One-third of global 'bad' cholesterol burden occurred in India, China in 2023: Study

In 2023, high LDL or 'bad' cholesterol was responsible for 3.6 million deaths -- 6 per cent of all deaths -- and 90.7 million years of healthy life lost, with one-third of the global LDL-C burden occurring in India and China, according to a study.

Findings published in The Journal of the American Medical Association (JAMA) show that absolute LDL cholesterol (LDL-C) burden has increased since 1990 due to demographic changes and shifted towards middle-sociodemographic countries, with population growth and ageing driving the increasing burden, researchers said.

"Despite declining age-standardised rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries," authors forming the Global Burden of Disease (GBD) 2023 LDL Cholesterol Collaborators said.

"In 2023, elevated LDL-C accounted for 3.6 million deaths (6.0 per cent of global mortality) and 90.7 million DALYs (3.2 per cent of DALYs)," they said. One DALY or disability adjusted life year equates to one year of healthy life lost.

"One-third of the global LDL-C burden occurred in India and China," the team added.

Using data from the GBD 2023, the researchers quantified the burden attributable to high LDL-C among adults aged 25 years or older across 204 countries and territories by age and sex from 1990 to 2023.

Between 1990 and 2023, the number of adults aged 25 or more with LDL-C levels of 54 milligrams per decilitre or greater increased from about 2.5 billion to 4.6 billion, the study estimated.

Age-standardised average of LDL-C in 2023 was found to be lowest in Burkina Faso, Lesotho, Somalia, and Rwanda (under 80 milligrams per decilitre) and highest in Serbia, Slovenia, Russia, Norway, and Austria (over 135 milligrams per decilitre).

High LDL-C was also the second leading driver of cardiovascular disease mortality and a top-10 contributor to the global all-cause burden in 2023.

The same year, high LDL-C accounted for 6.0 per cent of all-cause deaths, 8.1 per cent of noncommunicable disease deaths, and 18.9 per cent of deaths due to cardiovascular disease, the researchers found.

High LDL-C also contributed to nearly one-third of deaths due to ischaemic heart disease (2.7 million) and 27 per cent of ischaemic stroke deaths (0.87 million). Blood supply to the heart muscle is restricted in ischaemic heart disease.

The researchers said statins remain the cornerstone of LDL-C management, though real-world impact of the drug is constrained by under use, even where available.

Barriers include the asymptomatic nature of hypercholesterolemia, low awareness and costs of testing and treatment, along with inconsistent supply, health system inefficiencies, and concerns about adverse effects, they said.

Addressing the gaps requires a strengthening of primary care systems, improving access to affordable diagnostics and medications, and standardised, guideline-based treatment, the team said.