Cholesterol levels are declining sharply in Western nations – but rising in Asia, according to the largest global study of its kind.
Led by Imperial College London, UK, the research involved hundreds of researchers from across the world, using data from 102.6 million individuals in 200 countries between 1980 and 2018.
The study, which is published in the latest edition of Nature, found that high cholesterol is responsible for about 3.9 million worldwide deaths, half of which happen in East, South and Southeast Asia.
The analysis showed that total and non- high-density lipoprotein (HDL) cholesterol levels have fallen sharply in high-income nations between 1980 and 2018, particularly in North-western Europe, North America and Australasia.
However, it saw significant increases in low- and middle-income nations, particularly in East and Southeast Asia. China, which had some of the lowest levels of non-HDL cholesterol in 1980 yet one of the largest increases in non-HDL over the 39-year study period.
Lead author Professor Majid Ezzati, of Imperial’s School of Public Health, said: “For the first time, the highest levels of non-HDL cholesterol are outside of the Western world.
“This suggests we now need to set into place throughout the world pricing and regulatory policies that shift diets from saturated to non-saturated fats, and to prepare health systems to treat those in need with effective medicines. This will help save millions of deaths from high non-HDL cholesterol in these regions.”
Countries with the highest levels of non-HDL cholesterol changed from those in Western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and Pacific, such as Tokelau, Malaysia, the Philippines and Thailand.
Prof Ezzati said some of the reduction in non-HDL cholesterol levels in Western nations is due to increased use of statins, which are not yet used widely in low- and middle-income countries. The team also highlighted that some countries had less data than others.
Professor Sir Nilesh Samani, medical director at the British Heart Foundation, which co-funded the study with Wellcome Trust, said: “It’s encouraging to see the reduction in levels of non-HDL, or ‘bad’, cholesterol in the UK since 1980.
“Public health initiatives about the risks of a diet high in saturated fat, and wider treatment with statins in those with high levels will have made a big contribution. The result is undoubtedly fewer heart attacks and strokes. However, we mustn’t be complacent or be misled by this change
“High numbers of people still have undiagnosed or uncontrolled levels of non-HDL cholesterol putting them at greater risk of heart and circulatory diseases. We strongly encourage people, especially those over 40, to have their cholesterol checked. It’s important for those diagnosed with high non-HDL cholesterol to follow their doctor’s advice for lowering it.”
Nature 3 June 2020
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