Physicians' Academy for Cardiovascular Education

Lipid parameters strongly depend on age and sex

Lipid and lipoprotein reference values from 133,450 Dutch Lifelines participants: Age- and gender-specific baseline lipid values and percentiles

Literature - Balder JW, de Vries JK, Nolte IM, et al., - J Clin Lipidol. 2017; 11 (4): 1055–1064.e6


Considering that plaque formation already starts at a very young age, early prevention is the preferred approach to curb the LDL-c related progression and associated chronic disease. Thus, identification of modifiable risk factors, especially dyslipidemia, is key to effective prevention and management of CVD.

The Lifelines cohort study was initiated in 2006 and is the largest ongoing prospective observational European population study to date [1]. 152180 adult inhabitants of the northern part of The Netherlands have been recruited through their primary care physician, through family or by registering at The 5-year follow-up visit is in process, and the 10-year follow-up visit is being planned. Total duration of follow-up will be 30 years. By means of self-reported/validated questionnaires (every 1,5 years), routine clinical biochemistry, physical examination, biobanking of blood, urine and feces and genome-wide genotyping, Lifelines can provide insight into the prevalence and incidence of multifactorial disease and their risk factors.

Knowing the normal distribution of blood lipids in the population is necessary to identify dyslipidemia. Although reference values for total cholesterol (TC), LDL-c, HDL-c and triglycerides (TG) have been collected in various cohorts, contemporary and comprehensive percentile-based reference values are lacking. These values may vary with geographical region [2], and are time-dependent, considering changes in age, lifestyle and pharmaceutical interventions [3,4].

This article aims to provide age- and gender-based reference values for lipid levels, to be able to compare levels with populations in a given region or a specific genetic background, and it can facilitate future research, to monitor prospective changes. For this analysis, participants were included between 2006 and 2013, almost exclusively of Caucasian descent. No data of children <18 years old were included in this analysis, and those with a history of CVD (myocardial infarction, coronary surgery or stroke) or those using lipid-lowering drugs at baseline were excluded.

Main results


These data of the three-generation Lifelines cohort show prominent gender- and age-related differences in all main plasma lipids and lipoproteins, suggesting the need to correct for age and sex when evaluating a person’s lipid profile.

The prevalence of high LDL-c in young individuals was higher in this region of the Netherlands than anticipated. The presented data and the accompanying website can facilitate evaluation of (population) interventions or be used as a comparator for other prospective or retrospective lipid profile analyses in other geographic regions. The interactive website may serve as a tool to identify young individuals with atherogenic dyslipidemia.


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Find this article online at J Clin Lipidol

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