Repositioning of the global epicentre of non-optimal cholesterol
Cristina Taddei, Bin Zhou, Honor Bixby, Rodrigo M. Carrillo‐Larco, Goodarz Danaei, Rod Jackson, Farshad Farzadfar, Marisa K. Sophiea, Mariachiara Di Cesare, Maria Laura Caminia Iurilli, Andrea Rodríguez Martínez, Golaleh Asghari, Klodian Dhana, Pablo Gulayin, Sujay Kakarmath, Marilina Santero, Trudy Voortman, Leanne M Riley, Melanie Cowan, Stefan Savin, James E. Bennett, Gretchen A Stevens, Christopher Paciorek, Wichai Aekplakorn, Renata Cífková, Simona Giampaoli, André Pascal Kengne, Young‐Ho Khang, Kari Kuulasmaa, Avula Laxmaiah, Paula Margozzini, Prashant Mathur, Børge G. Nordestgaard, Dong Zhao, Mette Aadahl, Leandra Abarca-Gómez, Hanan F. Abdul Rahim, Niveen Abu-Rmeileh, Benjamín Acosta-Cázares, Robert Adams, Imelda Angeles‐Agdeppa, Javad Aghazadeh-Attari, Carlos A. Aguilar-Salinas, Charles Agyemang, Tarunveer S. Ahluwalia, Noor Ani Ahmad, Ali Ahmadi, Naser Ahmadi, Soheir H. Ahmed, Wolfgang Ahrens, Kamel Ajlouni, Monira Alarouj, Fadia AlBuhairan, Shahla AlDhukair, Mohamed M. Ali, Abdullah Alkandari, Ala’a Alkerwi, Eman Aly, Deepak Amarapurkar, Philippe Amouyel, Lars Bo Andersen, Sigmund A. Anderssen, Ranjit Mohan Anjana, Alireza Ansari‐Moghaddam, Hajer Aounallah-Skhiri, Joana Araújo, Inger Ariansen, Tahir Aris, Raphael E. Arku, Nimmathota Arlappa, Krishna Kumar Aryal, Thor Aspelund, Maria Cecília F Assunção, Juha Auvinen, Mária Avdičová, Ana Azevedo, Fereidoun Azizi, Mehrdad Azmin, Nagalla Balakrishna, Mohamed Bamoshmoosh, Maciej Banach, Piotr Bandosz, José R. Banegas, Carlo M Barbagallo, Alberto Barceló, Amina Barkat, Iqbal Bata, Anwar Batieha, Batyrbek Assembekov, Louise A. Baur, R Beaglehole, Belavendra Antonisamy, Habiba Ben Romdhane, Mikhail Benet Rodríguez, Marianne Benn, Salim Berkinbayev, Antonio Bernabé‐Ortiz, Gailutė Bernotienė, Heloísa Bettiol, Santosh K. Bhargava
Abstract
Abstract High blood cholesterol is typically considered a feature of wealthy western countries 1,2 . However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world 3 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 health 4,5 . 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.