{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T23:51:41Z","timestamp":1783122701840,"version":"3.54.6"},"reference-count":60,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T00:00:00Z","timestamp":1613433600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43 TW009744"],"award-info":[{"award-number":["D43 TW009744"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>With the introduction of effective antiretroviral therapy (ART), people living with HIV (PLWH) are surviving longer and are at risk for developing metabolic abnormalities that contribute to cardiovascular disease (CVD). In Sub-Saharan Africa (SSA), there is a paucity of epidemiological data on lipid profiles among young adults receiving ART. This study aimed to estimate the prevalence of low high-density lipoprotein cholesterol (HDL-c), a cardioprotective lipid class, and whether it differed by age among adults on ART in Livingstone, Zambia.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>From April to December 2019, we conducted a cross-sectional study of 597 PLWH [n = 58 aged 18\u201324 years (young adults); n = 539 aged \u226525 years (adults)] on ART for \u22656 months. Data collected included demographic and lifestyle information, anthropometrics, viral load (VL), CD4 count, blood pressure, lipid profiles and fasting\/random blood glucose. Clinical measures were defined as: low HDL-c [&lt;1.0 mmol\/L for men, &lt;1.3 for women], increased waist circumference (WC) [\u226594 cm for men, \u226580 cm for women], high triglycerides (TG) [\u22651.7 mmol\/l], and virological failure (VF) [VL \u22651000 copies\/\u03bcl]. We used logistic regression to examine the association between age and low HDL-c after adjusting for multiple variables.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Among the young adults, 60% (35\/58) were women, median (25<jats:sup>th<\/jats:sup>, 75<jats:sup>th<\/jats:sup> percentile) age 21 years (18, 23), and median time on ART 116 months (60, 144). Among adults, 63% (342\/539) were women, median age 46 years (40, 53) and median time on ART 108 months (60, 144). Young adults had a lower CD4 count compared to adults (median, 492 vs. 568 cells\/\u03bcL, p = 0.010) and higher prevalence of VF (29% vs. 17%, p = 0.016). In young adults, prevalence of low HDL-c was significantly higher than in adults (63 vs. 38%, p&lt;0.001). A high proportion of young adults (75%) and adults (58%) with low HDL-c were on dolutegravir (DTG)-based ART regimens. After adjusting for sex, duration on ART, WC, body mass index, ART regimen, VF, CD4 count, low density lipoprotein cholesterol, blood pressure and smoking, young adults were significantly more likely than adults to have low HDL-c (odds ratio 2.93; 95% confidence interval 1.46\u20135.86).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Low HDL-c is highly prevalent among young adult with HIV in SSA independent of other risk factors for metabolic derangements. Lipid abnormalities among young PLWH may contribute to the early development of cardiovascular diseases in this population. This highlights the need to consider low HDL-c in the quest to reduce CVD risk among young adults on ART in SSA.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0247004","type":"journal-article","created":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T21:17:21Z","timestamp":1613510241000},"page":"e0247004","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Prevalence of low high-density lipoprotein among young adults receiving antiretroviral therapy in Zambia: An opportunity to consider non-communicable diseases in resource-limited settings"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1385-0998","authenticated-orcid":true,"given":"Benson M.","family":"Hamooya","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Musonda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilbroad","family":"Mutale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sepiso K.","family":"Masenga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hikabasa","family":"Halwiindi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katongo H.","family":"Mutengo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaseya O. R.","family":"Chiye\u00f1u","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3303-308X","authenticated-orcid":true,"given":"Gershom","family":"Chongwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R.","family":"Koethe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Loren","family":"Lipworth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3551-9710","authenticated-orcid":true,"given":"Douglas C.","family":"Heimburger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,16]]},"reference":[{"issue":"9947","key":"pone.0247004.ref001","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/S0140-6736(14)60844-8","article-title":"Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990\u20132013: a systematic analysis for the Global Burden of Disease Study 2013","volume":"384","author":"C. J. L. Murray","year":"2014","journal-title":"The Lancet"},{"issue":"5","key":"pone.0247004.ref002","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1097\/QAD.0b013e3283365356","article-title":"Risk of All-cause Mortality Associated with Non-fatal AIDS and Serious Non-AIDS Events among Adults Infected with HIV","volume":"24","author":"J. NEUHAUS","year":"2010","journal-title":"AIDS Lond. Engl."},{"issue":"2","key":"pone.0247004.ref003","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1097\/QAI.0b013e3181e9be6b","article-title":"Serious Fatal and Nonfatal Non-AIDS-Defining Illnesses in Europe","volume":"55","author":"A. Mocroft","year":"2010","journal-title":"JAIDS J. Acquir. Immune Defic. Syndr."},{"issue":"10","key":"pone.0247004.ref004","doi-asserted-by":"crossref","first-page":"1387","DOI":"10.1086\/652283","article-title":"Causes of death in HIV-1\u2014infected patients treated with antiretroviral therapy, 1996\u20132006: collaborative analysis of 13 HIV cohort studies","volume":"50","author":"A. T. C. Collaboration","year":"2010","journal-title":"Clin. Infect. Dis."},{"issue":"11","key":"pone.0247004.ref005","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1161\/CIRCULATIONAHA.117.033369","article-title":"Global Burden of Atherosclerotic Cardiovascular Disease in People Living with the Human Immunodeficiency Virus: A Systematic Review and Meta-Analysis","volume":"138","author":"A. S. V. Shah","year":"2018","journal-title":"Circulation"},{"issue":"9","key":"pone.0247004.ref006","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1161\/hc0902.104353","article-title":"Inflammation and atherosclerosis","volume":"105","author":"P. Libby","year":"2002","journal-title":"Circulation"},{"key":"pone.0247004.ref007","first-page":"5A","article-title":"Cholesterol and lipids in the risk of coronary artery disease\u2014the Framingham Heart Study.","volume":"4","author":"C. Wp","year":"1988","journal-title":"Can. J. Cardiol."},{"issue":"13","key":"pone.0247004.ref008","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1056\/NEJMoa064278","article-title":"HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events","volume":"357","author":"P. Barter","year":"2007","journal-title":"N. Engl. J. Med."},{"key":"pone.0247004.ref009","doi-asserted-by":"crossref","first-page":"78","DOI":"10.2174\/1874091X01206010078","article-title":"High Density Lipoprotein and it\u2019s Dysfunction","volume":"6","author":"E. Eren","year":"2012","journal-title":"Open Biochem. J."},{"issue":"6","key":"pone.0247004.ref010","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1161\/01.ATV.8.6.737","article-title":"High density lipoprotein cholesterol and mortality. The Framingham Heart Study","volume":"8","author":"P. W. Wilson","year":"1988","journal-title":"Arterioscler. Dallas Tex"},{"issue":"5","key":"pone.0247004.ref011","doi-asserted-by":"crossref","first-page":"e0197728","DOI":"10.1371\/journal.pone.0197728","article-title":"Dyslipidemia among rural and urban HIV patients in south-east Malawi","volume":"13","author":"A. Amberbir","year":"2018","journal-title":"PLOS ONE"},{"issue":"2","key":"pone.0247004.ref012","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1177\/2325957415614642","article-title":"Lipid Profile in HIV-Infected Patients Using First-Line Antiretroviral Drugs","volume":"15","author":"W. Ombeni","year":"2016","journal-title":"J. Int. Assoc. Provid. AIDS Care"},{"issue":"3","key":"pone.0247004.ref013","article-title":"Anti-Retroviral Therapy Increases the Prevalence of Dyslipidemia in South African HIV-Infected Patients","volume":"11","author":"J. A. Dave","year":"2016","journal-title":"PLoS ONE"},{"issue":"5","key":"pone.0247004.ref014","doi-asserted-by":"crossref","first-page":"626","DOI":"10.4103\/1119-3077.154208","article-title":"Lipoatrophy among patients on antiretroviral therapy in Lagos, Nigeria: Prevalence, pattern and association with cardiovascular risk factors","volume":"18","author":"S. O. Iwuala","year":"2015","journal-title":"Niger. J. Clin. Pract."},{"issue":"Suppl 1","key":"pone.0247004.ref015","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1097\/QAD.0000000000001888","article-title":"Noncommunicable diseases among HIV-infected persons in low-income and middle-income countries: a systematic review and meta-analysis","volume":"32","author":"P. Patel","year":"2018","journal-title":"AIDS Lond. Engl."},{"issue":"6","key":"pone.0247004.ref016","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0177440","article-title":"High correlation between Framingham equations with BMI and with lipids to estimate cardiovascular risks score at baseline in HIV-infected adults in the Temprano trial, ANRS 12136 in C\u00f4te d\u2019Ivoire","volume":"12","author":"C. Ghehi","year":"2017","journal-title":"PLoS ONE"},{"key":"pone.0247004.ref017","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1186\/1756-0500-7-380","article-title":"Antiretroviral treatment associated hyperglycemia and dyslipidemia among HIV infected patients at Burayu Health Center, Addis Ababa, Ethiopia: a cross-sectional comparative study","volume":"7","author":"M. Abebe","year":"2014","journal-title":"BMC Res. Notes"},{"issue":"2","key":"pone.0247004.ref018","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1177\/2325957415601503","article-title":"\u201cFeatures of Metabolic Syndrome and Its Associated Factors during Highly Active Antiretroviral Therapy in Ouagadougou (Burkina Faso),\u201d","volume":"15","author":"O. Guira","year":"2016","journal-title":"J. Int. Assoc. Provid. AIDS Care"},{"issue":"1","key":"pone.0247004.ref019","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1186\/s12944-017-0503-9","article-title":"Low HDL-cholesterol among HIV-1 infected and HIV-1 uninfected individuals in Nairobi, Kenya","volume":"16","author":"A. Njoroge","year":"2017","journal-title":"Lipids Health Dis."},{"issue":"2","key":"pone.0247004.ref020","first-page":"88","article-title":"Age of HIV Acquisition Affects the Risk of Multi-Morbidity After 25 Years of Infection Exposure","volume":"8","author":"G. Guaraldi","year":"2019","journal-title":"J. Frailty Aging"},{"issue":"23","key":"pone.0247004.ref021","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1056\/NEJM199806043382302","article-title":"Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. The Bogalusa Heart Study","volume":"338","author":"G. S. Berenson","year":"1998","journal-title":"N. Engl. J. Med."},{"issue":"5","key":"pone.0247004.ref022","first-page":"641","article-title":"Factors affecting high-density lipoprotein cholesterol in HIV-infected patients on nevirapine-based antiretroviral therapy","volume":"145","author":"C. Padmapriyadarsini","year":"2017","journal-title":"Indian J. Med. Res."},{"key":"pone.0247004.ref023","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1186\/1471-2458-14-904","article-title":"Magnitude and risk factors of non-communicable diseases among people living with HIV in Tanzania: a cross sectional study from Mbeya and Dar es Salaam regions","volume":"14","author":"G. B. Kagaruki","year":"2014","journal-title":"BMC Public Health"},{"key":"pone.0247004.ref024","article-title":"Lipid levels, insulin resistance and cardiovascular risk over 96 weeks of antiretroviral therapy: a randomised controlled trial comparing low-dose stavudine and tenofovir","volume":"15","author":"A. G. Vos","year":"2018","journal-title":"Retrovirology"},{"issue":"5","key":"pone.0247004.ref025","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/s11883-011-0189-9","article-title":"Progress in HDL-based therapies for atherosclerosis","volume":"13","author":"K.-Y. Chyu","year":"2011","journal-title":"Curr. Atheroscler. Rep."},{"issue":"12","key":"pone.0247004.ref026","doi-asserted-by":"crossref","first-page":"1820","DOI":"10.1093\/cid\/cit120","article-title":"First-line antiretroviral therapy and changes in lipid levels over 3 years among HIV-infected adults in Tanzania","volume":"56","author":"E. Liu","year":"2013","journal-title":"Clin. Infect. DisOff. Publ. Infect. Dis. Soc. Am."},{"key":"pone.0247004.ref027","unstructured":"WHO, \u201cNCDs | STEPwise approach to surveillance (STEPS),\u201d WHO. http:\/\/www.who.int\/ncds\/surveillance\/steps\/en\/ (accessed Mar. 18, 2020)."},{"issue":"16","key":"pone.0247004.ref028","doi-asserted-by":"crossref","first-page":"1640","DOI":"10.1161\/CIRCULATIONAHA.109.192644","article-title":"Harmonizing the metabolic syndrome: a joint interim statement of the international diabetes federation task force on epidemiology and prevention; national heart, lung, and blood institute; American heart association; world heart federation; international atherosclerosis society; and international association for the study of obesity","volume":"120","author":"K. Alberti","year":"2009","journal-title":"Circulation"},{"issue":"24","key":"pone.0247004.ref029","doi-asserted-by":"crossref","first-page":"e285","DOI":"10.1016\/j.jacc.2018.11.003","article-title":"2018 AHA\/ACC\/AACVPR\/AAPA\/ABC\/ACPM\/ADA\/AGS\/APhA\/ASPC\/NLA\/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"73","author":"S. M. Grundy","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"pone.0247004.ref030","volume-title":"World Health Organization global strategy for the surveillance and monitoring of HIV drug resistance: An update","author":"WHO","year":"2012"},{"key":"pone.0247004.ref031","unstructured":"WHO, \u201cBody mass index\u2014BMI,\u201d Jan. 17, 2020. http:\/\/www.euro.who.int\/en\/health-topics\/disease-prevention\/nutrition\/a-healthy-lifestyle\/body-mass-index-bmi (accessed Jan. 17, 2020)."},{"issue":"5","key":"pone.0247004.ref032","doi-asserted-by":"crossref","first-page":"e0126166","DOI":"10.1371\/journal.pone.0126166","article-title":"Prevalence of Dyslipidaemia and Associated Risk Factors in a Rural Population in South-Western Uganda: A Community Based Survey","volume":"10","author":"G. Asiki","year":"2015","journal-title":"PLOS ONE"},{"issue":"4","key":"pone.0247004.ref033","doi-asserted-by":"crossref","first-page":"141","DOI":"10.3810\/pgm.2000.04.986","article-title":"HIV-associated metabolic and morphologic abnormality syndrome: Welcome therapy may have unwelcome effects","volume":"107","author":"G. R. Cohan","year":"2000","journal-title":"Postgrad. Med."},{"key":"pone.0247004.ref034","doi-asserted-by":"crossref","first-page":"49","DOI":"10.2174\/1874192401105010049","article-title":"\u201cHIV and HAART-associated dyslipidemia.","volume":"5","author":"E. R. Feeney","year":"2011","journal-title":"Open Cardiovasc Med J"},{"issue":"3","key":"pone.0247004.ref035","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1097\/QAI.0b013e31815e7453","article-title":"Changes in Lipid Profile Over 24 Months Among Adults on First-Line Highly Active Antiretroviral Therapy in the Home-Based AIDS Care Program in Rural Uganda","volume":"47","author":"K. Buchacz","year":"2008","journal-title":"JAIDS J. Acquir. Immune Defic. Syndr."},{"key":"pone.0247004.ref036","article-title":"Changes in Lipid Profiles of HIV+ Adults over Nine Months at a Harare HIV Clinic: A Longitudinal Study","volume":"2016","author":"D. T. Zhou","year":"2016","journal-title":"Biochem. Res. Int."},{"issue":"3","key":"pone.0247004.ref037","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1007\/s40261-014-0266-2","article-title":"Comparative Changes of Lipid Levels in Treatment-Naive, HIV-1-Infected Adults Treated with Dolutegravir vs. Efavirenz, Raltegravir, and Ritonavir-Boosted Darunavir-Based Regimens Over 48 Weeks","volume":"35","author":"R. Quercia","year":"2015","journal-title":"Clin. Drug Investig."},{"key":"pone.0247004.ref038","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.2147\/IDR.S203813","article-title":"Lipid profile improvement in virologically suppressed HIV-1-infected patients switched to dolutegravir\/abacavir\/lamivudine: data from the SCOLTA project","volume":"12","author":"P. Bagella","year":"2019","journal-title":"Infect. Drug Resist."},{"issue":"1","key":"pone.0247004.ref039","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/QAI.0b013e318042d5fe","article-title":"Association of serum lipid levels with HIV serostatus, specific antiretroviral agents, and treatment regimens","volume":"45","author":"K. Anastos","year":"2007","journal-title":"J. Acquir. Immune Defic. Syndr. 1999"},{"issue":"7","key":"pone.0247004.ref040","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1089\/apc.2007.0186","article-title":"High-density lipoprotein cholesterol in HIV-infected patients: evidence for an association with HIV-1 viral load, antiretroviral therapy status, and regimen composition","volume":"22","author":"E. Bernal","year":"2008","journal-title":"AIDS Patient Care STDs"},{"issue":"1","key":"pone.0247004.ref041","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.atherosclerosis.2005.04.013","article-title":"Protease inhibitor-based HAART, HDL, and CHD-risk in HIV-infected patients","volume":"184","author":"B. F. Asztalos","year":"2006","journal-title":"Atherosclerosis"},{"issue":"5","key":"pone.0247004.ref042","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1086\/507333","article-title":"Current concepts in the diagnosis and management of metabolic complications of HIV infection and its therapy","volume":"43","author":"D. A. Wohl","year":"2006","journal-title":"Clin. Infect. Dis."},{"issue":"6","key":"pone.0247004.ref043","first-page":"575","article-title":"Dyslipidemia in HIV-infected individuals","volume":"14","author":"E. Sprinz","year":"2010","journal-title":"Braz. J. Infect. Dis."},{"issue":"2","key":"pone.0247004.ref044","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/S1413-8670(11)70161-1","article-title":"Dyslipidemia in AIDS patients on highly active antiretroviral therapy","volume":"15","author":"M. W. Nery","year":"2011","journal-title":"Braz. J. Infect. Dis."},{"issue":"2","key":"pone.0247004.ref045","doi-asserted-by":"crossref","first-page":"56","DOI":"10.5501\/wjv.v4.i2.56","article-title":"Impact of antiretroviral therapy on lipid metabolism of human immunodeficiency virus-infected patients: Old and new drugs","volume":"4","author":"J. da Cunha","year":"2015","journal-title":"World J. Virol."},{"key":"pone.0247004.ref046","doi-asserted-by":"crossref","first-page":"e1000981","DOI":"10.1371\/journal.ppat.1000981","article-title":"PPARgamma and LXR signaling inhibit dendritic cell-mediated HIV-1 capture and trans-infection","volume":"6","author":"T. M. Hanley","year":"2010","journal-title":"PLoS Pathog."},{"issue":"20","key":"pone.0247004.ref047","doi-asserted-by":"crossref","first-page":"10834","DOI":"10.1128\/JVI.00789-11","article-title":"Nuclear receptor signaling inhibits HIV-1 replication in macrophages through multiple trans-repression mechanisms","volume":"85","author":"T. M. Hanley","year":"2011","journal-title":"J. Virol."},{"issue":"5","key":"pone.0247004.ref048","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/S0022-2275(20)39181-1","article-title":"Factors associated with low and elevated plasma high density lipoprotein cholesterol and apolipoprotein A-I levels in the Framingham Offspring Study.","volume":"35","author":"E. J. Schaefer","year":"1994","journal-title":"J. Lipid Res."},{"key":"pone.0247004.ref049","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1186\/s13104-016-1953-2","article-title":"Influences of gender in metabolic syndrome and its components among people living with HIV virus using antiretroviral treatment in Hawassa, southern Ethiopia","volume":"9","author":"A. T. Hirigo","year":"2016","journal-title":"BMC Res. Notes"},{"issue":"19","key":"pone.0247004.ref050","doi-asserted-by":"crossref","first-page":"2486","DOI":"10.1001\/jama.285.19.2486","article-title":"Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, \u201cExecutive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III),","volume":"285","year":"2001","journal-title":"JAMA"},{"issue":"6","key":"pone.0247004.ref051","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1080\/13697137.2019.1640197","article-title":"Metabolic and cardiovascular effects of TX-001HR in menopausal women with vasomotor symptoms","volume":"22","author":"R. A. Lobo","year":"2019","journal-title":"Climacteric"},{"issue":"3","key":"pone.0247004.ref052","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/S0008-6363(01)00478-3","article-title":"Hormones, genetic factors, and gender differences in cardiovascular disease","volume":"53","author":"J. E. Rossouw","year":"2002","journal-title":"Cardiovasc. Res."},{"issue":"1","key":"pone.0247004.ref053","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/1476-511X-9-147","article-title":"The association between adiponectin, HDL-cholesterol and \u03b11-antitrypsin-LDL in female subjects without metabolic syndrome","volume":"9","author":"K. Kotani","year":"2010","journal-title":"Lipids Health Dis."},{"issue":"1","key":"pone.0247004.ref054","doi-asserted-by":"crossref","first-page":"e2949","DOI":"10.1002\/dmrr.2949","article-title":"Association of change in waist circumference and dyslipidaemia risk: The rural Chinese cohort study","volume":"34","author":"J. Zhou","year":"2018","journal-title":"Diabetes Metab. Res. Rev."},{"issue":"141","key":"pone.0247004.ref055","doi-asserted-by":"crossref","DOI":"10.1098\/rsif.2017.0387","article-title":"Opportunities and obstacles for deep learning in biology and medicine","volume":"15","author":"T. Ching","year":"2018","journal-title":"J. R. Soc. Interface"},{"key":"pone.0247004.ref056","doi-asserted-by":"crossref","first-page":"104493","DOI":"10.1016\/j.yexmp.2020.104493","article-title":"LEPR hypomethylation is significantly associated with gastric cancer in males","volume":"116","author":"H. Yu","year":"2020","journal-title":"Exp. Mol. Pathol."},{"key":"pone.0247004.ref057","doi-asserted-by":"crossref","first-page":"116459","DOI":"10.1016\/j.neuroimage.2019.116459","article-title":"A multi-model deep convolutional neural network for automatic hippocampus segmentation and classification in Alzheimer\u2019s disease","volume":"208","author":"M. Liu","year":"2020","journal-title":"NeuroImage"},{"key":"pone.0247004.ref058","doi-asserted-by":"crossref","DOI":"10.1016\/j.jhealeco.2020.102300","article-title":"Mendelian Randomization analysis of the causal effect of adiposity on hospital costs","volume":"70","author":"P. Dixon","year":"2020","journal-title":"J. Health Econ."},{"issue":"1","key":"pone.0247004.ref059","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s10020-019-0133-y","article-title":"Exploring the causal pathway from ischemic stroke to atrial fibrillation: a network Mendelian randomization study","volume":"26","author":"L. Hou","year":"2020","journal-title":"Mol. Med."},{"key":"pone.0247004.ref060","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1258\/000456307780480963","article-title":"Metabolic syndrome and cardiovascular disease","volume":"443","author":"Q. Qiao","year":"2007","journal-title":"Ann. Clin. Biochem."}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0247004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,16]],"date-time":"2021-02-16T21:18:00Z","timestamp":1613510280000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0247004"}},"subtitle":[],"editor":[{"given":"Mingqing","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,2,16]]},"references-count":60,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0247004","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,16]]}}}