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Seasonal Variation in Serum Cholesterol Levels
Treatment Implications and Possible Mechanisms
Ira S. Ockene, MD;
David E. Chiriboga, MD, MPH;
Edward J. Stanek III, PhD;
Morton G. Harmatz, PhD;
Robert Nicolosi, PhD;
Gordon Saperia, MD;
Arnold D. Well, PhD;
Patty Freedson, PhD;
Philip A. Merriam, MSPH;
George Reed, PhD;
Yunsheng Ma, PhD, MPH;
Charles E. Matthews, PhD;
James R. Hebert, ScD
Arch Intern Med. 2004;164:863-870.
Background A variety of studies have noted seasonal variation in blood lipid levels. Although the mechanism for this phenomenon is not clear, such variation could result in larger numbers of people being diagnosed as having hypercholesterolemia during the winter.
Methods We conducted a longitudinal study of seasonal variation in lipid levels in 517 healthy volunteers from a health maintenance organization serving central Massachusetts. Data collected during a 12-month period for each individual included baseline demographics and quarterly anthropometric, blood lipid, dietary, physical activity, light exposure, and behavioral information. Data were analyzed using sinusoidal regression modeling techniques.
Results The average total cholesterol level was 222 mg/dL (5.75 mmol/L) in men and 213 mg/dL (5.52 mmol/L) in women. Amplitude of seasonal variation was 3.9 mg/dL (0.10 mmol/L) in men, with a peak in December, and 5.4 mg/dL (0.14 mmol/L) in women, with a peak in January. Seasonal amplitude was greater in hypercholesterolemic participants. Seasonal changes in plasma volume explained a substantial proportion of the observed variation. Overall, 22% more participants had total cholesterol levels of 240 mg/dL or greater ( 6.22 mmol/L) in the winter than in the summer.
Conclusions This study confirms seasonal variation in blood lipid levels and suggests greater amplitude in seasonal variability in women and hypercholesterolemic individuals, with changes in plasma volume accounting for much of the variation. A relative plasma hypervolemia during the summer seems to be linked to increases in temperature and/or physical activity. These findings have implications for lipid screening guidelines. Further research is needed to better understand the effects of a relative winter hemoconcentration.
From the Division of Cardiovascular Medicine, Department of Medicine (Dr Ockene), the Preventive Medicine Program, Department of Family Medicine and Community Health (Dr Chiriboga), and the Division of Preventive and Behavioral Medicine, Department of Medicine (Mr Merriam and Drs Reed and Ma), University of Massachusetts Medical School, Worcester; the Departments of Biostatistics and Epidemiology (Dr Stanek) and Exercise Science (Dr Freedson), School of Public Health and Health Sciences, and the Department of Psychology (Drs Harmatz and Well), University of Massachusetts, Amherst; the Department of Health and Clinical Sciences, University of Massachusetts, Lowell (Dr Nicolosi); Division of Cardiovascular Medicine, St Vincent Hospital at Worcester Medical Center, Worcester (Dr Saperia); Vanderbilt Center for Health Services Research, Department of Medicine, Vanderbilt University, Nashville, Tenn (Dr Matthews); and the Department of Epidemiology and Biostatistics, Norman J. Arnold School of Public Health, University of South Carolina, Columbia (Dr Hebert).
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