Research & Publications

Repositioning of the global epicentre of non-optimal cholesterol

By June 1, 2020September 24th, 2020No Comments



NCD Risk Factor Collaboration (NCD-RisC)

High blood cholesterol is typically considered a feature of wealthy
western countries1,2. However, dietary and behavioural determinants of blood cholesterol are
changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These
changes can have distinct effects on the levels of high-density lipoprotein
(HDL) cholesterol and non-HDL cholesterol, which have different effects on
human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have
not been previously reported in a global analysis. Here we pooled 1,127
population-based studies that measured blood lipids in 102.6 million
individuals aged 18 years and older to estimate trends from 1980 to 2018 in
mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally,
there was little change in total or non-HDL cholesterol from 1980 to 2018.
This was a net effect of increases in low- and middle-income countries,
especially in east and southeast Asia, and decreases in high-income western
countries, especially those in northwestern Europe, and in central and
eastern Europe. As a result, countries with the highest level of non-HDL
cholesterol-which is a marker of cardiovascular risk-changed from those in
western Europe such as Belgium, Finland, Greenland, Iceland, Norway,
Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific,
such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high
non-HDL cholesterol was responsible for an estimated 3.9 million (95%
credible interval 3.7 million-4.2 million) worldwide deaths, half of which
occurred in east, southeast and south Asia. The global repositioning of
lipid-related risk, with non-optimal cholesterol shifting from a distinct
feature of high-income countries in northwestern Europe, north America and
Australasia to one that affects countries in east and southeast Asia and
Oceania should motivate the use of population-based policies and personal
interventions to improve nutrition and enhance access to treatment
throughout the world.


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