Repositioning of the global epicentre of non-optimal cholesterol

Abstract

Repositioning of the global epicentre of non-optimal cholesterol NCD Risk Factor Collaboration (NCD-RisC)* 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 riskchanged from those in western Europe such as Belgium,

Prevalence and management of hypercholesterolemia in France, the Esteban observational study

“…The mean level of LDL-c found in our study was similar to the mean level of non-HDL-c reported in a recent analysis of 1,127 patients in a pooled population-based study (3.3 mmol/l). [ 18 ] Our results therefore are not in favor of a French specificity in terms of lipids (basis of the “French paradox”). Although the role of cholesterol serum levels as potential risk factor for ischemic stroke has been reported as conflicting, with complex relations, [ 19 – 21 ] cholesterol is undoubtly a major cardiometabolic risk factor [ 22 ]…”

Nutritional Viewpoints on Eggs and Cholesterol

“…However, many Japanese recognize that egg consumption results in elevation of blood cholesterol level and causes CHD. Moreover, a recent epidemiologic study indicates that blood cholesterol levels are increasing in East Asian countries, including Japan, in contrast to a lowering trend in Western countries [15].…”

Trends in lipid-modifying agent use in 83 countries

“…Country-level estimates for mean total and non-HDL cholesterol were obtained from the NCD Risk Factor Collaboration. The NCD Risk Factor Collaboration used publicly available data from population-based surveys to estimate age-standardized total and non-HDL cholesterol for 200 countries, from 1980 to 2018, using a Bayesian model with the Markov chain Monte Carlo algorithm [6]. Although low-density lipoprotein (LDL) cholesterol is often the primary treatment target in lipid guidelines, both total and non-HDL cholesterol (the total mass of cholesterol in atherogenic lipoproteins) has been more widely measured [6].…”

“…Several developing regions now face a greater burden from elevated cholesterol levels, yet they have lower consumption of lipid-modifying agents as compared to high-income regions [6,7]. Since 1980, parts of Africa and East and Southeast Asia have experienced increases in total and non-high-density lipoprotein (non-HDL) cholesterol, while high-income Western countries have experienced decreases [6]. It is unknown whether recent consumption trends of lipid-modifying agents correspond to the observed changes in cholesterol levels.…”