title: Low HDL cholesterol as a cardiovascular risk factor in rural, urban, and rural-urban migrants: PERU MIGRANT cohort study.
abstract: BACKGROUND
  Whilst the relationship between lipids and cardiovascular mortality has been well studied and appears to be controversial, very little has been explored in the context of rural-to-urban migration in low-resource settings.
  
  
  OBJECTIVE
  Determine the profile and related factors for HDL-c patterns (isolated and non-isolated low HDL-c) in three population-based groups according to their migration status, and determine the effect of HDL-c patterns on the rates of cardiovascular outcomes (i.e. non-fatal stroke and non-fatal myocardial infarction) and mortality.
  
  
  METHODS
  Cross-sectional and 5-year longitudinal data from the PERU MIGRANT study, designed to assess the effect of migration on cardiovascular risk profiles and mortality in Peru. Two different analyses were performed: first, we estimated prevalence and associated factors with isolated and non-isolated low HDL-c at baseline. Second, using longitudinal information, relative risk ratios (RRR) of composite outcomes of mortality, non-fatal stroke and non-fatal myocardial infarction were calculated according to HDL-c levels at baseline.
  
  
  RESULTS
  Data from 988 participants, rural (n = 201), rural-to-urban migrants (n = 589), and urban (n = 199) groups, was analysed. Low HDL-c was present in 56.5% (95%CI: 53.4%-59.6%) without differences by study groups. Isolated low HDL-c was found in 36.5% (95%CI: 33.5-39.5%), with differences between study groups. In multivariable analysis, urban group (vs. rural), female gender, overweight and obesity were independently associated with isolated low HDL-c. Only female gender, overweight and obesity were associated with non-isolated low HDL-c. Longitudinal analyses showed that non-isolated low HDL-c increased the risk of negative cardiovascular outcomes (RRR = 3.46; 95%CI: 1.23-9.74).
  
  
  CONCLUSIONS
  Isolated low HDL-c was the most common dyslipidaemia in the study population and was more frequent in rural subjects. Non-isolated low HDL-c increased three-to fourfold the 5-year risk of cardiovascular outcomes.
authors.affiliation: CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: María
authors.initials: M
authors.lastname: Lazo-Porras
authors.affiliation: CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Antonio
authors.initials: A
authors.lastname: Bernabe-Ortiz
authors.affiliation: CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Germán
authors.initials: G
authors.lastname: Málaga
authors.affiliation: Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA; Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Gilman
authors.affiliation: Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Ana
authors.initials: A
authors.lastname: Acuña-Villaorduña
authors.affiliation: Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: Deborah
authors.initials: D
authors.lastname: Cardenas-Montero
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
authors.affiliation: CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru. Electronic address: Jaime.Miranda@upch.pe.
authors.forename: J Jaime
authors.initials: JJ
authors.lastname: Miranda
mesh_terms: D000328:Adult; D017677:Age Distribution; D015415:Biomarkers / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D015536:Down-Regulation; D050171:Dyslipidemias / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D016017:Odds Ratio; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012423:Rural Health; D017678:Sex Distribution; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D014171:Transients and Migrants; D014504:Urban Health
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL
keywords: Cholesterol; HDL; Human migration; Mortality; Myocardial infarction; Stroke