• Elevated blood cholesterol levels are typically considered a feature of wealthy western nations
  • There is a rapid change in the dietary and behavioral determinant of blood cholesterol levels worldwide
  • A new study reported the repositioning of the global epicenter of non-optimal cholesterol

Wealthy western countries are seeing cholesterol levels drop while the same can’t be said for low to middle-income nations. Recent research shows that this applies for both the friendly cholesterol and the (‘bad’) non-HDL type.

Researchers from across the world, led by the Imperial College London, conducted a large study of global cholesterol levels and published the results in the journal Nature.

The study

The researchers used data from 102.6 million people from 200 countries across a 39-year period (1980-2018) and examined their cholesterol levels.

The Wellcome Trust and British Heart Foundation funded the research and found that high blood cholesterol levels were responsible for nearly 3.9 million deaths throughout the world. Fifty percent of these deaths happened in East, South, and Southeast Asia countries.

Major implications of the study

  • The decrease in non-HDL cholesterol levels in western nations began in the 1980s even before introducing statins.
  • Changes in diet, particularly the replacement of saturated fats and reduced consumption of trans fats.
  • Increased use of statins from the 1990s might explain up to one half of the decease in cholesterol levels in countries where the drug gets use.
  • Consumption of animal-source foods, palm oil, and refined carbohydrates has ballooned in east and southeast Asian countries where statin use remains low.
  • High-income regions, that had almost no increase in obesity, saw changes in diet that had an impact. Particularly a decrease in carbohydrates and increased fat in the diets of their people. This might have led to the surge in HDL cholesterol observed by the study in these regions.

"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," MedicalXpress quoted Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation.

"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," said Professor Samani.

Importance of this study

Cholesterol levels are a prime risk factor for heart disease and stroke. Information pertaining to cholesterol levels, and the trends that cause them, can help set benchmarks needed for addressing these problems. They can also help us understand the reasons behind such trends. This is necessary for any meaningful intervention and could also help identify which parts of the world might need these interventions the most.