Repositioning of the global epicentre of non-optimal cholesterol

NCD Risk Factor Collaboration (NCD-RisC); Robert J. Adams

doi:10.1038/s41586-020-2338-1

Repositioning of the global epicentre of non-optimal cholesterol

NCD Risk Factor Collaboration (NCD-RisC), Robert J. Adams

College of Medicine and Public Health

Research output: Contribution to journal › Article › peer-review

186 Citations (Scopus)

21 Downloads (Pure)

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 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 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.

Original language	English
Pages (from-to)	73-77
Number of pages	5
Journal	Nature
Volume	582
Issue number	7810
DOIs	https://doi.org/10.1038/s41586-020-2338-1
Publication status	Published - 4 Jun 2020

Bibliographical note

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

Keywords

Cardiovascular diseases
Risk factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1038/s41586-020-2338-1Licence: CC BY

NCD_Repositioning_P2020Final published version, 13.2 MBLicence: CC BY

Cite this

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title = "Repositioning of the global epicentre of non-optimal cholesterol",

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.",

keywords = "Cardiovascular diseases, Risk factors",

author = "{NCD Risk Factor Collaboration (NCD-RisC)} and Cristina Taddei and Bin Zhou and Honor Bixby and Carrillo-Larco, {Rodrigo M.} and Goodarz Danaei and Jackson, {Rod T.} and Farshad Farzadfar and Sophiea, {Marisa K.} and {Di Cesare}, Mariachiara and Iurilli, {Maria Laura Caminia} and Martinez, {Andrea Rodriguez} and Golaleh Asghari and Klodian Dhana and Pablo Gulayin and Sujay Kakarmath and Marilina Santero and Trudy Voortman and Riley, {Leanne M.} and Cowan, {Melanie J.} and Stefan Savin and Bennett, {James E.} and Stevens, {Gretchen A.} and Paciorek, {Christopher J.} and Wichai Aekplakorn and Renata Cifkova and Simona Giampaoli and Kengne, {Andre Pascal} and Khang, {Young Ho} and Kari Kuulasmaa and Avula Laxmaiah and Paula Margozzini and Prashant Mathur and Nordestgaard, {B{\o}rge G.} and Dong Zhao and Mette Aadahl and Leandra Abarca-G{\'o}mez and Rahim, {Hanan Abdul} and Abu-Rmeileh, {Niveen M.} and Benjamin Acosta-Cazares and Adams, {Robert J.} and Agdeppa, {Imelda A.} and Javad Aghazadeh-Attari and Aguilar-Salinas, {Carlos A.} and Charles Agyemang and Ahluwalia, {Tarunveer S.} and Ahmad, {Noor Ani} and Ali Ahmadi and Naser Ahmadi and Ahmed, {Soheir H.} and Wolfgang Ahrens and Kamel Ajlouni and Monira Alarouj and Fadia AlBuhairan and Shahla AlDhukair and Ali, {Mohamed M.} and Abdullah Alkandari and Ala{\textquoteright}a Alkerwi and Eman Aly and Amarapurkar, {Deepak N.} and Philippe Amouyel and Andersen, {Lars Bo} and Anderssen, {Sigmund A.} and Anjana, {Ranjit Mohan} and Alireza Ansari-Moghaddam and Hajer Aounallah-Skhiri and Joana Ara{\'u}jo and Inger Ariansen and Tahir Aris and Arku, {Raphael E.} and Nimmathota Arlappa and Aryal, {Krishna K.} and Thor Aspelund and Assun{\c c}{\~a}o, {Maria Cec{\'i}lia F.} and Juha Auvinen and M{\'a}ria Avdicov{\'a} and Ana Azevedo and Fereidoun Azizi and Mehrdad Azmin and Nagalla Balakrishna and Mohamed Bamoshmoosh and Maciej Banach and Piotr Bandosz and Banegas, {Jos{\'e} R.} and Barbagallo, {Carlo M.} and Alberto Barcel{\'o} and Amina Barkat and Iqbal Bata and Batieha, {Anwar M.} and Assembekov Batyrbek and Baur, {Louise A.} and Robert Beaglehole and Antonisamy Belavendra and {Ben Romdhane}, Habiba and Mikhail Benet and Marianne Benn and Salim Berkinbayev and Antonio Bernabe-Ortiz and Gailute Bernotiene and Heloisa Bettiol and Bhargava, {Santosh K.} and Yufang Bi and Asako Bienek and Mukharram Bikbov and Bihungum Bista and Peter Bjerregaard and Espen Bjertness and Bjertness, {Marius B.} and Cecilia Bj{\"o}rkelund and Bloch, {Katia V.} and Anneke Blokstra and Simona Bo and Boehm, {Bernhard O.} and Boggia, {Jose G.} and Boissonnet, {Carlos P.} and Marialaura Bonaccio and Vanina Bongard and Rossana Borchini and Herman Borghs and Pascal Bovet and Imperia Brajkovich and Juergen Breckenkamp and Hermann Brenner and Brewster, {Lizzy M.} and Graziella Bruno and Anna Bugge and Busch, {Markus A.} and {de Le{\'o}n}, {Antonio Cabrera} and Joseph Cacciottolo and G{\"u}nay Can and C{\^a}ndido, {Ana Paula C.} and Capanzana, {Mario V.} and Eduardo Capuano and Vincenzo Capuano and Cardoso, {Viviane C.} and Joana Carvalho and Casanueva, {Felipe F.} and Laura Censi and Chadjigeorgiou, {Charalambos A.} and Snehalatha Chamukuttan and Nish Chaturvedi and Chen, {Chien Jen} and Fangfang Chen and Shuohua Chen and Cheng, {Ching Yu} and Bahman Cheraghian and Angela Chetrit and Chiou, {Shu Ti} and Chirlaque, {Mar{\'i}a Dolores} and Belong Cho and Yumi Cho and Jerzy Chudek and Frank Claessens and Janine Clarke and Els Clays and Hans Concin and Confortin, {Susana C.} and Cyrus Cooper and Simona Costanzo and Dominique Cottel and Chris Cowell and Crujeiras, {Ana B.} and Sem{\'a}nov{\'a} Csilla and Liufu Cui and Cureau, {Felipe V.} and Graziella D{\textquoteright}Arrigo and Eleonora d{\textquoteright}Orsi and Jean Dallongeville and Albertino Damasceno and Rachel Dankner and Dantoft, {Thomas M.} and Luc Dauchet and Kairat Davletov and {De Backer}, Guy and {De Bacquer}, Dirk and {de Gaetano}, Giovanni and {De Henauw}, Stefaan and {de Oliveira}, {Paula Duarte} and {De Ridder}, David and {De Smedt}, Delphine and Mohan Deepa and Deev, {Alexander D.} and Abbas Dehghan and H{\'e}l{\`e}ne Delisle and Elaine Dennison and Val{\'e}rie Deschamps and Meghnath Dhimal and {Di Castelnuovo}, {Augusto F.} and Zivka Dika and Shirin Djalalinia and Dobson, {Annette J.} and Chiara Donfrancesco and Donoso, {Silvana P.} and Angela D{\"o}ring and Maria Dorobantu and Nico Dragano and Wojciech Drygas and Yong Du and Duante, {Charmaine A.} and Duda, {Rosemary B.} and Vilnis Dzerve and Elzbieta Dziankowska-Zaborszczyk and Ricky Eddie and Ebrahim Eftekhar and Robert Eggertsen and Sareh Eghtesad and Gabriele Eiben and Ulf Ekelund and {El Ati}, Jalila and Denise Eldemire-Shearer and Marie Eliasen and Roberto Elosua and Erasmus, {Rajiv T.} and Raimund Erbel and Cihangir Erem and Louise Eriksen and Eriksson, {Johan G.} and {Escobedo-de la Pe{\~n}a}, Jorge and Saeid Eslami and Ali Esmaeili and Alun Evans and David Faeh and Fall, {Caroline H.} and Elnaz Faramarzi and Mojtaba Farjam and Fattahi, {Mohammad Reza} and Felix-Redondo, {Francisco J.} and Ferguson, {Trevor S.} and Daniel Fern{\'a}ndez-Berg{\'e}s and Daniel Ferrante and Marika Ferrari and Catterina Ferreccio and Jean Ferrieres and Bernhard F{\"o}ger and Foo, {Leng Huat} and Forslund, {Ann Sofie} and Maria Forsner and Fouad, {Heba M.} and Francis, {Damian K.} and {do Carmo Franco}, Maria and Franco, {Oscar H.} and Guillermo Frontera and Yuki Fujita and Matsuda Fumihiko and Takuro Furusawa and Zbigniew Gaciong and Fabio Galvano and Jingli Gao and Edward Janus and Tiina Laatikainen and Julie Taylor",

note = "Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article{\textquoteright}s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article{\textquoteright}s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.",

year = "2020",

month = jun,

day = "4",

doi = "10.1038/s41586-020-2338-1",

language = "English",

volume = "582",

pages = "73--77",

journal = "Nature",

issn = "0028-0836",

publisher = "Nature Publishing Group",

number = "7810",

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TY - JOUR

T1 - Repositioning of the global epicentre of non-optimal cholesterol

AU - NCD Risk Factor Collaboration (NCD-RisC)

AU - Taddei, Cristina

AU - Zhou, Bin

AU - Bixby, Honor

AU - Carrillo-Larco, Rodrigo M.

AU - Danaei, Goodarz

AU - Jackson, Rod T.

AU - Farzadfar, Farshad

AU - Sophiea, Marisa K.

AU - Di Cesare, Mariachiara

AU - Iurilli, Maria Laura Caminia

AU - Martinez, Andrea Rodriguez

AU - Asghari, Golaleh

AU - Dhana, Klodian

AU - Gulayin, Pablo

AU - Kakarmath, Sujay

AU - Santero, Marilina

AU - Voortman, Trudy

AU - Riley, Leanne M.

AU - Cowan, Melanie J.

AU - Savin, Stefan

AU - Bennett, James E.

AU - Stevens, Gretchen A.

AU - Paciorek, Christopher J.

AU - Aekplakorn, Wichai

AU - Cifkova, Renata

AU - Giampaoli, Simona

AU - Kengne, Andre Pascal

AU - Khang, Young Ho

AU - Kuulasmaa, Kari

AU - Laxmaiah, Avula

AU - Margozzini, Paula

AU - Mathur, Prashant

AU - Nordestgaard, Børge G.

AU - Zhao, Dong

AU - Aadahl, Mette

AU - Abarca-Gómez, Leandra

AU - Rahim, Hanan Abdul

AU - Abu-Rmeileh, Niveen M.

AU - Acosta-Cazares, Benjamin

AU - Adams, Robert J.

AU - Agdeppa, Imelda A.

AU - Aghazadeh-Attari, Javad

AU - Aguilar-Salinas, Carlos A.

AU - Agyemang, Charles

AU - Ahluwalia, Tarunveer S.

AU - Ahmad, Noor Ani

AU - Ahmadi, Ali

AU - Ahmadi, Naser

AU - Ahmed, Soheir H.

AU - Ahrens, Wolfgang

AU - Ajlouni, Kamel

AU - Alarouj, Monira

AU - AlBuhairan, Fadia

AU - AlDhukair, Shahla

AU - Ali, Mohamed M.

AU - Alkandari, Abdullah

AU - Alkerwi, Ala’a

AU - Aly, Eman

AU - Amarapurkar, Deepak N.

AU - Amouyel, Philippe

AU - Andersen, Lars Bo

AU - Anderssen, Sigmund A.

AU - Anjana, Ranjit Mohan

AU - Ansari-Moghaddam, Alireza

AU - Aounallah-Skhiri, Hajer

AU - Araújo, Joana

AU - Ariansen, Inger

AU - Aris, Tahir

AU - Arku, Raphael E.

AU - Arlappa, Nimmathota

AU - Aryal, Krishna K.

AU - Aspelund, Thor

AU - Assunção, Maria Cecília F.

AU - Auvinen, Juha

AU - Avdicová, Mária

AU - Azevedo, Ana

AU - Azizi, Fereidoun

AU - Azmin, Mehrdad

AU - Balakrishna, Nagalla

AU - Bamoshmoosh, Mohamed

AU - Banach, Maciej

AU - Bandosz, Piotr

AU - Banegas, José R.

AU - Barbagallo, Carlo M.

AU - Barceló, Alberto

AU - Barkat, Amina

AU - Bata, Iqbal

AU - Batieha, Anwar M.

AU - Batyrbek, Assembekov

AU - Baur, Louise A.

AU - Beaglehole, Robert

AU - Belavendra, Antonisamy

AU - Ben Romdhane, Habiba

AU - Benet, Mikhail

AU - Benn, Marianne

AU - Berkinbayev, Salim

AU - Bernabe-Ortiz, Antonio

AU - Bernotiene, Gailute

AU - Bettiol, Heloisa

AU - Bhargava, Santosh K.

AU - Bi, Yufang

AU - Bienek, Asako

AU - Bikbov, Mukharram

AU - Bista, Bihungum

AU - Bjerregaard, Peter

AU - Bjertness, Espen

AU - Bjertness, Marius B.

AU - Björkelund, Cecilia

AU - Bloch, Katia V.

AU - Blokstra, Anneke

AU - Bo, Simona

AU - Boehm, Bernhard O.

AU - Boggia, Jose G.

AU - Boissonnet, Carlos P.

AU - Bonaccio, Marialaura

AU - Bongard, Vanina

AU - Borchini, Rossana

AU - Borghs, Herman

AU - Bovet, Pascal

AU - Brajkovich, Imperia

AU - Breckenkamp, Juergen

AU - Brenner, Hermann

AU - Brewster, Lizzy M.

AU - Bruno, Graziella

AU - Bugge, Anna

AU - Busch, Markus A.

AU - de León, Antonio Cabrera

AU - Cacciottolo, Joseph

AU - Can, Günay

AU - Cândido, Ana Paula C.

AU - Capanzana, Mario V.

AU - Capuano, Eduardo

AU - Capuano, Vincenzo

AU - Cardoso, Viviane C.

AU - Carvalho, Joana

AU - Casanueva, Felipe F.

AU - Censi, Laura

AU - Chadjigeorgiou, Charalambos A.

AU - Chamukuttan, Snehalatha

AU - Chaturvedi, Nish

AU - Chen, Chien Jen

AU - Chen, Fangfang

AU - Chen, Shuohua

AU - Cheng, Ching Yu

AU - Cheraghian, Bahman

AU - Chetrit, Angela

AU - Chiou, Shu Ti

AU - Chirlaque, María Dolores

AU - Cho, Belong

AU - Cho, Yumi

AU - Chudek, Jerzy

AU - Claessens, Frank

AU - Clarke, Janine

AU - Clays, Els

AU - Concin, Hans

AU - Confortin, Susana C.

AU - Cooper, Cyrus

AU - Costanzo, Simona

AU - Cottel, Dominique

AU - Cowell, Chris

AU - Crujeiras, Ana B.

AU - Csilla, Semánová

AU - Cui, Liufu

AU - Cureau, Felipe V.

AU - D’Arrigo, Graziella

AU - d’Orsi, Eleonora

AU - Dallongeville, Jean

AU - Damasceno, Albertino

AU - Dankner, Rachel

AU - Dantoft, Thomas M.

AU - Dauchet, Luc

AU - Davletov, Kairat

AU - De Backer, Guy

AU - De Bacquer, Dirk

AU - de Gaetano, Giovanni

AU - De Henauw, Stefaan

AU - de Oliveira, Paula Duarte

AU - De Ridder, David

AU - De Smedt, Delphine

AU - Deepa, Mohan

AU - Deev, Alexander D.

AU - Dehghan, Abbas

AU - Delisle, Hélène

AU - Dennison, Elaine

AU - Deschamps, Valérie

AU - Dhimal, Meghnath

AU - Di Castelnuovo, Augusto F.

AU - Dika, Zivka

AU - Djalalinia, Shirin

AU - Dobson, Annette J.

AU - Donfrancesco, Chiara

AU - Donoso, Silvana P.

AU - Döring, Angela

AU - Dorobantu, Maria

AU - Dragano, Nico

AU - Drygas, Wojciech

AU - Du, Yong

AU - Duante, Charmaine A.

AU - Duda, Rosemary B.

AU - Dzerve, Vilnis

AU - Dziankowska-Zaborszczyk, Elzbieta

AU - Eddie, Ricky

AU - Eftekhar, Ebrahim

AU - Eggertsen, Robert

AU - Eghtesad, Sareh

AU - Eiben, Gabriele

AU - Ekelund, Ulf

AU - El Ati, Jalila

AU - Eldemire-Shearer, Denise

AU - Eliasen, Marie

AU - Elosua, Roberto

AU - Erasmus, Rajiv T.

AU - Erbel, Raimund

AU - Erem, Cihangir

AU - Eriksen, Louise

AU - Eriksson, Johan G.

AU - Escobedo-de la Peña, Jorge

AU - Eslami, Saeid

AU - Esmaeili, Ali

AU - Evans, Alun

AU - Faeh, David

AU - Fall, Caroline H.

AU - Faramarzi, Elnaz

AU - Farjam, Mojtaba

AU - Fattahi, Mohammad Reza

AU - Felix-Redondo, Francisco J.

AU - Ferguson, Trevor S.

AU - Fernández-Bergés, Daniel

AU - Ferrante, Daniel

AU - Ferrari, Marika

AU - Ferreccio, Catterina

AU - Ferrieres, Jean

AU - Föger, Bernhard

AU - Foo, Leng Huat

AU - Forslund, Ann Sofie

AU - Forsner, Maria

AU - Fouad, Heba M.

AU - Francis, Damian K.

AU - do Carmo Franco, Maria

AU - Franco, Oscar H.

AU - Frontera, Guillermo

AU - Fujita, Yuki

AU - Fumihiko, Matsuda

AU - Furusawa, Takuro

AU - Gaciong, Zbigniew

AU - Galvano, Fabio

AU - Gao, Jingli

AU - Janus, Edward

AU - Laatikainen, Tiina

AU - Taylor, Julie

N1 - Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

PY - 2020/6/4

Y1 - 2020/6/4

N2 - 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.

AB - 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.

KW - Cardiovascular diseases

KW - Risk factors

UR - http://www.scopus.com/inward/record.url?scp=85085994877&partnerID=8YFLogxK

U2 - 10.1038/s41586-020-2338-1

DO - 10.1038/s41586-020-2338-1

M3 - Article

C2 - 32494083

AN - SCOPUS:85085994877

SN - 0028-0836

VL - 582

SP - 73

EP - 77

JO - Nature

JF - Nature

IS - 7810

ER -

Repositioning of the global epicentre of non-optimal cholesterol

Abstract

Bibliographical note

Keywords

UN SDGs

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