| Authors |
Farzadfar
F, Finucane MM, Danaei G, Pelizzari PM, Cowan MJ, Paciorek CJ,
Singh GM, Lin JK, Stevens GA, Riley LM, Ezzati M; Global Burden
of Metabolic Risk Factors of Chronic Diseases Collaborating Group
(Cholesterol).
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| Abstract
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BACKGROUND: Data for trends in serum cholesterol are needed to
understand the effects of its dietary, lifestyle, and pharmacological
determinants; set intervention priorities; and evaluate national
programmes. Previous analyses of trends in serum cholesterol were
limited to a few countries, with no consistent and comparable
global analysis. We estimated worldwide trends in population mean
serum total cholesterol.
METHODS: We estimated trends and their uncertainties in mean serum
total cholesterol for adults 25 years and older in 199 countries
and territories. We obtained data from published and unpublished
health examination surveys and epidemiological studies (321 country-years
and 3·0 million participants). For each sex, we used a
Bayesian hierarchical model to estimate mean total cholesterol
by age, country, and year, accounting for whether a study was
nationally representative.
FINDINGS: In 2008, age-standardised mean total cholesterol worldwide
was 4·64 mmol/L (95% uncertainty interval 4·51-4·76)
for men and 4·76 mmol/L (4·62-4·91) for women.
Globally, mean total cholesterol changed little between 1980 and
2008, falling by less than 0·1 mmol/L per decade in men
and women. Total cholesterol fell in the high-income region consisting
of Australasia, North America, and western Europe, and in central
and eastern Europe; the regional declines were about 0·2
mmol/L per decade for both sexes, with posterior probabilities
of these being true declines 0·99 or greater. Mean total
cholesterol increased in east and southeast Asia and Pacific by
0·08 mmol/L per decade (-0·06 to 0·22, posterior
probability=0·86) in men and 0·09 mmol/L per decade
(-0·07 to 0·26, posterior probability=0·86)
in women. Despite converging trends, serum total cholesterol in
2008 was highest in the high-income region consisting of Australasia,
North America, and western Europe; the regional mean was 5·24
mmol/L (5·08-5·39) for men and 5·23 mmol/L
(5·03-5·43) for women. It was lowest in sub-Saharan
Africa at 4·08 mmol/L (3·82-4·34) for men
and 4·27 mmol/L (3·99-4·56) for women.
INTERPRETATION: Nutritional policies and pharmacological interventions
should be used to accelerate improvements in total cholesterol
in regions with decline and to curb or prevent the rise in Asian
populations and elsewhere. Population-based surveillance of cholesterol
needs to be improved in low-income and middle-income countries.
FUNDING: Bill & Melinda Gates Foundation and WHO.
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