Back to cited text no. 17
18.Al-Nozha MM, Arafah MR, Al-Maatouq MA, Khalil MZ, Khan NB, Al-Marzouki K, et al. Hyperlipidemia in Saudi Arabia. Saudi Med J 2008;29:282-7.  Back to cited text no. 18
19.Agheli N, Movahedi A. Serum Cholesterol level and its association with their fats and Cholesterol intake. J Med Fac Guilan Univ Med Sci 2001;38-37:77-69.  Back to cited text no. 19
20.Janghorbani M, Amini M, Gouya MM, Delavari A, Alikhani S, Mahdavi A. Nationwide survey of prevalence and risk factors of prehypertension and hypertension in Iranian adults. J Hypertens 2008;26:419-26.  Back to cited text no. 20 AR, Mirdad S, al-Rubeaan K, al-Mazrou Y, al-Attas O, al-Daghari N, et al. Population-based epidemiological study on characteristics of risk factors of hypercholesterolemia in Saudi Arabia. Int J Cardiol 1997;31;62:47-54.  Back to cited text no. 21
22.Gast GC, Grobbee DE, Pop VJ, Keyzer JJ, Wijnands-van Gent CJ, Samsioe GN, et al. Menopausal complaints are associated with cardiovascular risk factors. Hypertension 2008;51:1492-8.  Back to cited text no. 22
23.Karimi F, Rayani M, Akbarzadeh S, Khakzad M, Tahmasebi R, Arab J, et al. Prevalence of hy1perlipidemias in adult population (=>19 years) of Bushehr port, 1999. Iranian South Med J 2001;2:106-98.  Back to cited text no. 23
24.Panagiotakos DB, Pitsavos C, Chrysohoou C, Skoumas J, Zeimbekis A, Papaioannou I, et al. Effect of leisure time physical activity on blood lipid levels: The ATTICA study. Coron Artery Dis 2003;14:533-9.  Back to cited text no. 24
25.Kende M. Superiority of traditional village diet and lifestyle in minimizing cardiovascular disease risk in Papua New Guineans. P N G Med J 2001;44:135-50.  Back to cited text no. 25
26.Oppert JM, Thomas F, Charles MA, Benetos A, Basdevant A, Simon C. Leisure-time and occupational physical activity in relation to cardiovascular risk factors and eating habits in French adults. Public Health Nutr 2006;9:746-54.  Back to cited text no. 26
27.Ko GT, Chan JC, Chan AW, Wong PT, Hui SS, Tong SD, et al. Low levels of awareness of suboptimal health conditions in a high-risk working population: The "better health for better Hong Kong" health promotion campaign. Int J Behav Med 2007;14:63-9.  Back to cited text no. 27
28.Williams PT, Hoffman K, La I. Weight-related increases in hypertension, hypercholesterolemia, and diabetes risk in normal weight male and female runners. Arterioscler Thromb Vasc Biol 2007;27:1811-9.  Back to cited text no. 28
29.Remsberg KE, Rogers NL, Demerath EW, Czerwinski SA, Choh AC, Lee M, et al. Sex differences in young adulthood metabolic syndrome and physical activity: The Fels longitudinal study. Am J Hum Biol 2007;19:544-50.  Back to cited text no. 29
30.Chen JL, Wu Y. Cardiovascular risk factors in Chinese American children: Associations between overweight, acculturation, and physical activity. J Pediatr Health Care 2008;22:103-10.  Back to cited text no. 30
31.Perkins GM, Owen A, Kearney EM, Swaine IL. Biomarkers of cardiovascular disease risk in 40-65-year-old men performing recommended levels of physical activity, compared with sedentary men. Br J Sports Med 2009;43:136-41.  Back to cited text no. 31


  [Table 1], [Table 2], [Table 3], [Table 4]

This article has been cited by
1 Appropriate Total cholesterol cut-offs for detection of abnormal LDL cholesterol and non-HDL cholesterol among low cardiovascular risk population
Nopakoon Nantsupawat,Apaputch Booncharoen,Anawat Wisetborisut,Wichuda Jiraporncharoen,Kanokporn Pinyopornpanish,Lalita Chutarattanakul,Chaisiri Angkurawaranon
Lipids in Health and Disease. 2019; 18(1)
[Pubmed] | [DOI]
2 Mean serum lipid levels in Iranian adult populations: a systematic review and meta-analysis
Mostafa Qorbani,Ozra Tabatabaei-Malazy,Roya Kelishadi,Bagher Larijani
Clinical Lipidology. 2015; 10(5): 449
[Pubmed] | [DOI]


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article
    Materials and Me...
    Article Tables

 Article Access Statistics
    PDF Downloaded218    
    Comments [Add]    
    Cited by others 2    

Recommend this journal