Global Burden of Elevated LDL-C
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Importance: Elevated low-density lipoprotein cholesterol (LDL-C) is a modifiable risk factor for cardiovascular disease, the leading cause of premature death worldwide. Assessing the LDL-C-related burden is critical for guiding prevention and treatment strategies. Objectives: To estimate the global, regional, and national burden of ischemic heart disease and ischemic stroke attributable to elevated LDL-C (relative to 35-54 mg/dL) from 1990 to 2023 and to quantify the contributions of population growth, aging, risk-deleted burden, and exposure changes to burden trends. Design, Setting, and Population: This comparative risk assessment, part of the Global Burden of Disease Study 2023, estimated population-level LDL-C exposure and associated health loss in 204 countries and territories. Mean LDL-C levels were estimated using spatiotemporal gaussian process regression based on 806 studies across 161 countries. Relative risks were derived from meta-analyses of 38 randomized clinical trials. Population-attributable fractions for deaths and disability-adjusted life-years (DALYs) were estimated by age and sex for adults aged 25 years or older from 1990 to 2023, with 95% uncertainty intervals. Exposure: Population-level LDL-C concentrations. Main Outcomes and Measures: Population-attributable fractions, counts, and rates (all ages and age standardized per 100 000) of LDL-C-attributable deaths and DALYs from ischemic heart disease and ischemic stroke, with uncertainty intervals. Results: In 2023, elevated LDL-C accounted for 3.6 million deaths (95% uncertainty interval, 2.2-5.4 million; 6.0% of global mortality) and 90.7 million DALYs (95% uncertainty interval, 58.9-123.3 million; 3.2% of DALYs). Although global all-ages rates remained stable, age-standardized death and DALY rates decreased by 45.6% and 39.5%, respectively, since 1990. In 2023, age-standardized LDL-C-attributable DALY rates were highest in Eastern Europe and lowest in high-income Asia-Pacific. One-third of the global LDL-C burden occurred in India and China. Population growth and aging drove the increasing burden, with notable regional disparities in LDL-C exposure and risk-deleted DALY rates shifting toward middle-sociodemographic settings. Conclusions and Relevance: Despite declining age-standardized rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries. Measurement and surveillance gaps persist. Strengthened prevention, diagnosis, and treatment access strategies are essential to mitigate the health burden of LDL-C.
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University of WashingtonInstitute for Health Metrics and EvaluationAl-Zaytoonah University of JordanUniversity of NigeriaUniversity of the West of ScotlandAlexandria UniversityMarshall UniversityMayo Clinic HospitalTanta UniversityWest Hertfordshire Hospitals NHS TrustJazan UniversitySt. George's UniversityIran University of Medical SciencesUniversity Ferhat Abbas of SetifCentre Hospito Universitaire de SétifCairo UniversityUniversity of DuhokKwararafa UniversityFederal University WukariBayero University KanoWollo UniversityUniversity of GondarBabcock UniversityFederal Medical CentreHarvard University PressMassachusetts General HospitalNorthumbria UniversityBenha UniversityUniversity of Ha'ilLoma Linda University Medical CenterLoma Linda UniversityAddis Ababa UniversityShahid Beheshti University of Medical SciencesApplied Science Private UniversityNigerian Institute of Medical ResearchUsmanu Danfodiyo UniversityUniversity of SharjahHamad bin Khalifa UniversityHamad Medical CorporationUniversity of JordanUnited Arab Emirates UniversityPalo Alto UniversityTechnical University of MunichStanford UniversityModibbo Adama University of TechnologyBahir Dar UniversityThe University of SydneyUNSW SydneyRoswell Park Comprehensive Cancer CenterUniversity at Buffalo, State University of New YorkEast Tennessee State UniversityJohnson City Medical CenterUniversity of AbujaBowen UniversityBowen University Teaching HospitalUniversity of IbadanWoldia UniversityQueensland University of TechnologyMetro South HealthMedical Laboratory Science Council of NigeriaEdith Cowan UniversityKing Edward Medical UniversityPunjab Institute of CardiologyKing Edward Memorial HospitalUniversity of Health Sciences LahoreInstitute of Public Health BengaluruUniversity of Health and Allied SciencesQueen's UniversityShaqra UniversityKing Khaled Eye Specialist HospitalBangor UniversityAbasyn UniversityLebanese American UniversityUniversity of LahoreUniversity of Human DevelopmentRawalpindi Medical UniversityMajmaah UniversityMansoura University HospitalHaramaya UniversityEast Carolina UniversityShaheed Zulfiqar Ali Bhutto Institute of Science and TechnologyMaharashtra University of Health SciencesCharles Sturt UniversityNorth-West UniversityFudan UniversityNorthwestern UniversityMidwestern UniversityUniversity of NottinghamWashington University in St. LouisUniversity of MissouriAl Ain UniversityAlliance for Clinical Trials in OncologyArab International UniversityUniversity of BahrainDepartment of Veterans AffairsUniversity of NizwaImam Abdulrahman Bin Faisal UniversitySaudi Center for Organ TransplantationMinistry of HealthUniversity of Science and TechnologyIraqi UniversityJordan University of Science and TechnologyPhiladelphia UniversityAl al-Bayt UniversitySuez Canal UniversityKing Saud UniversityQatar UniversityAbdul Wali Khan University MardanAll India Institute of Medical SciencesChinese University of Hong KongUniversity of MaiduguriJamia Millia IslamiaUniversity 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UniversityMario Negri Institute for Pharmacological ResearchUniversidad Diego PortalesUniversity of PalermoAmsterdam University of the ArtsUniversity of AmsterdamSiberian State Medical UniversityTomsk National Research Medical CenterVinUniversityINCLEN Trust InternationalTribhuvan UniversityInstitute of Liver and Biliary SciencesFirst Affiliated Hospital of Henan University of Science and TechnologyGuangdong Academy of Medical SciencesGuangdong Provincial People's HospitalUniversiti Sains MalaysiaCancer Institute (WIA)All India Institute of Medical Sciences JodhpurNational Institute of Mental Health and NeurosciencesOsh State UniversityKocaeli ÜniversitesiTorbat Heydarieh University of Medical SciencesSohar UniversityUniversity of RajshahiCentre for Chronic Disease ControlSiddhartha Medical CollegeSinhgad Dental College and HospitalUniversity of Social Welfare and Rehabilitation SciencesRajarata University of Sri LankaPublic Health EnglandValparaiso UniversityKohat University of Science and TechnologyUniversity of TehranRafsanjan University of Medical SciencesUniversidad de AntioquiaUniversidade de Ribeirão PretoOspedale “M. Bufalini” di CesenaInternational University of Business Agriculture and TechnologyNew Mexico State UniversityPublic Health WalesOspedale SS. AnnunziataMuhimbili University of Health and Allied SciencesSouth Valley UniversityGdańsk Medical UniversityNear East UniversitySzéchenyi István UniversitySaveh University of Medical SciencesUniversity of BergenUniversity of MosulUniversity of GujratAhvaz Jundishapur University of Medical SciencesInstitut für Arbeitsmarkt und BerufsforschungLMU KlinikumLudwig-Maximilians-Universität MünchenUniversity of PuthisastraLahore University of Management SciencesKashan University of Medical SciencesNational Taiwan UniversityIndira Gandhi Medical College and Research InstituteKoforidua Technical UniversityDr. D.Y. Patil Vidyapeeth, PuneBournemouth UniversityUniversity of Campania "Luigi Vanvitelli"Baker Heart and Diabetes InstituteKU LeuvenAzienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano NiguardaSwami Vivekanand Subharti UniversitySanata Dharma UniversityColorado State UniversityGastroenterology Hospital "Saverio de Bellis"Northwell HealthLancaster UniversityColumbia UniversityJahangirnagar UniversityUniversität für Weiterbildung KremsShree Guru Gobind Singh Tricentenary UniversityGraphic Era UniversityGovernment Medical CollegeB.J. 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