India, China bore one-third of global 'bad' cholesterol burden in 2023: Study

High LDL or "bad" cholesterol was responsible for 3.6 million deaths worldwide in 2023, accounting for 6 per cent of all deaths, while one-third of the global disease burden linked to elevated LDL cholesterol was concentrated in India and China, according to a study published in The Journal of the American Medical Association (JAMA).

The study, conducted by the Global Burden of Disease (GBD) 2023 LDL Cholesterol Collaborators, found that high LDL cholesterol (LDL-C) also resulted in 90.7 million disability-adjusted life years (DALYs), a measure representing years of healthy life lost. Researchers said the global burden has grown in absolute terms since 1990, largely because of population growth and ageing, even as age-standardised rates have declined.

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"Despite declining age-standardised rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries," the authors said.

"In 2023, elevated LDL-C accounted for 3.6 million deaths (6.0 per cent of global mortality) and 90.7 million DALYs (3.2 per cent of DALYs)," they said.

"One-third of the global LDL-C burden occurred in India and China," the team added.

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Using data from the GBD 2023 study, researchers assessed the burden attributable to high LDL-C among adults aged 25 years and older across 204 countries and territories between 1990 and 2023.

The study estimated that the number of adults aged 25 years or older with LDL-C levels of 54 milligrams per decilitre or higher rose from about 2.5 billion in 1990 to 4.6 billion in 2023.

Researchers found that age-standardised average LDL-C levels in 2023 were lowest in Burkina Faso, Lesotho, Somalia and Rwanda, at below 80 milligrams per decilitre, and highest in Serbia, Slovenia, Russia, Norway and Austria, where they exceeded 135 milligrams per decilitre.

The study identified high LDL-C as the second-leading driver of cardiovascular disease mortality and one of the top 10 contributors to the global all-cause disease burden in 2023.

According to the findings, elevated LDL-C accounted for 6 per cent of all deaths, 8.1 per cent of deaths from non-communicable diseases and 18.9 per cent of cardiovascular disease deaths globally in 2023.

High LDL-C also contributed to nearly one-third of deaths from ischaemic heart disease, or around 2.7 million deaths, and 27 per cent of ischaemic stroke deaths, estimated at 870,000.

The researchers said statins continue to be the cornerstone of LDL-C management, but their real-world impact remains limited because they are underused despite being available in many settings.

They said low awareness, the asymptomatic nature of high cholesterol, the cost of testing and treatment, inconsistent medicine supply, health system inefficiencies and concerns about adverse effects remain key barriers to effective treatment.

The study said addressing these gaps will require stronger primary healthcare systems, wider access to affordable diagnostics and medicines, and standardised, guideline-based treatment.