Five-year transition in dyslipidemia patterns and their correlates in adult population of Shahroud, Iran: a latent Markov model in a longitudinal study

Dyslipidemia is a multifactorial metabolic disorder associated with an increased risk of cardiovascular and other chronic diseases. This study investigated changes in dyslipidemia patterns over a 5-year period and factors associated with transitions across different dyslipidemia states in the adult population of Shahroud. This longitudinal study used data related to 4054 adults aged 45–70 years from the second (2014) and third (2019) phases of the Shahroud Eye Cohort Study (ShECS). The data included indicators (abnormalities in total cholesterol, triglycerides, LDL-C, and HDL-C levels) and covariates (age, sex, body mass index, economic status, diabetes, blood pressure status, tobacco use, and lipid-lowering medication use). Data analysis was performed using a latent Markov model to identify dyslipidemia states and to estimate 5-year transition probabilities between them. Four latent dyslipidemia states were identified: normal (41.0%), HDL-predominant (32.0%), TG-predominant (17.0%), and TC/LDL-predominant (10.0%). Over the 5-year follow-up, the prevalence of the normal state increased, whereas the prevalence of the other dyslipidemia states decreased. The TC/LDL-predominant state was the least stable, with about two-thirds of individuals in this state transitioning to the normal or HDL-predominant states. Higher body mass index and diabetes were associated with transitions toward less favourable dyslipidemia states, whereas lipid-lowering medications use was associated with transitions toward more favourable states; sex, age, economic status, blood pressure, and current smoking were also associated with transition patterns. Overweight, obesity and diabetes appear to play important roles in the persistence and progression of dyslipidemia, while lipid-lowering therapy is associated with transition to more favourable lipid states. Strategies for dyslipidemia control should combine risk-factor reduction with appropriate pharmacological management.