Distribution characteristics of dyslipidemia in ABO blood groups in Suburbs of Shanghai,China: A cross-sectional study

Abstract

Objective

To investigate the distribution features of dyslipidemia within the ABO blood group system Suburbs of Shanghai, China.

Methods

This retrospective cross-sectional study analyzed 12,926 sets of blood lipid data associated with the ABO blood group from January 2018 to December 2024 at Tinglin Hospital in Suburbs of Shanghai. We presented the overall prevalence of dyslipidemia across various ABO blood groups with respect to sex and blood lipid indicators.

Results

Among the 12,926 individuals included in the study, the overall prevalence of dyslipidemia was 53.44%. The prevalence by blood group was 55.59% in type A, 51.82% in type B, 52.49% in type O, and 54.89% in type AB. Across all blood groups, males consistently showed higher dyslipidemia rates than females, and the sex differences were significant in each ABO group (all P < 0.001).

Conclusion

In this hospital-based adult population, dyslipidemia was common and crude prevalence differed modestly across ABO blood groups, with type A showing the highest and type B the lowest prevalence. Across all blood groups, prevalence in male was significantly higher than in female (all P < 0.001). After adjustment for age and sex, adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) indicated higher odds of dyslipidemia for blood group A and lower odds for blood group B compared with group O. However, these comparisons are derived from a retrospective hospital-based dataset and are subject to residual confounding because key lifestyle and clinical factors (e.g., BMI, smoking, comorbidities, and medications) were not available for full adjustment; therefore, the findings should be interpreted as descriptive rather than causal.

Keywords

ABO blood group blood lipids sex prevalence dyslipidemia cross-sectional study

Introduction

Dyslipidemia is a major and modifiable risk factor for atherosclerotic cardiovascular disease.^1–3 Contemporary population surveys in China have consistently reported a high prevalence of dyslipidemia, underscoring the need for more granular epidemiological descriptions across demographic and biological strata.^4,5 In routine practice, lipid abnormalities are typically evaluated using total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C), and dyslipidemia is commonly defined by the presence of at least one abnormal lipid parameter.⁶

The ABO blood group system is a genetically determined phenotype with established relevance to hemostatic and vascular biology.^7–11 ABO antigens are determined by glycosyltransferase activity, which may influence circulating glycoproteins and lipid-related pathways. In addition, ABO phenotypes are associated with levels of von Willebrand factor and other adhesion molecules, providing a plausible link to cardiometabolic risk profiles.¹² Nevertheless, evidence regarding ABO and lipid abnormalities has been inconsistent across populations, highlighting the need for descriptive data from different settings.¹³ Increasing evidence suggests that ABO phenotypes may also be associated with cardiometabolic traits, including lipid metabolism¹²; however, findings across populations are not fully consistent, and evidence from community-based adult cohorts in China remains limited.¹⁴ Moreover, sex differences in lipid profiles are well recognized, yet sex-stratified descriptions of dyslipidemia patterns across ABO blood groups are less frequently reported in clinical datasets.

Therefore, we conducted a retrospective cross-sectional analysis of adult patients and examinees with concurrent ABO typing and lipid testing at Tinglin Hospital in Suburbs of Shanghai, from January 2018 to December 2024. We aimed to (1) estimate the prevalence of dyslipidemia across ABO blood groups, (2) describe sex-stratified patterns, and (3) summarize the distribution of abnormal lipid components (TC, TG, LDL-C, and HDL-C) by ABO phenotype.

Methods

A retrospective cross-sectional study was conducted to examine the distribution of dyslipidemia across ABO blood groups in Suburbs of Shanghai, China. We additionally described sex-specific patterns and variation in lipid profiles (HDL-C, LDL-C, TC, and TG) across ABO phenotypes. Data were obtained from the laboratory information system of Tinglin Hospital (Suburbs of Shanghai) from January 2018 through December 2024, including records with concurrent ABO typing and fasting lipid testing. This retrospective study was reviewed and approved by the Institutional Review Board of Tinglin Hospital in 2025-11. A waiver of informed consent was granted because only de-identified data were analyzed. The study was conducted in accordance with the Declaration of Helsinki. The reporting of this study conforms to the STROBE guidelines.¹⁵

Covariates

The underlying laboratory information system provided ABO phenotype, sex, age at testing, and lipid measurements. Data on body mass index, smoking, alcohol use, diet, physical activity, comorbidities (e.g., diabetes, hypertension), and non–lipid-lowering medications were not consistently available in the extract and were therefore not included in the analyses. All models were therefore adjusted for age and sex only, and effect estimates may be affected by residual confounding from unmeasured factors in this single-center hospital-based dataset.

Data collection

Data were extracted from Tinglin Hospital (Suburbs of Shanghai) for the period January 2018 to December 2024. Eligible records were restricted to adults aged ≥18 years with concurrent ABO blood typing and fasting lipid testing (TC, TG, LDL-C, and HDL-C) performed during outpatient visits, hospitalizations, or health check-ups. Records from individuals aged <18 years were excluded because pediatric lipid reference ranges and diagnostic thresholds differ from adult guideline criteria. Participants were classified into four ABO blood groups (A, B, O, and AB) and stratified by sex. All data were de-identified prior to analysis.

Recruitment

The participants were recruited during outpatient visits, hospitalizations, and health check-ups at our hospital throughout the study period. The inclusion criteria were ages 18 to 101 years. Because this was a retrospective study using previously recorded clinical and laboratory data, obtaining individual informed consent from patients was not feasible. The Institutional Review Board of Tinglin Hospital reviewed the study protocol and granted a waiver of informed consent.

Diagnostic criteria for dyslipidemia and exclusion criteria

Dyslipidemia was defined as the presence of at least one abnormal lipid parameter according to the Chinese Guidelines for the Prevention and Treatment of Adult Dyslipidemia (2016 revision): TC ≥ 5.7 mmol/L, TG ≥ 1.73 mmol/L, LDL-C ≥ 3.1 mmol/L, and/or HDL-C < 0.9 mmol/L. Participants receiving lipid-lowering therapy at the time of testing were excluded. Individuals with documented familial dyslipidemia were also excluded.

Sample collection

The specialized nursing and laboratory staff carried out the ABO blood group specimen collection and preservation procedures. For each participant, technicians collected 3–5 mL of venous blood using EDTA-K2 anticoagulant vacuum tubes, ensuring proper mixing to prevent coagulation. Subsequent centrifugation of the samples enabled separation of plasma and red blood cell components. Samples were stored vertically at room temperature until analysis. The maximum allowable storage durations were: ≤24 hours at room temperature or ≤7 days at 2–8°C. All testing procedures were completed on the same day of sample processing.

Blood samples for lipid testing were collected by trained nurses and laboratory technicians after an 8–12-hour overnight fast, using sterile disposable needles and vacuum blood collection tubes. After collection, the specimens were stored upright at room temperature until analysis. The maximum allowable storage duration was 24 hours at ambient temperature or up to 7 days if refrigerated at 2–8°C. All testing procedures were performed on the same day whenever possible.

ABO blood grouping reagents and analyzers

Reagents: Anti-B and Anti-A standard sera (Shanghai Blood Biological Medicine Co., Ltd.), blood type detection reagent cards (Changchun Bosun Biotechnology Co., Ltd.), ABO reverse grouping standard red blood cells (Shanghai Blood Biological Medicine Co., Ltd.).

Instruments: FYQ Immuno-Microcolumn Incubator (Changchun Boyan Scientific Instruments Co., Ltd.), Card Centrifuge (Changchun Boyan Scientific Instruments Co., Ltd.), TD-A Serological Centrifuge for Blood Grouping (Changchun Boyan Scientific Instruments Co., Ltd.), Fully Automated Blood Group Analyzer (Microlab STARmini IVD, Hamilton Bonaduz AG, Switzerland).

Laboratory testing

ABO blood grouping

ABO blood type determination was performed using the microcolumn gel card method, which included both forward and reverse typing. Red blood cell suspensions were prepared and added to the gel card reaction columns according to the manufacturer’s instructions. For each batch of tests, internal quality control was conducted using standard anti-A, anti-B sera and reverse grouping standard red blood cells from the same lot. Results were interpreted based on the position of red blood cell agglutinates within the gel column: agglutination retained in the upper or middle layer of the column was interpreted as positive, whereas red blood cells settling at the bottom were interpreted as negative. Samples showing discrepancies between forward and reverse grouping underwent manual re-testing to confirm results. All procedures strictly followed the instructions provided with the reagents and instruments.

Blood lipid testing

Blood lipid measurements—including HDL-C, LDL-C, TG, and TC—were performed using a fully automated biochemical analysis platform (cobas 8000 modular analyzer series, Roche Diagnostics, Switzerland). Whole-blood specimens were centrifuged using a low-speed balanced centrifuge to separate plasma or serum before testing. Processed samples were then loaded directly onto the analyzer for automatic detection using manufacturer-supplied reagents and calibration solutions. Quality control procedures were performed at the beginning of each testing day and with every new reagent lot to ensure analytical accuracy and instrument stability. All analyses were conducted in accordance with the manufacturer’s protocols.

Missing data

Records with missing ABO blood group, sex, age, or any lipid measurement required to define dyslipidemia were excluded from the corresponding analyses (complete-case approach). The extent of missingness was assessed descriptively prior to analysis and was low for the primary variables in the final analytic dataset. After complete-case screening, 12,926 records were retained for the primary analyses.

Statistical analysis

All analyses were performed using IBM SPSS Statistics (version 25.0; IBM Corp., Armonk, NY, USA). Continuous variables were summarized as mean (SD) or median (IQR) as appropriate, and categorical variables as counts and percentages. Normality was assessed visually and/or using the Shapiro–Wilk test as needed. Dyslipidemia was defined as a binary outcome (yes/no) based on the presence of ≥1 abnormal lipid parameter (TC, TG, LDL-C and/or HDL-C) according to the 2016 Chinese adult dyslipidemia guideline thresholds.

Crude differences in dyslipidemia prevalence across ABO blood groups were assessed using the χ² test. To account for confounding by age and sex, multivariable logistic regression models were fitted with dyslipidemia (yes/no) as the dependent variable and ABO blood group as the main exposure. ABO blood group was entered as a categorical variable using dummy indicators, with type O as the reference group. Age was modeled as a continuous variable (years), and sex was included as a binary covariate (male/female). Results are reported as adjusted odds ratios (aORs) with 95% confidence intervals (CIs) and two-sided P values based on Wald tests.

To explore potential effect modification by sex, an additional model included an ABO×sex interaction term; the interaction was evaluated using the P value for the cross-product term (Pinteraction). If the interaction was not statistically significant, results from the main effects model were presented as the primary analysis.

As secondary descriptive outcomes, the prevalence of each abnormal lipid component (elevated TG, elevated TC, elevated LDL-C, and low HDL-C) was reported by ABO group and sex. Lipid parameters were additionally analyzed as continuous outcomes using general linear models adjusting for age and sex, with adjusted mean differences and 95% CIs reported. Analyses were conducted using complete cases with non-missing data for the variables required in each model. A two-sided P value <0.05 was considered statistically significant.

Results

Distribution characteristics of ABO blood groups

This study collected 12,926 cases of test results from January 2018 to December 2024 in Tinglin Hospital, Suburbs of Shanghai, aged 18–101 years, and the statistical analysis of the percentages of different ABO blood types was as follows: Type A: 29.20% (3,774/12,926), Type B: 28.29% (3,657/12,926), Type O: 32.62% (4,216/12,926), Type AB: 9.89% (1,279/12,926). According to the number of ABO blood types, the order is Type O > Type A > Type B > Type AB. Distribution of ABO blood groups by sex: In the dataset of 12,926 individuals, males accounted for 39.72% (5,134/12,926) and females for 60.28% (7,792/12,926). Specifically, among the ABO blood groups, the gender-specific distributions were: males constituted 39.03% of blood type A, 40.68% of type B, 39.78% of type O, and 38.86% of type AB; females accounted for 60.97% of type A, 59.32% of type B, 60.22% of type O, and 61.14% of type AB. The proportion of females was higher than that of males in all four blood types (A, B, O, and AB), as shown in Figure 1 and Table 1.

Figure 1.

Distribution of ABO blood groups by sex.

Table 1.

Gender distribution of ABO blood groups.

Gender groups	Males	Females
A n=3774	39.03% (1473/3774)	60.97% (2301/3774)
B n=3657	40.66% (1487/3657)	59.34% (2170/3657)
O n=4216	39.78% (1677/4216)	60.22% (2539/4216)
AB n=1279	38.86% (497/1279)	61.14% (782/1279)
Total n =12926	39.72% (5134/12926)	60.28% (7792/12926)

Distribution of abnormal blood lipids in different ABO blood groups

The results of 12,926 cases collected in this study showed that the lipid detection items were triglyceride, total cholesterol, high-density lipoprotein (HDL) and low-density lipoprotein (LDL). According to the study definition, dyslipidemia was present if at least one lipid parameter was abnormal. The overall prevalence of dyslipidemia (≥1 abnormal lipid parameter) was 53.44% (6,908/12,926). The prevalence by blood group was 55.59% (2,098/3,774) in type A, 51.82% (1,895/3,657) in type B, 52.49% (2,213/4,216) in type O, and 54.89% (702/1,279) in type AB (see Figure 2 and Table 2). The crude prevalence ranked A > AB > O > B, and the difference across ABO groups was statistically significant (χ²=13.43, df=3, P<0.05).

Figure 2.

Distribution of dyslipidemia in different ABO blood groups.

Table 2.

Distribution of abnormal blood lipids across different ABO blood groups.

Blood groups	Total N	Dyslipidemia N	Percentages
A	3774	2098	55.59
B	3657	1895	51.82
O	4216	2213	52.49
AB	1279	702	54.89
χ² (df=3)		13.43
p		< 0.05

Distribution of abnormal blood lipid items across ABO blood groups by gender

Among the 12,926 individuals tested, 6,908 (53.44%) exhibited at least one abnormal lipid parameter. The distribution of dyslipidemia across ABO blood groups differed between males and females.

In males, the overall dyslipidemia rate was 58.20%, with blood group–specific rates of 60.22% in type A, 57.70% in type B, 56.11% in type O, and 63.05% in type AB.

In females, the overall dyslipidemia rate was50.31%, with corresponding rates of 52.63% in type A, 47.79% in type B, 50.10% in type O, and 51.15% in type AB (Table 3).

Table 3.

Sex-stratified prevalence of dyslipidemia across ABO blood groups.

Sex	A (n, %)	B (n, %)	O (n, %)	AB (n, %)
Male	887 (60.22%)	858 (57.70%)	941 (56.11%)	302 (63.05%)
Female	1211 (52.63%)	1037 (47.79%)	1272 (50.10%)	400 (51.15%)
χ² (df=1)	20.96	34.70	11.63	17.05
P value	< 0.001	< 0.001	< 0.001	< 0.001

Values are dyslipidemia cases (n) and prevalence within sex-specific ABO subgroups (%).

Across all blood groups, dyslipidemia was consistently more prevalent in males than in females. The differences between male and female groups for each ABO blood type were statistically significant (P < 0.05).

Distribution rates of dyslipidemia items across ABO blood groups

Among all 12,926 individuals, abnormality counts for each lipid component were summarized, and Figure 3 presents within–blood group percentages for each component, defined as (number abnormal/total number in that ABO group) × 100%. Overall, the crude prevalence of abnormal TG was 27.12% (3,505/12,926), followed by abnormal TC 22.77% (2,943/12,926), abnormal LDL-C 22.31% (2,883/12,926), and low HDL-C 22.08% (2,854/12,926). When expressed as within-group percentages, low HDL-C was 22.50%, 21.58%, 22.08%, and 22.28% in blood types A, B, O, and AB, respectively; elevated LDL-C was 25.33%, 20.26%, 21.04%, and 23.38%; elevated TC was 25.57%, 21.36%, 20.92%, and 24.63%; and elevated TG was 26.39%, 27.70%, 26.90%, and 28.30%. Overall, TG showed the highest abnormality percentage across groups, while LDL-C was lowest in blood type B.

Figure 3.

Percentages of abnormal lipid components within each ABO blood group (i.e.,the proportion of individuals with each lipid abnormality within that blood group).

Values are expressed as within-group percentages, calculated as (number of individuals with abnormal TG/TC/LDL-C or low HDL-C in a given ABO group)/(total number of individuals in that ABO group) × 100%. Denominators were A=3,774; B=3,657; O=4,216; AB=1,279. Abnormal components were defined using the 2016 Chinese adult dyslipidemia guideline thresholds.

Subtype distribution of dyslipidemia across ABO blood groups

Dyslipidemia in this dataset was defined by the presence of at least one abnormal lipid parameter (TG, TC, LDL-C, and/or HDL-C). Given that individuals may present with multiple concurrent abnormalities, subtype-specific (isolated vs mixed) estimates were not analyzed in the current study and are planned for future work.

Discussion

This study statistically analyzed 12,926 cases of ABO blood group lipid data collected from Tinglin Hospital in Suburbs of Shanghai, between January 2018 and December 2024. The order of ABO blood group proportions was type O > type A > type B > type AB. A previous study¹⁶ on the distribution of ABO blood group composition ratios in the Chinese population reported findings consistent with those of this study. This consistency suggests that our sample reflects the typical ABO distribution pattern observed in large-scale Chinese epidemiological data.

This study evaluates the high distribution rates of dyslipidemia across diverse ABO blood groups. Recent research has suggested associations between ABO blood groups and cardiometabolic traits, including lipid-related phenotypes.^17–21 The lipid tests included triglyceride, total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL). Lipid abnormality was defined as an increase in triglyceride, total cholesterol, and LDL levels or a decrease in HDL level. The overall percentages of at least one abnormal lipid test result was 53.44%. Abnormal lipid levels in ABO blood groups followed the order: type A > type AB > type O > type B. The distribution of dyslipidemia rates across ABO blood groups tends to be overlooked or ignored. Recent years have seen numerous studies on the association between ABO blood groups and diseases, yet some findings remain unconfirmed or unclear. A previous study¹⁸ has indicated a potential correlation between ABO blood groups and dyslipidemia. Our findings provide additional population-level evidence supporting these observations and help clarify the direction and magnitude of these associations. To strengthen contemporary support for ABO-lipid associations, we additionally cited recent studies on dyslipidemia and lipid-related metabolism.^22,23

An association between blood lipid lipoproteins and ABO blood groups has been demonstrated by a previous study.²⁴ Moreover, our research offers novel perspectives on the distribution patterns of abnormal lipid patterns within ABO blood groups stratified by sex. In our study, the overall abnormal detection rate of dyslipidemia in male ABO blood groups was 58.20%. The overall abnormal detection rate of dyslipidemia in female ABO blood groups was50.31%. The rate of dyslipidemia in male ABO blood groups was higher than that in females. One possible biological explanation is that ABO glycosyltransferase-related variation may influence glycosylated adhesion/hemostatic proteins, including vWF, which could be linked to lipid-metabolic pathways. This gender-specific pattern aligns with previous lipid epidemiology research but has rarely been described in relation to ABO blood groups, adding to the limited literature on sex-stratified ABO-lipid associations in routine clinical datasets. This biological plausibility is further supported by molecular and genetic evidence, including studies linking ABO-related molecular variation to vascular-lipid phenotypes.²⁵

Of the 12,926 cases, 6,908 (53.44%) were diagnosed with dyslipidemia. A total of 12,185 abnormal lipid items (HDL-C, LDL-C, TC, TG) were identified among these 6,908 cases. The TC abnormality rates in blood types A, B, and AB were all significantly higher than those in type O. Prior studies linking ABO phenotypes to thrombosis and coronary events primarily address vascular outcomes rather than lipid abnormalities per se. Therefore, those reports (Refs. 26–28) should not be interpreted as evidence that type O has a higher prevalence of dyslipidemia. In our dataset, dyslipidemia was defined by adult lipid thresholds and evaluated as a composite outcome (≥1 abnormal lipid parameter). The crude prevalence was highest in type A and lowest in type B, and the between-group differences were modest. Discrepancies across studies may reflect differences in endpoints (vascular events vs lipid abnormalities), population structure, and the extent of confounding control. Importantly, because this is a hospital-based retrospective cross-sectional analysis and key lifestyle/clinical covariates were unavailable, our findings should be interpreted as descriptive patterns that require confirmation in population-based studies with comprehensive adjustment.^29,30

This study helps us understand the distribution characteristics of dyslipidemia in Suburbs of Shanghai, China, across different ABO blood types and genders. However, it also has limitations. First, the study is confined to Suburbs of Shanghai, introducing geographical restrictions and potential sampling bias. Second, it does not explore the relationship between ABO blood types and dyslipidemia in conjunction with other influencing factors such as age, BMI, diet, alcohol consumption, smoking, socioeconomic status, or underlying conditions. Future research should incorporate these factors to validate the findings. Furthermore, as a retrospective cross-sectional observational study, the observed associations cannot be attributed to the ABO system itself and may reflect confounding by unmeasured lifestyle or clinical factors.

A key finding of this study is that male appear more susceptible to dyslipidemia than female. Additionally, the prevalence of dyslipidemia among ABO blood type was observed to be highest in type A, followed by type AB, type O, and then type B (A > AB > O > B). It is important to note that these results may not fully reflect the situation in other regions with distinct population or socioeconomic characteristics. Future research should employ more rigorous scientific designs to conduct in-depth, multi-regional studies involving multiple factors. Taken together, these findings provide new epidemiological insight into how ABO blood group traits may interact with lipid metabolism patterns in local populations.

Conclusion

In this hospital-based retrospective cross-sectional adult sample, dyslipidemia was common and crude prevalence differed modestly across ABO blood groups, with higher rates observed in type A and lower rates in type B. After adjustment for age and sex, blood group A was associated with higher odds of dyslipidemia compared to group O, while group B was associated with lower odds. However, due to unmeasured confounding, these findings are descriptive and require confirmation in studies with comprehensive risk factor adjustment.

Footnotes

Acknowledgements

We thank Shanshan Chen and Jing Chen for their assistance with data processing and manuscript preparation.

ORCID iDs

Jing Chen

Shanshan Chen

Tao Xiao

Ethical considerations

This retrospective study was reviewed and approved by the Institutional Review Board of Tinglin Hospital in 2025-11, all patient data were anonymized prior to analysis.

Author contributions

Tao Xiao designed the study and drafted the manuscript. Shanshan Chen and Jing Chen collected the data and performed the statistical analyses. All authors reviewed and approved the final manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets generated and analyzed during the current study are not publicly available due to patient privacy and confidentiality regulations but are available from the corresponding author on reasonable request.*

Appendix

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