Burden and trends of cardiovascular diseases attributable to high LDL-C in China, 1990–2021: an age-period-cohort analysis with projectioans to 2050

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Objective: To analyze the changing trend of the burden of cardiovascular diseases (CVD) caused by high low-density lipoprotein cholesterol (LDL-C) among Chinese residents from 1990 to 2021, as well as the variations in CVD burden by age, period, and cohort, and to predict the trend of CVD burden in 2050, providing a reference for the formulation of CVD prevention strategies in China. Methods: Data on CVD caused by high LDL-C in China from 1990 to 2021 were collected from the Global Burden of Disease (GBD) database. Age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years rate (ASDR) were obtained to assess the burden of CVD. The Joinpoint model was used to calculate the average annual percentage change (AAPC) of CVD burden and analyze the changing trends of disease burden by gender. The Age-Period-Cohort (APC) model was employed to explore the relationships among age, period, and cohort factors in CVD burden. The Auto Regressive Integrated Moving Average (ARIMA) model was applied to predict the trend of CVD burden in 2050. Results: In 2021, the total number of CVD deaths caused by high LDL-C in China reached 832,884.39(424,042.39-1,289,266.00), a significant increase of 194.37% compared to 1990. The disability-adjusted life years (DALYs) were 18,407,759 (95% UI: 10,268,061-27,106,771), a substantial increase of 132.86% compared to 1990. ASMR slightly increased from 43.10 (95% UI: 21.29-67.60) per 100,000 in 1990 to 44.97 (95% UI: 23.22-69.89) per 100,000 in 2021, with an AAPC of -0.47 (95% CI -0.83 to -0.10). ASDR decreased from 385.65 (95% UI: 129.83-647.51) per 100,000 in 1990 to 335.59 (95% CI: 112.75-566.25) per 100,000 in 2021, with an AAPC of -0.49 (95% CI -0.83 to -0.10). Stratified by gender, ASMR significantly increased by 9.75% in men (from 48.82 per 100,000 to 58.57 per 100,000), while it decreased by -3.96% in women (from 38.91 per 100,000 to 34.95 per 100,000). The burden of disease increased sharply with age from 1990 to 2021. The period effect showed that mortality and DALYs increased from 1990 to 2009 and then decreased after 2010. The cohort effect indicated that women born before 1940 had a higher burden, while the risk for men continued to rise after 1940. The ARIMA model's prediction indicates that by 2050, the age-standardized mortality rate (ASMR) of CVD caused by high LDL-C in China is expected to increase by 55.14%, and the age-standardized death rate (ASDR) will rise to 1873.18 per 100,000. Conclusion: The burden of CVD caused by high LDL-C in China increased overall from 1990 to 2021. The stratified results by gender indicated that the ASMR and ASDR of men were higher than those of women. Stratification by age showed that the burden was the greatest among people over 70 years old. This was mainly due to population growth, aging, and risk factors. The prediction shows that the disease burden will continue to rise until 2050, and men will remain a high-risk group. Given the continuous trend of population aging, it is necessary to consider various lipid-lowering strategies and the effective allocation of medical resources in the future to reduce the disease burden related to CVD caused by high LDL-C.

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