Repositioning of the global epicentre of non-optimal cholesterol
Authors
NCD Risk Factor Collaboration (NCD-RisC):
Cristina Taddei, Bin Zhou, Honor Bixby, Rodrigo M Carrillo-Larco, Goodarz Danaei, Rod T Jackson, Farshad Farzadfar, Marisa K Sophiea, Mariachiara Di Cesare, Maria Laura Caminia Iurilli, Andrea Rodriguez Martinez, Golaleh Asghari, Klodian Dhana, Pablo Gulayin, Sujay Kakarmath, Marilina Santero, Trudy Voortman, Leanne M Riley, Melanie J Cowan, Stefan Savin, James E Bennett, Gretchen A Stevens, Christopher J Paciorek, Wichai Aekplakorn, Renata Cifkova, Simona Giampaoli, Andre Pascal Kengne, Young-Ho Khang, Kari Kuulasmaa, Avula Laxmaiah, Paula Margozzini, Prashant Mathur, Børge G Nordestgaard, Dong Zhao, Mette Aadahl, Leandra Abarca-Gómez, Hanan Abdul Rahim, Niveen M Abu-Rmeileh, Benjamin Acosta-Cazares, Robert J Adams, Imelda A Agdeppa, Javad Aghazadeh-Attari, Carlos A Aguilar-Salinas, Charles Agyemang, Tarunveer S Ahluwalia, Noor Ani Ahmad, Ali Ahmadi, Naser Ahmadi, Soheir H Ahmed, Wolfgang Ahrens, Kamel Ajlouni, Monira Alarouj, Fadia AlBuhairan, Shahla AlDhukair, Mohamed M Ali, Abdullah Alkandari, Ala’a Alkerwi, Eman Aly, Deepak N Amarapurkar, Philippe Amouyel, Lars Bo Andersen, Sigmund A Anderssen, Ranjit Mohan Anjana, Alireza Ansari-Moghaddam, Hajer Aounallah-Skhiri, Joana Araújo, Inger Ariansen, Tahir Aris, Raphael E Arku, Nimmathota Arlappa, Krishna K Aryal, Thor Aspelund, Maria Cecília F Assunção, Juha Auvinen, Mária Avdicová, Ana Azevedo, Fereidoun Azizi, Mehrdad Azmin, Nagalla Balakrishna, Mohamed Bamoshmoosh, Maciej Banach, Piotr Bandosz, José R Banegas, Carlo M Barbagallo, Alberto Barceló, Amina Barkat, Iqbal Bata, Anwar M Batieha, Assembekov Batyrbek, Louise A Baur, Robert Beaglehole, Antonisamy Belavendra, Habiba Ben Romdhane, Mikhail Benet, Marianne Benn, Salim Berkinbayev, Antonio Bernabe-Ortiz, Gailute Bernotiene, Heloisa Bettiol, Santosh K Bhargava, Yufang Bi, Asako Bienek, Mukharram Bikbov, Bihungum Bista, Peter Bjerregaard, Espen Bjertness, Marius B Bjertness, Cecilia Björkelund, Katia V Bloch, Anneke Blokstra, Simona Bo, Bernhard O Boehm, Jose G Boggia, Carlos P Boissonnet, Marialaura Bonaccio, Vanina Bongard, Rossana Borchini, Herman Borghs, Pascal Bovet, Imperia Brajkovich, Juergen Breckenkamp, Hermann Brenner, Lizzy M Brewster, Graziella Bruno, Anna Bugge, Markus A Busch, Antonio Cabrera de León, Joseph Cacciottolo, Günay Can, Ana Paula C Cândido, Mario V Capanzana, Eduardo Capuano, Vincenzo Capuano, Viviane C Cardoso, Joana Carvalho, Felipe F Casanueva, Laura Censi, Charalambos A Chadjigeorgiou, Snehalatha Chamukuttan, Nish Chaturvedi, Chien-Jen Chen, Fangfang Chen, Shuohua Chen, Ching-Yu Cheng, Bahman Cheraghian, Angela Chetrit, Shu-Ti Chiou, María-Dolores Chirlaque, Belong Cho, Yumi Cho, Jerzy Chudek, Frank Claessens, Janine Clarke, Els Clays, Hans Concin, Susana C Confortin, Cyrus Cooper, Simona Costanzo, Dominique Cottel, Chris Cowell, Ana B Crujeiras, Semánová Csilla, Liufu Cui, Felipe V Cureau, Graziella D’Arrigo, Eleonora d’Orsi, Jean Dallongeville, Albertino Damasceno, Rachel Dankner, Thomas M Dantoft, Luc Dauchet, Kairat Davletov, Guy De Backer, Dirk De Bacquer, Giovanni de Gaetano, Stefaan De Henauw, Paula Duarte de Oliveira, David De Ridder, Delphine De Smedt, Mohan Deepa, Alexander D Deev, Abbas Dehghan, Hélène Delisle, Elaine Dennison, Valérie Deschamps, Meghnath Dhimal, Augusto F Di Castelnuovo, Zivka Dika, Shirin Djalalinia, Annette J Dobson, Chiara Donfrancesco, Silvana P Donoso, Angela Döring, Maria Dorobantu, Nico Dragano, Wojciech Drygas, Yong Du, Charmaine A Duante, Rosemary B Duda, Vilnis Dzerve, Elzbieta Dziankowska-Zaborszczyk, Ricky Eddie, Ebrahim Eftekhar, Robert Eggertsen, Sareh Eghtesad, Gabriele Eiben, Ulf Ekelund, Jalila El Ati, Denise Eldemire-Shearer, Marie Eliasen, Roberto Elosua, Rajiv T Erasmus, Raimund Erbel, Cihangir Erem, Louise Eriksen, Johan G Eriksson, Jorge Escobedo-de la Peña, Saeid Eslami, Ali Esmaeili, Alun Evans, David Faeh, Caroline H Fall, Elnaz Faramarzi, Mojtaba Farjam, Mohammad Reza Fattahi, Francisco J Felix-Redondo, Trevor S Ferguson, Daniel Fernández-Bergés, Daniel Ferrante, Marika Ferrari, Catterina Ferreccio, Jean Ferrieres, Bernhard Föger, Leng Huat Foo, Ann-Sofie Forslund, Maria Forsner, Heba M Fouad, Damian K Francis, Maria do Carmo Franco, Oscar H Franco, Guillermo Frontera, Yuki Fujita, Matsuda Fumihiko, Takuro Furusawa, Zbigniew Gaciong, Fabio Galvano, Jingli Gao, Manoli Garcia-de-la-Hera, Sarah P Garnett, Jean-Michel Gaspoz, Magda Gasull, Andrea Gazzinelli, Johanna M Geleijnse, Ali Ghanbari, Erfan Ghasemi, Oana-Florentina Gheorghe-Fronea, Anup Ghimire, Francesco Gianfagna, Tiffany K Gill, Jonathan Giovannelli, Glen Gironella, Aleksander Giwercman, David Goltzman, Helen Gonçalves, David A Gonzalez-Chica, Marcela Gonzalez-Gross, Juan P González-Rivas, Clicerio González-Villalpando, María-Elena González-Villalpando, Angel R Gonzalez, Frederic Gottrand, Sidsel Graff-Iversen, Dušan Grafnetter, Ronald D Gregor, Tomasz Grodzicki, Anders Grøntved, Giuseppe Grosso, Gabriella Gruden, Dongfeng Gu, Pilar Guallar-Castillón, Ong Peng Guan, Elias F Gudmundsson, Vilmundur Gudnason, Ramiro Guerrero, Idris Guessous, Johanna Gunnlaugsdottir, Rajeev Gupta, Laura Gutierrez, Felix Gutzwiller, Seongjun Ha, Farzad Hadaegh, Rosa Haghshenas, Hamid Hakimi, Ian R Hambleton, Behrooz Hamzeh, Sari Hantunen, Rachakulla Hari Kumar, Seyed Mohammad Hashemi-Shahri, Jun Hata, Teresa Haugsgjerd, Alison J Hayes, Jiang He, Yuna He, Marleen Elisabeth Hendriks, Ana Henriques, Sauli Herrala, Ramin Heshmat, Allan G Hill, Sai Yin Ho, Suzanne C Ho, Michael Hobbs, Albert Hofman, Reza Homayounfar, Wilma M Hopman, Andrea R V R Horimoto, Claudia M Hormiga, Bernardo L Horta, Leila Houti, Christina Howitt, Thein Thein Htay, Aung Soe Htet, Maung Maung Than Htike, José María Huerta, Ilpo Tapani Huhtaniemi, Martijn Huisman, Monica L Hunsberger, Abdullatif S Husseini, Inge Huybrechts, Nahla Hwalla, Licia Iacoviello, Anna G Iannone, Mohsen M Ibrahim, Norazizah Ibrahim Wong, Iris Iglesia, Nayu Ikeda, M Arfan Ikram, Violeta Iotova, Vilma E Irazola, Takafumi Ishida, Muhammad Islam, Aziz Al-Safi Ismail, Masanori Iwasaki, Jeremy M Jacobs, Hashem Y Jaddou, Tazeen Jafar, Kenneth James, Konrad Jamrozik, Imre Janszky, Edward Janus, Marjo-Riitta Jarvelin, Grazyna Jasienska, Ana Jelakovic, Bojan Jelakovic, Garry Jennings, Gorm B Jensen, Seung-Lyeal Jeong, Anjani Kumar Jha, Chao Qiang Jiang, Ramon O Jimenez, Karl-Heinz Jöckel, Michel Joffres, Jari J Jokelainen, Jost B Jonas, Torben Jørgensen, Pradeep Joshi, Farahnaz Joukar, Jacek Józwiak, Anne Juolevi, Anthony Kafatos, Eero O Kajantie, Ofra Kalter-Leibovici, Nor Azmi Kamaruddin, Pia R Kamstrup, Khem B Karki, Joanne Katz, Jussi Kauhanen, Prabhdeep Kaur, Maryam Kavousi, Gyulli Kazakbaeva, Ulrich Keil, Sirkka Keinänen-Kiukaanniemi, Roya Kelishadi, Maryam Keramati, Alina Kerimkulova, Mathilde Kersting, Yousef Saleh Khader, Davood Khalili, Mohammad Khateeb, Motahareh Kheradmand, Alireza Khosravi, Ursula Kiechl-Kohlendorfer, Stefan Kiechl, Japhet Killewo, Hyeon Chang Kim, Jeongseon Kim, Yeon-Yong Kim, Jurate Klumbiene, Michael Knoflach, Stephanie Ko, Hans-Peter Kohler, Iliana V Kohler, Elin Kolle, Patrick Kolsteren, Jürgen König, Raija Korpelainen, Paul Korrovits, Jelena Kos, Seppo Koskinen, Katsuyasu Kouda, Sudhir Kowlessur, Wolfgang Kratzer, Susi Kriemler, Peter Lund Kristensen, Steiner Krokstad, Daan Kromhout, Urho M Kujala, Pawel Kurjata, Catherine Kyobutungi, Fatima Zahra Laamiri, Tiina Laatikainen, Carl Lachat, Youcef Laid, Tai Hing Lam, Christina-Paulina Lambrinou, Vera Lanska, Georg Lappas, Bagher Larijani, Tint Swe Latt, Lars E Laugsand, Maria Lazo-Porras, Jeannette Lee, Jeonghee Lee, Nils Lehmann, Terho Lehtimäki, Naomi S Levitt, Yanping Li, Christa L Lilly, Wei-Yen Lim, M Fernanda Lima-Costa, Hsien-Ho Lin, Xu Lin, Yi-Ting Lin, Lars Lind, Allan Linneberg, Lauren Lissner, Jing Liu, Helle-Mai Loit, Esther Lopez-Garcia, Tania Lopez, Paulo A Lotufo, José Eugenio Lozano, Dalia Luksiene, Annamari Lundqvist, Robert Lundqvist, Nuno Lunet, Guansheng Ma, George L L Machado-Coelho, Aristides M Machado-Rodrigues, Suka Machi, Ahmed A Madar, Stefania Maggi, Dianna J Magliano, Emmanuella Magriplis, Gowri Mahasampath, Bernard Maire, Marcia Makdisse, Fatemeh Malekzadeh, Reza Malekzadeh, Kodavanti Mallikharjuna Rao, Yannis Manios, Jim I Mann, Fariborz Mansour-Ghanaei, Enzo Manzato, Pedro Marques-Vidal, Reynaldo Martorell, Luis P Mascarenhas, Ellisiv B Mathiesen, Tandi E Matsha, Christina Mavrogianni, Shelly R McFarlane, Stephen T McGarvey, Stela McLachlan, Rachael M McLean, Scott B McLean, Breige A McNulty, Sounnia Mediene-Benchekor, Parinaz Mehdipour, Kirsten Mehlig, Amir Houshang Mehrparvar, Aline Meirhaeghe, Christa Meisinger, Ana Maria B Menezes, Geetha R Menon, Shahin Merat, Alibek Mereke, Indrapal I Meshram, Patricia Metcalf, Haakon E Meyer, Jie Mi, Nathalie Michels, Jody C Miller, Cláudia S Minderico, G K Mini, Juan Francisco Miquel, J Jaime Miranda, Mohammad Reza Mirjalili, Erkin Mirrakhimov, Pietro A Modesti, Sahar Saeedi Moghaddam, Bahram Mohajer, Mostafa K Mohamed, Kazem Mohammad, Zahra Mohammadi, Noushin Mohammadifard, Reza Mohammadpourhodki, Viswanathan Mohan, Salim Mohanna, Muhammad Fadhli Mohd Yusoff, Iraj Mohebbi, Farnam Mohebi, Marie Moitry, Line T Møllehave, Niels C Møller, Dénes Molnár, Amirabbas Momenan, Charles K Mondo, Eric Monterrubio-Flores, Mahmood Moosazadeh, Alain Morejon, Luis A Moreno, Karen Morgan, Suzanne N Morin, George Moschonis, Malgorzata Mossakowska, Aya Mostafa, Jorge Mota, Mohammad Esmaeel Motlagh, Jorge Motta, Kelias P Msyamboza, Maria L Muiesan, Martina Müller-Nurasyid, Jaakko Mursu, Norlaila Mustafa, Iraj Nabipour, Shohreh Naderimagham, Gabriele Nagel, Balkish M Naidu, Farid Najafi, Harunobu Nakamura, Jana Námešná, Ei Ei K Nang, Vinay B Nangia, Matthias Nauck, William A Neal, Azim Nejatizadeh, Ilona Nenko, Flavio Nervi, Nguyen D Nguyen, Quang Ngoc Nguyen, Ramfis E Nieto-Martínez, Thomas Nihal, Teemu J Niiranen, Guang Ning, Toshiharu Ninomiya, Marianna Noale, Oscar A Noboa, Davide Noto, Mohannad Al Nsour, Irfan Nuhoğlu, Terence W O’Neill, Dermot O’Reilly, Angélica M Ochoa-Avilés, Kyungwon Oh, Ryutaro Ohtsuka, Örn Olafsson, Valérie Olié, Isabel O Oliveira, Mohd Azahadi Omar, Altan Onat, Sok King Ong, Pedro Ordunez, Rui Ornelas, Pedro J Ortiz, Clive Osmond, Sergej M Ostojic, Afshin Ostovar, Johanna A Otero, Ellis Owusu-Dabo, Fred Michel Paccaud, Elena Pahomova, Andrzej Pajak, Luigi Palmieri, Wen-Harn Pan, Songhomitra Panda-Jonas, Francesco Panza, Winsome R Parnell, Nikhil D Patel, Nasheeta Peer, Sergio Viana Peixoto, Markku Peltonen, Alexandre C Pereira, Annette Peters, Astrid Petersmann, Janina Petkeviciene, Niloofar Peykari, Son Thai Pham, Rafael N Pichardo, Iris Pigeot, Aida Pilav, Lorenza Pilotto, Aleksandra Piwonska, Andreia N Pizarro, Pedro Plans-Rubió, Silvia Plata, Hermann Pohlabeln, Miquel Porta, Marileen L P Portegies, Anil Poudyal, Farhad Pourfarzi, Hossein Poustchi, Rajendra Pradeepa, Jacqueline F Price, Rui Providencia, Jardena J Puder, Soile E Puhakka, Margus Punab, Mostafa Qorbani, Tran Quoc Bao, Ricardas Radisauskas, Salar Rahimikazerooni, Olli Raitakari, Sudha Ramachandra Rao, Ambady Ramachandran, Elisabete Ramos, Rafel Ramos, Lekhraj Rampal, Sanjay Rampal, Josep Redon, Paul Ferdinand M Reganit, Luis Revilla, Abbas Rezaianzadeh, Robespierre Ribeiro, Adrian Richter, Fernando Rigo, Tobias F Rinke de Wit, Fernando Rodríguez-Artalejo, María Del Cristo Rodriguez-Perez, Laura A Rodríguez-Villamizar, Ulla Roggenbuck, Rosalba Rojas-Martinez, Dora Romaguera, Elisabetta L Romeo, Annika Rosengren, Joel G R Roy, Adolfo Rubinstein, Jean-Bernard Ruidavets, Blanca Sandra Ruiz-Betancourt, Paola Russo, Petra Rust, Marcin Rutkowski, Charumathi Sabanayagam, Harshpal S Sachdev, Alireza Sadjadi, Ali Reza Safarpour, Saeid Safiri, Olfa Saidi, Nader Saki, Benoit Salanave, Diego Salmerón, Veikko Salomaa, Jukka T Salonen, Massimo Salvetti, Jose Sánchez-Abanto, Susana Sans, Alba M Santaliestra-Pasías, Diana A Santos, Maria Paula Santos, Rute Santos, Jouko L Saramies, Luis B Sardinha, Nizal Sarrafzadegan, Kai-Uwe Saum, Savvas C Savva, Norie Sawada, Mariana Sbaraini, Marcia Scazufca, Beatriz D Schaan, Herman Schargrodsky, Christa Scheidt-Nave, Anja Schienkiewitz, Sabine Schipf, Carsten O Schmidt, Ben Schöttker, Sara Schramm, Sylvain Sebert, Aye Aye Sein, Abhijit Sen, Sadaf G Sepanlou, Jennifer Servais, Ramin Shakeri, Svetlana A Shalnova, Teresa Shamah-Levy, Maryam Sharafkhah, Sanjib K Sharma, Jonathan E Shaw, Amaneh Shayanrad, Zumin Shi, Kenji Shibuya, Hana Shimizu-Furusawa, Dong Wook Shin, Youchan Shin, Majid Shirani, Rahman Shiri, Namuna Shrestha, Khairil Si-Ramlee, Alfonso Siani, Rosalynn Siantar, Abla M Sibai, Diego Augusto Santos Silva, Mary Simon, Judith Simons, Leon A Simons, Michael Sjöström, Tea Skaaby, Jolanta Slowikowska-Hilczer, Przemyslaw Slusarczyk, Liam Smeeth, Marieke B Snijder, Stefan Söderberg, Agustinus Soemantri, Reecha Sofat, Vincenzo Solfrizzi, Mohammad Hossein Somi, Emily Sonestedt, Thorkild I A Sørensen, Charles Sossa Jérome, Aïcha Soumaré, Kaan Sozmen, Karen Sparrenberger, Jan A Staessen, Maria G Stathopoulou, Bill Stavreski, Jostein Steene-Johannessen, Peter Stehle, Aryeh D Stein, Jochanan Stessman, Ranko Stevanović, Jutta Stieber, Doris Stöckl, Jakub Stokwiszewski, Karien Stronks, Maria Wany Strufaldi, Ramón Suárez-Medina, Chien-An Sun, Johan Sundström, Paibul Suriyawongpaisal, Rody G Sy, René Charles Sylva, Moyses Szklo, E Shyong Tai, Abdonas Tamosiunas, Eng Joo Tan, Mohammed Rasoul Tarawneh, Carolina B Tarqui-Mamani, Anne Taylor, Julie Taylor, Grethe S Tell, Tania Tello, K R Thankappan, Lutgarde Thijs, Betina H Thuesen, Ulla Toft, Hanna K Tolonen, Janne S Tolstrup, Murat Topbas, Roman Topór-Madry, María José Tormo, Michael J Tornaritis, Maties Torrent, Laura Torres-Collado, Pierre Traissac, Oanh T H Trinh, Julia Truthmann, Shoichiro Tsugane, Marshall K Tulloch-Reid, Tomi-Pekka Tuomainen, Jaakko Tuomilehto, Anne Tybjaerg-Hansen, Christophe Tzourio, Peter Ueda, Eunice Ugel, Hanno Ulmer, Belgin Unal, Hannu M T Uusitalo, Gonzalo Valdivia, Damaskini Valvi, Rob M van Dam, Yvonne T van der Schouw, Koen Van Herck, Hoang Van Minh, Lenie van Rossem, Natasja M Van Schoor, Irene G M van Valkengoed, Dirk Vanderschueren, Diego Vanuzzo, Anette Varbo, Patricia Varona-Pérez, Senthil K Vasan, Lars Vatten, Tomas Vega, Toomas Veidebaum, Gustavo Velasquez-Melendez, Silvia J Venero-Fernández, Giovanni Veronesi, W M Monique Verschuren, Cesar G Victora, Dhanasari Vidiawati, Lucie Viet, Salvador Villalpando, Jesus Vioque, Jyrki K Virtanen, Sophie Visvikis-Siest, Bharathi Viswanathan, Tiina Vlasoff, Peter Vollenweider, Ari Voutilainen, Alisha N Wade, Aline Wagner, Janette Walton, Wan Mohamad Wan Bebakar, Wan Nazaimoon Wan Mohamud, Ming-Dong Wang, Ningli Wang, Qian Wang, Ya Xing Wang, Ying-Wei Wang, S Goya Wannamethee, Niels Wedderkopp, Wenbin Wei, Peter H Whincup, Kurt Widhalm, Indah S Widyahening, Andrzej Wiecek, Alet H Wijga, Rainford J Wilks, Johann Willeit, Peter Willeit, Tom Wilsgaard, Bogdan Wojtyniak, Roy A Wong-McClure, Andrew Wong, Tien Yin Wong, Jean Woo, Mark Woodward, Frederick C Wu, Shouling Wu, Haiquan Xu, Liang Xu, Weili Yan, Xiaoguang Yang, Tabara Yasuharu, Xingwang Ye, Toh Peng Yeow, Panayiotis K Yiallouros, Moein Yoosefi, Akihiro Yoshihara, San-Lin You, Novie O Younger-Coleman, Ahmad Faudzi Yusoff, Ahmad A Zainuddin, Seyed Rasoul Zakavi, Mohammad Reza Zali, Farhad Zamani, Sabina Zambon, Antonis Zampelas, Ko Ko Zaw, Tomasz Zdrojewski, Tajana Zeljkovic Vrkic, Zhen-Yu Zhang, Wenhua Zhao, Shiqi Zhen, Yingfeng Zheng, Bekbolat Zholdin, Baurzhan Zhussupov, Nada Zoghlami, Julio Zuñiga Cisneros, Edward W Gregg, Majid Ezzati
Affiliations
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran.
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
Abstract
High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 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 health4,5. 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 risk-changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.
How to Cite
NCD Risk Factor Collaboration (NCD-RisC). Repositioning of the global epicentre of non-optimal cholesterol. Nature. 2020 Jun;582(7810):73-77. doi: 10.1038/s41586-020-2338-1. Epub 2020 Jun 3. PMID: 32494083; PMCID: PMC7332422.
Repositioning of the global epicentre of non-optimal cholesterol
Authors
NCD Risk Factor Collaboration (NCD-RisC):
Cristina Taddei, Bin Zhou, Honor Bixby, Rodrigo M Carrillo-Larco, Goodarz Danaei, Rod T Jackson, Farshad Farzadfar, Marisa K Sophiea, Mariachiara Di Cesare, Maria Laura Caminia Iurilli, Andrea Rodriguez Martinez, Golaleh Asghari, Klodian Dhana, Pablo Gulayin, Sujay Kakarmath, Marilina Santero, Trudy Voortman, Leanne M Riley, Melanie J Cowan, Stefan Savin, James E Bennett, Gretchen A Stevens, Christopher J Paciorek, Wichai Aekplakorn, Renata Cifkova, Simona Giampaoli, Andre Pascal Kengne, Young-Ho Khang, Kari Kuulasmaa, Avula Laxmaiah, Paula Margozzini, Prashant Mathur, Børge G Nordestgaard, Dong Zhao, Mette Aadahl, Leandra Abarca-Gómez, Hanan Abdul Rahim, Niveen M Abu-Rmeileh, Benjamin Acosta-Cazares, Robert J Adams, Imelda A Agdeppa, Javad Aghazadeh-Attari, Carlos A Aguilar-Salinas, Charles Agyemang, Tarunveer S Ahluwalia, Noor Ani Ahmad, Ali Ahmadi, Naser Ahmadi, Soheir H Ahmed, Wolfgang Ahrens, Kamel Ajlouni, Monira Alarouj, Fadia AlBuhairan, Shahla AlDhukair, Mohamed M Ali, Abdullah Alkandari, Ala’a Alkerwi, Eman Aly, Deepak N Amarapurkar, Philippe Amouyel, Lars Bo Andersen, Sigmund A Anderssen, Ranjit Mohan Anjana, Alireza Ansari-Moghaddam, Hajer Aounallah-Skhiri, Joana Araújo, Inger Ariansen, Tahir Aris, Raphael E Arku, Nimmathota Arlappa, Krishna K Aryal, Thor Aspelund, Maria Cecília F Assunção, Juha Auvinen, Mária Avdicová, Ana Azevedo, Fereidoun Azizi, Mehrdad Azmin, Nagalla Balakrishna, Mohamed Bamoshmoosh, Maciej Banach, Piotr Bandosz, José R Banegas, Carlo M Barbagallo, Alberto Barceló, Amina Barkat, Iqbal Bata, Anwar M Batieha, Assembekov Batyrbek, Louise A Baur, Robert Beaglehole, Antonisamy Belavendra, Habiba Ben Romdhane, Mikhail Benet, Marianne Benn, Salim Berkinbayev, Antonio Bernabe-Ortiz, Gailute Bernotiene, Heloisa Bettiol, Santosh K Bhargava, Yufang Bi, Asako Bienek, Mukharram Bikbov, Bihungum Bista, Peter Bjerregaard, Espen Bjertness, Marius B Bjertness, Cecilia Björkelund, Katia V Bloch, Anneke Blokstra, Simona Bo, Bernhard O Boehm, Jose G Boggia, Carlos P Boissonnet, Marialaura Bonaccio, Vanina Bongard, Rossana Borchini, Herman Borghs, Pascal Bovet, Imperia Brajkovich, Juergen Breckenkamp, Hermann Brenner, Lizzy M Brewster, Graziella Bruno, Anna Bugge, Markus A Busch, Antonio Cabrera de León, Joseph Cacciottolo, Günay Can, Ana Paula C Cândido, Mario V Capanzana, Eduardo Capuano, Vincenzo Capuano, Viviane C Cardoso, Joana Carvalho, Felipe F Casanueva, Laura Censi, Charalambos A Chadjigeorgiou, Snehalatha Chamukuttan, Nish Chaturvedi, Chien-Jen Chen, Fangfang Chen, Shuohua Chen, Ching-Yu Cheng, Bahman Cheraghian, Angela Chetrit, Shu-Ti Chiou, María-Dolores Chirlaque, Belong Cho, Yumi Cho, Jerzy Chudek, Frank Claessens, Janine Clarke, Els Clays, Hans Concin, Susana C Confortin, Cyrus Cooper, Simona Costanzo, Dominique Cottel, Chris Cowell, Ana B Crujeiras, Semánová Csilla, Liufu Cui, Felipe V Cureau, Graziella D’Arrigo, Eleonora d’Orsi, Jean Dallongeville, Albertino Damasceno, Rachel Dankner, Thomas M Dantoft, Luc Dauchet, Kairat Davletov, Guy De Backer, Dirk De Bacquer, Giovanni de Gaetano, Stefaan De Henauw, Paula Duarte de Oliveira, David De Ridder, Delphine De Smedt, Mohan Deepa, Alexander D Deev, Abbas Dehghan, Hélène Delisle, Elaine Dennison, Valérie Deschamps, Meghnath Dhimal, Augusto F Di Castelnuovo, Zivka Dika, Shirin Djalalinia, Annette J Dobson, Chiara Donfrancesco, Silvana P Donoso, Angela Döring, Maria Dorobantu, Nico Dragano, Wojciech Drygas, Yong Du, Charmaine A Duante, Rosemary B Duda, Vilnis Dzerve, Elzbieta Dziankowska-Zaborszczyk, Ricky Eddie, Ebrahim Eftekhar, Robert Eggertsen, Sareh Eghtesad, Gabriele Eiben, Ulf Ekelund, Jalila El Ati, Denise Eldemire-Shearer, Marie Eliasen, Roberto Elosua, Rajiv T Erasmus, Raimund Erbel, Cihangir Erem, Louise Eriksen, Johan G Eriksson, Jorge Escobedo-de la Peña, Saeid Eslami, Ali Esmaeili, Alun Evans, David Faeh, Caroline H Fall, Elnaz Faramarzi, Mojtaba Farjam, Mohammad Reza Fattahi, Francisco J Felix-Redondo, Trevor S Ferguson, Daniel Fernández-Bergés, Daniel Ferrante, Marika Ferrari, Catterina Ferreccio, Jean Ferrieres, Bernhard Föger, Leng Huat Foo, Ann-Sofie Forslund, Maria Forsner, Heba M Fouad, Damian K Francis, Maria do Carmo Franco, Oscar H Franco, Guillermo Frontera, Yuki Fujita, Matsuda Fumihiko, Takuro Furusawa, Zbigniew Gaciong, Fabio Galvano, Jingli Gao, Manoli Garcia-de-la-Hera, Sarah P Garnett, Jean-Michel Gaspoz, Magda Gasull, Andrea Gazzinelli, Johanna M Geleijnse, Ali Ghanbari, Erfan Ghasemi, Oana-Florentina Gheorghe-Fronea, Anup Ghimire, Francesco Gianfagna, Tiffany K Gill, Jonathan Giovannelli, Glen Gironella, Aleksander Giwercman, David Goltzman, Helen Gonçalves, David A Gonzalez-Chica, Marcela Gonzalez-Gross, Juan P González-Rivas, Clicerio González-Villalpando, María-Elena González-Villalpando, Angel R Gonzalez, Frederic Gottrand, Sidsel Graff-Iversen, Dušan Grafnetter, Ronald D Gregor, Tomasz Grodzicki, Anders Grøntved, Giuseppe Grosso, Gabriella Gruden, Dongfeng Gu, Pilar Guallar-Castillón, Ong Peng Guan, Elias F Gudmundsson, Vilmundur Gudnason, Ramiro Guerrero, Idris Guessous, Johanna Gunnlaugsdottir, Rajeev Gupta, Laura Gutierrez, Felix Gutzwiller, Seongjun Ha, Farzad Hadaegh, Rosa Haghshenas, Hamid Hakimi, Ian R Hambleton, Behrooz Hamzeh, Sari Hantunen, Rachakulla Hari Kumar, Seyed Mohammad Hashemi-Shahri, Jun Hata, Teresa Haugsgjerd, Alison J Hayes, Jiang He, Yuna He, Marleen Elisabeth Hendriks, Ana Henriques, Sauli Herrala, Ramin Heshmat, Allan G Hill, Sai Yin Ho, Suzanne C Ho, Michael Hobbs, Albert Hofman, Reza Homayounfar, Wilma M Hopman, Andrea R V R Horimoto, Claudia M Hormiga, Bernardo L Horta, Leila Houti, Christina Howitt, Thein Thein Htay, Aung Soe Htet, Maung Maung Than Htike, José María Huerta, Ilpo Tapani Huhtaniemi, Martijn Huisman, Monica L Hunsberger, Abdullatif S Husseini, Inge Huybrechts, Nahla Hwalla, Licia Iacoviello, Anna G Iannone, Mohsen M Ibrahim, Norazizah Ibrahim Wong, Iris Iglesia, Nayu Ikeda, M Arfan Ikram, Violeta Iotova, Vilma E Irazola, Takafumi Ishida, Muhammad Islam, Aziz Al-Safi Ismail, Masanori Iwasaki, Jeremy M Jacobs, Hashem Y Jaddou, Tazeen Jafar, Kenneth James, Konrad Jamrozik, Imre Janszky, Edward Janus, Marjo-Riitta Jarvelin, Grazyna Jasienska, Ana Jelakovic, Bojan Jelakovic, Garry Jennings, Gorm B Jensen, Seung-Lyeal Jeong, Anjani Kumar Jha, Chao Qiang Jiang, Ramon O Jimenez, Karl-Heinz Jöckel, Michel Joffres, Jari J Jokelainen, Jost B Jonas, Torben Jørgensen, Pradeep Joshi, Farahnaz Joukar, Jacek Józwiak, Anne Juolevi, Anthony Kafatos, Eero O Kajantie, Ofra Kalter-Leibovici, Nor Azmi Kamaruddin, Pia R Kamstrup, Khem B Karki, Joanne Katz, Jussi Kauhanen, Prabhdeep Kaur, Maryam Kavousi, Gyulli Kazakbaeva, Ulrich Keil, Sirkka Keinänen-Kiukaanniemi, Roya Kelishadi, Maryam Keramati, Alina Kerimkulova, Mathilde Kersting, Yousef Saleh Khader, Davood Khalili, Mohammad Khateeb, Motahareh Kheradmand, Alireza Khosravi, Ursula Kiechl-Kohlendorfer, Stefan Kiechl, Japhet Killewo, Hyeon Chang Kim, Jeongseon Kim, Yeon-Yong Kim, Jurate Klumbiene, Michael Knoflach, Stephanie Ko, Hans-Peter Kohler, Iliana V Kohler, Elin Kolle, Patrick Kolsteren, Jürgen König, Raija Korpelainen, Paul Korrovits, Jelena Kos, Seppo Koskinen, Katsuyasu Kouda, Sudhir Kowlessur, Wolfgang Kratzer, Susi Kriemler, Peter Lund Kristensen, Steiner Krokstad, Daan Kromhout, Urho M Kujala, Pawel Kurjata, Catherine Kyobutungi, Fatima Zahra Laamiri, Tiina Laatikainen, Carl Lachat, Youcef Laid, Tai Hing Lam, Christina-Paulina Lambrinou, Vera Lanska, Georg Lappas, Bagher Larijani, Tint Swe Latt, Lars E Laugsand, Maria Lazo-Porras, Jeannette Lee, Jeonghee Lee, Nils Lehmann, Terho Lehtimäki, Naomi S Levitt, Yanping Li, Christa L Lilly, Wei-Yen Lim, M Fernanda Lima-Costa, Hsien-Ho Lin, Xu Lin, Yi-Ting Lin, Lars Lind, Allan Linneberg, Lauren Lissner, Jing Liu, Helle-Mai Loit, Esther Lopez-Garcia, Tania Lopez, Paulo A Lotufo, José Eugenio Lozano, Dalia Luksiene, Annamari Lundqvist, Robert Lundqvist, Nuno Lunet, Guansheng Ma, George L L Machado-Coelho, Aristides M Machado-Rodrigues, Suka Machi, Ahmed A Madar, Stefania Maggi, Dianna J Magliano, Emmanuella Magriplis, Gowri Mahasampath, Bernard Maire, Marcia Makdisse, Fatemeh Malekzadeh, Reza Malekzadeh, Kodavanti Mallikharjuna Rao, Yannis Manios, Jim I Mann, Fariborz Mansour-Ghanaei, Enzo Manzato, Pedro Marques-Vidal, Reynaldo Martorell, Luis P Mascarenhas, Ellisiv B Mathiesen, Tandi E Matsha, Christina Mavrogianni, Shelly R McFarlane, Stephen T McGarvey, Stela McLachlan, Rachael M McLean, Scott B McLean, Breige A McNulty, Sounnia Mediene-Benchekor, Parinaz Mehdipour, Kirsten Mehlig, Amir Houshang Mehrparvar, Aline Meirhaeghe, Christa Meisinger, Ana Maria B Menezes, Geetha R Menon, Shahin Merat, Alibek Mereke, Indrapal I Meshram, Patricia Metcalf, Haakon E Meyer, Jie Mi, Nathalie Michels, Jody C Miller, Cláudia S Minderico, G K Mini, Juan Francisco Miquel, J Jaime Miranda, Mohammad Reza Mirjalili, Erkin Mirrakhimov, Pietro A Modesti, Sahar Saeedi Moghaddam, Bahram Mohajer, Mostafa K Mohamed, Kazem Mohammad, Zahra Mohammadi, Noushin Mohammadifard, Reza Mohammadpourhodki, Viswanathan Mohan, Salim Mohanna, Muhammad Fadhli Mohd Yusoff, Iraj Mohebbi, Farnam Mohebi, Marie Moitry, Line T Møllehave, Niels C Møller, Dénes Molnár, Amirabbas Momenan, Charles K Mondo, Eric Monterrubio-Flores, Mahmood Moosazadeh, Alain Morejon, Luis A Moreno, Karen Morgan, Suzanne N Morin, George Moschonis, Malgorzata Mossakowska, Aya Mostafa, Jorge Mota, Mohammad Esmaeel Motlagh, Jorge Motta, Kelias P Msyamboza, Maria L Muiesan, Martina Müller-Nurasyid, Jaakko Mursu, Norlaila Mustafa, Iraj Nabipour, Shohreh Naderimagham, Gabriele Nagel, Balkish M Naidu, Farid Najafi, Harunobu Nakamura, Jana Námešná, Ei Ei K Nang, Vinay B Nangia, Matthias Nauck, William A Neal, Azim Nejatizadeh, Ilona Nenko, Flavio Nervi, Nguyen D Nguyen, Quang Ngoc Nguyen, Ramfis E Nieto-Martínez, Thomas Nihal, Teemu J Niiranen, Guang Ning, Toshiharu Ninomiya, Marianna Noale, Oscar A Noboa, Davide Noto, Mohannad Al Nsour, Irfan Nuhoğlu, Terence W O’Neill, Dermot O’Reilly, Angélica M Ochoa-Avilés, Kyungwon Oh, Ryutaro Ohtsuka, Örn Olafsson, Valérie Olié, Isabel O Oliveira, Mohd Azahadi Omar, Altan Onat, Sok King Ong, Pedro Ordunez, Rui Ornelas, Pedro J Ortiz, Clive Osmond, Sergej M Ostojic, Afshin Ostovar, Johanna A Otero, Ellis Owusu-Dabo, Fred Michel Paccaud, Elena Pahomova, Andrzej Pajak, Luigi Palmieri, Wen-Harn Pan, Songhomitra Panda-Jonas, Francesco Panza, Winsome R Parnell, Nikhil D Patel, Nasheeta Peer, Sergio Viana Peixoto, Markku Peltonen, Alexandre C Pereira, Annette Peters, Astrid Petersmann, Janina Petkeviciene, Niloofar Peykari, Son Thai Pham, Rafael N Pichardo, Iris Pigeot, Aida Pilav, Lorenza Pilotto, Aleksandra Piwonska, Andreia N Pizarro, Pedro Plans-Rubió, Silvia Plata, Hermann Pohlabeln, Miquel Porta, Marileen L P Portegies, Anil Poudyal, Farhad Pourfarzi, Hossein Poustchi, Rajendra Pradeepa, Jacqueline F Price, Rui Providencia, Jardena J Puder, Soile E Puhakka, Margus Punab, Mostafa Qorbani, Tran Quoc Bao, Ricardas Radisauskas, Salar Rahimikazerooni, Olli Raitakari, Sudha Ramachandra Rao, Ambady Ramachandran, Elisabete Ramos, Rafel Ramos, Lekhraj Rampal, Sanjay Rampal, Josep Redon, Paul Ferdinand M Reganit, Luis Revilla, Abbas Rezaianzadeh, Robespierre Ribeiro, Adrian Richter, Fernando Rigo, Tobias F Rinke de Wit, Fernando Rodríguez-Artalejo, María Del Cristo Rodriguez-Perez, Laura A Rodríguez-Villamizar, Ulla Roggenbuck, Rosalba Rojas-Martinez, Dora Romaguera, Elisabetta L Romeo, Annika Rosengren, Joel G R Roy, Adolfo Rubinstein, Jean-Bernard Ruidavets, Blanca Sandra Ruiz-Betancourt, Paola Russo, Petra Rust, Marcin Rutkowski, Charumathi Sabanayagam, Harshpal S Sachdev, Alireza Sadjadi, Ali Reza Safarpour, Saeid Safiri, Olfa Saidi, Nader Saki, Benoit Salanave, Diego Salmerón, Veikko Salomaa, Jukka T Salonen, Massimo Salvetti, Jose Sánchez-Abanto, Susana Sans, Alba M Santaliestra-Pasías, Diana A Santos, Maria Paula Santos, Rute Santos, Jouko L Saramies, Luis B Sardinha, Nizal Sarrafzadegan, Kai-Uwe Saum, Savvas C Savva, Norie Sawada, Mariana Sbaraini, Marcia Scazufca, Beatriz D Schaan, Herman Schargrodsky, Christa Scheidt-Nave, Anja Schienkiewitz, Sabine Schipf, Carsten O Schmidt, Ben Schöttker, Sara Schramm, Sylvain Sebert, Aye Aye Sein, Abhijit Sen, Sadaf G Sepanlou, Jennifer Servais, Ramin Shakeri, Svetlana A Shalnova, Teresa Shamah-Levy, Maryam Sharafkhah, Sanjib K Sharma, Jonathan E Shaw, Amaneh Shayanrad, Zumin Shi, Kenji Shibuya, Hana Shimizu-Furusawa, Dong Wook Shin, Youchan Shin, Majid Shirani, Rahman Shiri, Namuna Shrestha, Khairil Si-Ramlee, Alfonso Siani, Rosalynn Siantar, Abla M Sibai, Diego Augusto Santos Silva, Mary Simon, Judith Simons, Leon A Simons, Michael Sjöström, Tea Skaaby, Jolanta Slowikowska-Hilczer, Przemyslaw Slusarczyk, Liam Smeeth, Marieke B Snijder, Stefan Söderberg, Agustinus Soemantri, Reecha Sofat, Vincenzo Solfrizzi, Mohammad Hossein Somi, Emily Sonestedt, Thorkild I A Sørensen, Charles Sossa Jérome, Aïcha Soumaré, Kaan Sozmen, Karen Sparrenberger, Jan A Staessen, Maria G Stathopoulou, Bill Stavreski, Jostein Steene-Johannessen, Peter Stehle, Aryeh D Stein, Jochanan Stessman, Ranko Stevanović, Jutta Stieber, Doris Stöckl, Jakub Stokwiszewski, Karien Stronks, Maria Wany Strufaldi, Ramón Suárez-Medina, Chien-An Sun, Johan Sundström, Paibul Suriyawongpaisal, Rody G Sy, René Charles Sylva, Moyses Szklo, E Shyong Tai, Abdonas Tamosiunas, Eng Joo Tan, Mohammed Rasoul Tarawneh, Carolina B Tarqui-Mamani, Anne Taylor, Julie Taylor, Grethe S Tell, Tania Tello, K R Thankappan, Lutgarde Thijs, Betina H Thuesen, Ulla Toft, Hanna K Tolonen, Janne S Tolstrup, Murat Topbas, Roman Topór-Madry, María José Tormo, Michael J Tornaritis, Maties Torrent, Laura Torres-Collado, Pierre Traissac, Oanh T H Trinh, Julia Truthmann, Shoichiro Tsugane, Marshall K Tulloch-Reid, Tomi-Pekka Tuomainen, Jaakko Tuomilehto, Anne Tybjaerg-Hansen, Christophe Tzourio, Peter Ueda, Eunice Ugel, Hanno Ulmer, Belgin Unal, Hannu M T Uusitalo, Gonzalo Valdivia, Damaskini Valvi, Rob M van Dam, Yvonne T van der Schouw, Koen Van Herck, Hoang Van Minh, Lenie van Rossem, Natasja M Van Schoor, Irene G M van Valkengoed, Dirk Vanderschueren, Diego Vanuzzo, Anette Varbo, Patricia Varona-Pérez, Senthil K Vasan, Lars Vatten, Tomas Vega, Toomas Veidebaum, Gustavo Velasquez-Melendez, Silvia J Venero-Fernández, Giovanni Veronesi, W M Monique Verschuren, Cesar G Victora, Dhanasari Vidiawati, Lucie Viet, Salvador Villalpando, Jesus Vioque, Jyrki K Virtanen, Sophie Visvikis-Siest, Bharathi Viswanathan, Tiina Vlasoff, Peter Vollenweider, Ari Voutilainen, Alisha N Wade, Aline Wagner, Janette Walton, Wan Mohamad Wan Bebakar, Wan Nazaimoon Wan Mohamud, Ming-Dong Wang, Ningli Wang, Qian Wang, Ya Xing Wang, Ying-Wei Wang, S Goya Wannamethee, Niels Wedderkopp, Wenbin Wei, Peter H Whincup, Kurt Widhalm, Indah S Widyahening, Andrzej Wiecek, Alet H Wijga, Rainford J Wilks, Johann Willeit, Peter Willeit, Tom Wilsgaard, Bogdan Wojtyniak, Roy A Wong-McClure, Andrew Wong, Tien Yin Wong, Jean Woo, Mark Woodward, Frederick C Wu, Shouling Wu, Haiquan Xu, Liang Xu, Weili Yan, Xiaoguang Yang, Tabara Yasuharu, Xingwang Ye, Toh Peng Yeow, Panayiotis K Yiallouros, Moein Yoosefi, Akihiro Yoshihara, San-Lin You, Novie O Younger-Coleman, Ahmad Faudzi Yusoff, Ahmad A Zainuddin, Seyed Rasoul Zakavi, Mohammad Reza Zali, Farhad Zamani, Sabina Zambon, Antonis Zampelas, Ko Ko Zaw, Tomasz Zdrojewski, Tajana Zeljkovic Vrkic, Zhen-Yu Zhang, Wenhua Zhao, Shiqi Zhen, Yingfeng Zheng, Bekbolat Zholdin, Baurzhan Zhussupov, Nada Zoghlami, Julio Zuñiga Cisneros, Edward W Gregg, Majid Ezzati
Affiliations
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- The Persian Gulf Tropical Medicine Research Center, Bushehr University of Medical Sciences, Bushehr, Iran.
- Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- The Persian Gulf Marine Biotechnology Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran.
Abstract
High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 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 health4,5. 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 risk-changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.
How to Cite
NCD Risk Factor Collaboration (NCD-RisC). Repositioning of the global epicentre of non-optimal cholesterol. Nature. 2020 Jun;582(7810):73-77. doi: 10.1038/s41586-020-2338-1. Epub 2020 Jun 3. PMID: 32494083; PMCID: PMC7332422.
