Interethnic variation in lipid profiles: implications for underidentification of African–Americans at risk for metabolic disorders

Q: What is the clinical evidence from this study?

Study design: Review. Population: Dyslipidemia, Type 2 Diabetes, and Cardiovascular Disease. Intervention: African ancestry / ethnic variation in lipid metabolism vs. European Americans and other US ethnic groups. Primary outcome: Serum lipid concentrations (triglycerides and HDL-C) and metabolic disease risk.

Q: What does this research mean for the field?

African Americans exhibit a paradoxically healthier lipid profile with lower triglycerides and higher HDL-C than European Americans, resulting in the under-identification of their elevated risk for type 2 diabetes and cardiovascular disease when using standard lipid criteria. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

Amy R. Bentley; Charles N. Rotimi

doi:10.1586/eem.12.55

November 1, 2012Expert Review of Endocrinology & MetabolismOpen Access

Interethnic variation in lipid profiles: implications for underidentification of African–Americans at risk for metabolic disorders

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Key result

African Americans show more favorable lipid profiles despite a ~2-fold higher rate of type 2 diabetes.

Why the study?

African Americans experience a disproportionate burden of Type 2 Diabetes and Cardiovascular Disease despite generally having healthier serum lipid profiles than other US ethnic groups. Consequently, characterizing metabolic risk using standard lipid concentrations may under-identify African Americans at risk for metabolic disorders.

Key Points

To examine interethnic differences in serum lipid profiles and evaluate how these variations affect the identification of metabolic disease risk in African Americans.
Literature review analyzing epidemiological, physiological, and genetic data across racial and ethnic groups.
Evaluation of population-based datasets, including NHANES and ancestral West African cohorts, assessing lipid profiles, visceral adipose tissue, and lipase activity.
African Americans consistently exhibit lower mean triglycerides (113 mg/dl vs 143 mg/dl in European Americans and 158 mg/dl in Mexican Americans) and higher mean HDL cholesterol (54 mg/dl vs 50 mg/dl and 47 mg/dl, respectively) in NHANES.
African American children show 15.7 mg/dl lower triglycerides, 5.6 mg/dl lower LDL cholesterol, and 4.7 mg/dl higher HDL cholesterol compared to non-African American peers.
Despite favorable lipid profiles, African Americans face increased cardiovascular mortality and a 2-fold higher prevalence of type 2 diabetes than European Americans, indicating standard lipid cutoffs under-identify individuals at risk.

Structured PICO

P

Population

African Americans and other populations of African ancestry compared with European Americans and other US ethnic groups in a narrative review of serum lipid profiles and metabolic risk.

E

Exposure

Evaluation of interethnic variation in serum lipid profiles (triglycerides, HDL-C, LDL-C, Lp(a)), physiological determinants (visceral adipose tissue, lipoprotein lipase activity, acute insulin response), and genetic factors (African admixture, LPL, GCKR, ApoB, ANGPTL3/4, APOL1, CD36, PCSK9, LDLR, HMGCR).

C

Comparator

European Americans, Mexican Americans, and Hispanic Americans; standard uniform lipid threshold criteria (e.g., Metabolic Syndrome criteria).

O

Outcome

Serum lipid distributions and the identification/risk of metabolic disorders including insulin resistance, Metabolic Syndrome (MetSyn), Type 2 Diabetes (T2D), and Cardiovascular Disease (CVD).surrogate

Standard lipid thresholds used in Metabolic Syndrome criteria under-identify African Americans at risk for type 2 diabetes and cardiovascular disease because African Americans maintain more favorable triglyceride and HDL-C levels despite high insulin resistance and cardiometabolic risk.

Limitations

Standard metabolic syndrome lipid criteria under-identify African Americans at risk for metabolic disorders
Low transferability (only ~30-42%) of European-ancestry lipid GWAS loci to African Americans
Lack of large, long-term prospective studies evaluating the relationship between serum lipids, genetics, and cardiovascular mortality in African ancestry populations
Standard Metabolic Syndrome lipid criteria under-identify African Americans at risk due to differing relationships between serum lipids and insulin resistance.
Limited transferability of European ancestry GWAS findings to African Americans (only 30% of SNPs tested for each trait were generalizable in cited analyses).
Lack of large, long-term prospective studies examining the extent to which serum lipids are risk factors for CVD mortality and T2D in African ancestry populations.

Ask about this paper

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Implication

Standard lipid thresholds may under-identify cardiometabolic risk in African Americans; leaves open whether ethnicity-specific cutoffs improve prediction.

Abstract

Interethnic differences exist in the distribution of serum lipids, with African Americans (AA) generally having a healthier lipid profile than other US ethnic groups. Similar lipid distributions are observed among other African ancestry groups with distinct lifestyle characteristics, suggesting the importance of inherited factors. Despite healthier serum lipids, AA experience a disproportionate burden of Type 2 Diabetes and Cardiovascular Disease. As evidence of a different relationship between serum lipids and disease exists, the characterization of metabolic risk using lipid concentration (as in Metabolic Syndrome criteria) may lead to the under-identification of AA at risk. Given the disproportionately high rate of metabolic disorders in AA, understanding interethnic differences in the association between serum lipids and disease should be a research priority, as better appreciation of these differences will enhance knowledge of disease etiology, improve intervention targeting, and may lead to mechanisms to ameliorate debilitating health disparities in the US and globally.

Discussion

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Cite This Study

Bentley et al. (2012) conducted a review in Dyslipidemia, Type 2 Diabetes, and Cardiovascular Disease. African ancestry / ethnic variation in lipid metabolism vs. European Americans and other US ethnic groups was evaluated on Serum lipid concentrations (triglycerides and HDL-C) and metabolic disease risk. African Americans exhibit lower mean triglycerides and higher HDL-C than European Americans despite a 2-fold higher prevalence of type 2 diabetes.

synapsesocial.com/papers/6af32071d38b8a80edecd3cb https://doi.org/10.1586/eem.12.55

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Interethnic variation in lipid profiles: implications for underidentification of African–Americans at risk for metabolic disorders

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Interethnic variation in lipid profiles: implications for underidentification of African–Americans at risk for metabolic disorders

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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