Does Hypercholesterolemia Discriminate Against Certain Races More Than Other Races?

Abstract

The following text reviews the relationship between hypercholesterolemia and the race of patients that obtain higher cholesterol levels oppose to other races. Previous research uses consumption of eggs and/or diet in order to test cholesterol levels in different groups of people. This paper proposes research involving egg consumption as an independent variable and diet as a standardized variable in the experiment. To add on, researchers test how the intake of eggs affects cholesterol levels, which is the dependent variable. There were a variety of treatment groups and a varying sample size within the experiment. An issue found within this experimental design is also addressed. The niche is that although the experiment has a well designed experiment, it fails to take into consideration race and cultural background of their subjects which can have a strong impact on cholesterol levels. As a result, an extended experiment is suggested along with a hypothesis. The experiment in short, took 50 people in various races, and placing them on the same diet along with the same amount of egg consumption. The subjects are tested for cholesterol levels after a 30 day period to analyze how the egg consumption affected their health. This experiment would also consider race and culture. A hypothesis to this experiment was that non-caucasian men would have higher cholesterol levels than caucasian men. The results and discussion section touches upon the findings of various articles including two research articles. They all overall claim that eggs do increase cholesterol levels of a “bad” cholesterol called LDL, or low density lipoprotein. Overall, high cholesterol is a dangerous health issue, but it is true that some people of different races may have higher cholesterol levels than other races despite consuming the same diet due to familial hypercholesterolemia.

Introduction/Background

High cholesterol or hypercholesterolemia occurs when there are too much lipids or fats in your blood. Cholesterol levels are measured based off of a person’s lipoprotein profile. The lipoprotein profile includes level of LDL ( low density lipoproteins), HDL (high density lipoproteins) , and triglycerides. LDL are often associated as being the “bad” cholesterol because “LDL cholesterol can build up on the walls of your arteries and increase your chances of getting heart disease . . . The lower your LDL cholesterol number, the lower your risk” whereas HDL is associated as being the “ good” cholesterol because “HDL cholesterol protects against heart disease by taking the “bad” cholesterol out of your blood and keeping it from building up in your arteries.” (Beckerman 2018)

Having high cholesterol is very common and can lead to more serious health complications like heart attack and stroke. High cholesterol or hypercholesterolemia can be a result of poor lifestyle but also, inheritance in the form of  familial hypercholesterolemia. “Familial hypercholesterolemia is an inherited condition that causes high levels of LDL (low density lipoprotein) cholesterol levels beginning at birth, and heart attacks at an early age.” (Learning About Familial Hypercholesterolemia 2013) Certain ethnic groups are more vulnerable to having hypercholesterolemia due to dietary habits of their culture. The sorts of high fat diet of one generation can result in the next generations being at a higher risk regardless of what they are eating. I hypothesize that due to the genetic makeup and medical family histories of hispanic men and non-hispanic white men, hispanic men will have a higher cholesterol levels than non hispanic white men when consuming the same diets.

Methods

In previous research, the intake of eggs (independent variable) were used to see how it affects cholesterol levels (dependent variable)  in study groups. They “discuss how eggs and dietary cholesterol affect serum cholesterol concentrations, as well as more advanced lipoprotein measures, such as lipoprotein particle profiles and HDL metabolism … clinical studies examining the effects of added dietary cholesterol via egg intake on serum lipids during weight maintenance in healthy and hyperlipidemic populations” (Blesso & Luz 2018). They compared reported levels in each of  the following treatment groups : healthy boys and girls, healthy women, healthy men, healthy older adults, obese men, and diabetic patients overall in every group. The study took place over a varying amount of days (per group) and varying sample size of people (per group). The results of this study show that “The effect of egg intake on the LDL-C/HDL-C ratio is negligible during weight maintenance and weight loss conditions. The relationship between dietary cholesterol and/or egg intake and CVD risk in diabetics requires further investigation.”(Blesso & Luz 2018). The study included inconsistent sample sizes  and time period for each group. Additionally, the study neglected considering the race of these men/ women or consider if high cholesterol was a medical issue in their family history. It would be helpful to understand the variation of cholesterol levels if such information was provided. The variations or discrepancies in the cholesterol level in each group can be accounted for by their race and potential of carrying familial hypercholesterolemia.

The intake of eggs again were used in another study where they “studied the effects of four levels of dietary cholesterol intake on fasting lipid, lipoprotein, and apoprotein levels [dependent variable], as well as postprandial lipid levels, in a group of young, healthy men who were otherwise eating a low-fat, American Heart Association step 1 diet. Twenty young, healthy men completed a randomized, four-way crossover design study to test the effects of an American Heart Association step 1 diet containing 0, 1, 2, or 4 eggs per day [independent variable].”  (Departments of Medicine and Pediatrics 1994). The study was also conducted within a day involving blood samples taken every 2 hours for 6 hours following a 12 hour fasting period with the only food consumption of eggs. The mechanisms of egg intake as a means of cholesterol treatment levels is very similar to the previous experiment. The study was only conducted on “healthy young men” without having an alternative experimental group to serve as a comparison. Yet again, they did not take into account the race of these young men and what that would mean in terms of the variation of cholesterol levels for the same number of eggs that are consumed a day. Like the previous study the use of eggs/egg consumptions serves as a reliable independent variable. The gaps that need to be addressed though are how it affects one race over another as well as having the factor of hypercholesterolemia in the family medical history of a subject.

A potential way to test the hypothesis mentioned previously would be to have four experimental groups: 50 Mexican American men with hypercholesterolemia in family medical history, 50 Mexican American men without hypercholesterolemia in family medical history, 50 non- hispanic caucasian men with hypercholesterolemia in family medical history, and 50 non- hispanic caucasian men without hypercholesterolemia in family medical history. Therefore, race and hypercholesterolemia in family medical history are the independent variables.  All men having same diets including the same egg consumption (same cholesterol intake) to serve as standardized variables in the possible study. The dependent variable of the study would be cholesterol level that are examined after a 30 day period. If the hypothesis made about race and cholesterol levels is correct, then after the course of the 30 days, overall mexican american men in general would have the highest LDL levels but Mexican American men with hypercholesterolemia in family medical history with have the highest of all three after the 30 day period.

Results/ Discussion

In the article “New calculations expose racial differences for inherited high cholesterol”, it details the investigation between race and hypercholesterolemia. It also discussed familial hypercholesterolemia and the risks that it poses on certain ethnicities. There was a lot of emphasis on Mexican American men having the highest cases of high cholesterol. My hypothesis is supported by the following text that states that “data from the Centers for Disease Control and Prevention also show that Mexican-American men are more likely to have traditional high cholesterol than their white and black counterparts.”  (American Heart Association News 2016) This piece of evidence shows that race does play a role in the likelihood of high cholesterol.

In the article, “The Connection Between Race and High Cholesterol”  it discussed the patterns of race and hypercholesterolemia. It also mentions the risks that come with hypercholesterolemia such as increase in heart disease, obesity, and diabetes.  The article supports my hypothesis  when it states that, “non-Hispanic white men have the least incidence of high LDL cholesterol at 29.4% while non-Hispanic black men have 30.7% and Mexican American men have the highest incidence at 38.8%.”(Salamon 2018). This excerpt shows that Mexican/ Hispanic men have a higher level of cholesterol as opposed to non-hispanic white men.  Although these levels can be caused by their differing diets it can also be a result of familial hypercholesterolemia.  

The article “Learning About Familial Hypercholesterolemia” talks about what familial hypercholesterolemia is and what are symptoms of the having familial hypercholesterolemia. It addresses the issue “Familial hypercholesterolemia [being] an inherited condition that causes high levels of LDL (low density lipoprotein) cholesterol levels beginning at birth, and heart attacks at an early age.” The article also says that “two major symptoms and signs of familial hypercholesterolemia are that high levels of total cholesterol and LDL cholesterol and a strong family history of high levels of total and LDL cholesterol and/or early heart attack.” (Learning About Familial Hypercholesterolemia 2013). These sources imply that two men who follow the same diet, can still have a major difference in cholesterol levels depending upon their race, and family history when it comes to cholesterol, furthermore supporting my hypothesis.

 

Conclusion

Hypercholesterolemia is a dangerous health issue that can be the cause of so much more harm. The research conducted suggest that hypercholesterolemia is bias towards certain race and ethnics groups and makes it harder for them to maintain a healthy lifestyle when compared to other ethnicities. I anticipate the result from my proposed research to show that this health issue is hard to avoid for particular groups of people due to their race and family history of hypercholesterolemia. My goal is also that results from this research can provide a better understanding to patients and physicians of how to maintain a healthy lifestyle, be less at risk for other health problems and end a cycle of familial hypercholesterolemia within families.

 

References  

(Dec 2013). Learning About Familial Hypercholesterolemia. National Human Genome Research Institute. Retrieved from https://www.genome.gov/25520184/learning-about-familial-hypercholesterolemia/

American Heart Association News.  (March 2016). American Heart Association, Inc.  Retrieved from https://newsarchive.heart.org/new-calculations-expose-racial-differences-inherited-high-cholestrol/.  

Beckerman, J. (July 2018). Understanding Cholesterol Numbers. WebMD Medical Reference. Retrieved from https://www.webmd.com/cholesterol-management/guide/understanding-numbers#2.

Blesso, Christopher N. & Fernandez, Maria Luz. (April 2018) Dietary Cholesterol, Serum Lipids, and Heart Disease: Are Eggs Working for or Against You? Department of Nutritional Sciences, University of Connecticut. (4): 426. Retrieved from. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946211/.

Departments of Medicine and Pediatrics. (April 1994). A Dose-Response Study of the Effects of Dietary Cholesterol on Fasting and Postprandial Lipid and Lipoprotein Metabolism in Healthy Young Men. Columbia University College of Physicians and Surgeons. 14(4): 576–586. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3292202/.

Salamon, M. (May 2018). The Connection Between Race and High Cholesterol. VeryWell Health. Retrieved from https://www.verywellhealth.com/race-and-cholesterol-is-there-a-connection-698285.