In a new study, researchers found that cholesterol levels are declining sharply in Western nations, but rising in low- and middle-income nations—particularly in Asia.
They used data from 102.6 million individuals and examined cholesterol levels in 200 countries, across a 39-year time period, from 1980 to 2018.
They found that high cholesterol is responsible for about 3.9 million worldwide deaths. Half of these deaths happen in East, South, and Southeast Asia.
This is the largest ever study of global cholesterol levels.
The research was led by Imperial College London.
Cholesterol is a waxy substance found in the blood. The body needs cholesterol to build healthy cells, but too much can lead to a build-up in the blood vessels.
Cholesterol comes in different types. High-density lipoprotein (HDL) ‘good’ cholesterol, which should be 1mmol/L or above, is thought to have a protective effect against heart attack and stroke, by mopping up excess ‘bad’ cholesterol.
Non-HDL ‘bad’ cholesterol, which should be as low as possible, around 2mmol/L, can block blood supply and lead to heart attacks and strokes.
This type of cholesterol is usually raised by diets high in saturated and trans fats, which is found in many processed foods, instead of healthier unsaturated fats. It can be lowered effectively through the use of statins.
The results of the new study revealed total and non-HDL cholesterol levels have fallen sharply in high-income nations, particularly those in North-western Europe, North America, and Australasia while rising 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, had one of the largest rates of increase in non-HDL over the 39 year study period.
The findings show that 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.
The team added that some of the reduction in non-HDL cholesterol levels in Western nations are due to increased use of statins in Western countries, which are not yet used widely in low- and middle-income countries.
One author of the study is Professor Majid Ezzati.
The study is published in Nature.
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