ArticlesNational, regional, and global trends in serum total cholesterol since 1980: systematic analysis of health examination surveys and epidemiological studies with 321 country-years and 3·0 million participants
Introduction
Raised serum total cholesterol is an important cardiovascular risk factor, which causes an estimated 4·4 million deaths every year worldwide.1, 2, 3, 4 Variations in diet, especially consumption of animal-based versus plant-based fats, adiposity, and use of drugs to lower cholesterol have led to differences in serum cholesterol concentrations across populations and over time.5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19
Reliable population-based data for cholesterol trends are needed to assess the effects of diet, adiposity, and statin use; guide priority setting; and evaluate programmes. Investigators of the MONICA Project and other studies have analysed trends in serum cholesterol in specific communities and recorded changes as large as 0·7 mmol/L per decade.5, 9, 10, 18, 20, 21, 22, 23, 24, 25 Less is known about national trends, in high-income or developing countries.5, 17, 19, 26, 27, 28 Previous comparative cross-population analyses5, 8, 16, 18, 29 were based on a small number of data sources, used data that might not have been population based, did not explicitly address missing data for whole countries or for older ages, combined data from nationally representative surveys with subnational and community studies without distinguishing them, and did not quantify uncertainty. Our aim was to estimate trends in cholesterol by country, and to systematically quantify uncertainty.
Section snippets
Study design
We estimated 1980–2008 trends in mean serum total cholesterol and their uncertainties, by sex, for 199 countries and territories in 21 subregions of the Global Burden of Diseases, Injuries, and Risk Factors study, which are grouped into seven merged regions (webappendix p 16). Although LDL cholesterol, ratio of total to HDL cholesterol, and specific apolipoproteins might be better indicators of cardiovascular risk,1, 4, 30 our primary analysis was based on total cholesterol because our search
Results
Our analysis included 321 country-years of data for serum total cholesterol with 3·0 million participants (figure 1). 166 country-years were from 24 high-income countries and 155 from 66 low-income and middle-income countries, showing the global gap in lipids surveillance, even relative to blood pressure and BMI.31, 33 High-income Asia-Pacific, North America, and western Europe had the most data per country (webappendix pp 39–41). Japan had 20 years of national data since 1980, and the USA had
Discussion
Findings from our systematic analysis of worldwide serum total cholesterol have shown that the global average changed little between 1980 and 2008. This apparent lack of change stems from opposite trends in Australasia, North America, and Europe, where serum total cholesterol decreased from high concentrations, and in east and southeast Asia and Pacific, where it rose from low concentrations. Such polarised trends are arguably the most salient feature of this risk factor, especially relative to
References (47)
- et al.
Selected major risk factors and global and regional burden of disease
Lancet
(2002) - et al.
Lipids and coronary heart disease in Asia
Atherosclerosis
(2003) Coronary heart disease—the global picture
Atherosclerosis
(1975)- et al.
Different trends in serum cholesterol levels among rural and urban populations aged 40–59 in Japan from 1960 to 1990
J Clin Epidemiol
(1995) - et al.
Dietary saturated and trans fatty acids and cholesterol and 25-year mortality from coronary heart disease: the Seven Countries Study
Prev Med
(1995) - et al.
National trends in risk factors for cardiovascular disease in Germany
Prev Med
(1994) - et al.
The pattern of food and mortality in Belgium
Lancet
(1977) - et al.
Precision of a dry-chemistry method of lipid screening
Public Health
(2006) - et al.
Trends in hypercholesterolemia, treatment and control among United States adults
Int J Cardiol
(2010) - et al.
Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries
Lancet
(2009)
Benchmarking of performance of Mexican states with effective coverage
Lancet
Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial
Lancet
Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55 000 vascular deaths
Lancet
Cholesterol, coronary heart disease, and stroke in the Asia Pacific region
Int J Epidemiol
Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality
JAMA
Dietary fat and adult diseases and the implications for childhood nutrition: an epidemiologic approach
Am J Clin Nutr
International comparisons of plasma cholesterol and lipoproteins
Ann N Y Acad Sci
Time trends in population cholesterol levels 1986–2004: influence of lipid-lowering drugs, obesity, smoking and educational level. The northern Sweden MONICA study
J Intern Med
Trends in total and high density lipoprotein cholesterol and their determinants in The Netherlands between 1993 and 1997
Int J Epidemiol
Serum total and high density lipoprotein cholesterol concentrations and body mass index in adult men from 13 countries
Am J Epidemiol
An ecological study of serum cholesterol and ischaemic heart disease between 1950 and 1990
Eur J Clin Nutr
Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001
JAMA
The epidemiology of hypercholesterolemia. A global perspective
Am J Med
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