Repositioning of the global epicentre of non-optimal cholesterol
Repositioning of the global epicentre of non-optimal cholesterol
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.
73-77
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Dennison, Elaine
ee647287-edb4-4392-8361-e59fd505b1d1
Fall, Caroline
7171a105-34f5-4131-89d7-1aa639893b18
Osmond, Clive
2677bf85-494f-4a78-adf8-580e1b8acb81
NCD Risk Factor Collaboration (NCD-RisC)
4 June 2020
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Dennison, Elaine
ee647287-edb4-4392-8361-e59fd505b1d1
Fall, Caroline
7171a105-34f5-4131-89d7-1aa639893b18
Osmond, Clive
2677bf85-494f-4a78-adf8-580e1b8acb81
Cooper, Cyrus, Dennison, Elaine, Fall, Caroline and Osmond, Clive
,
NCD Risk Factor Collaboration (NCD-RisC)
(2020)
Repositioning of the global epicentre of non-optimal cholesterol.
Nature, 582 (7810), .
(doi:10.1038/s41586-020-2338-1).
Abstract
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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Repositioning of the global epicentre
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Accepted/In Press date: 2 April 2020
e-pub ahead of print date: 3 June 2020
Published date: 4 June 2020
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Acknowledgements This study was funded by a Wellcome Trust (Biomedical Resource & Multi-User Equipment grant 01506/Z/13/Z) and the British Heart Foundation (Centre of Research Excellence grant RE/18/4/34215). C.T. was supported by a Wellcome Trust Research Training Fellowship (203616/Z/16/Z). The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.
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Competing interests M.E. reports a charitable grant from the AstraZeneca Young Health Programme, and personal fees from Prudential, Scor and Third Bridge, outside the submitted work. The other authors declare no competing interests.
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© 2020, The Author(s), under exclusive licence to Springer Nature Limited.
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Local EPrints ID: 441622
URI: http://eprints.soton.ac.uk/id/eprint/441622
ISSN: 0028-0836
PURE UUID: 95698c30-cdde-40ee-b1d6-ee3160c86103
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Date deposited: 22 Jun 2020 16:30
Last modified: 18 Mar 2024 02:46
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Corporate Author: NCD Risk Factor Collaboration (NCD-RisC)
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