Shifted Global Epicenter of High Cholesterol

A global analysis of pooled population-based studies showed the global repositioning of lipid-related risk over the past nearly four decades, with non-optimal cholesterol shifting from high-income countries in northwestern Europe, north America and Australasia to countries in east and southeast Asia and Oceania. The analysis included 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, high-density lipoprotein (HDL) and non-HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018 due to 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. The change in non-HDL cholesterol was correlated with the change in a multi-dimensional score of animal-source foods and sugar, as well as the change in body-mass index and in diabetes prevalence. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million worldwide deaths, half of which occurred in east, southeast and south Asia. The decrease in non-HDL cholesterol in western countries may be due to changes in diet, especially the replacement of saturated with unsaturated fats and reduction in trans fats, as well as the increased use of statins. Source: https://www.nature.com/