Repositioning of the global epicentre of non-optimal cholesterol.

High blood cholesterol is typically considered a feature of wealthy westerncountries1,2. However, dietary and behavioural determinants of blood cholesterol arechanging rapidly throughout the world3 and countries are using lipid-loweringmedications at varying rates. These changes can have distinct effects on the levels ofhigh-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which havedifferent effects on human health4,5. However, the trends of HDL and non-HDLcholesterol levels over time have not been previously reported in a global analysis.Here we pooled 1,127 population-based studies that measured blood lipids in102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, therewas little change in total or non-HDL cholesterol from 1980 to 2018. This was a neteffect of increases in low- and middle-income countries, especially in east andsoutheast Asia, and decreases in high-income western countries, especially those innorthwestern Europe, and in central and eastern Europe. As a result, countries withthe highest level of non-HDL cholesterol--which is a marker of cardiovascular risk--changed from those in western Europe such as Belgium, Finland, Greenland, Iceland,Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific,such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDLcholesterol was responsible for an estimated 3.9 million (95% credible interval3.7 million-4.2 million) worldwide deaths, half of which occurred in east, southeastand south Asia. The global repositioning of lipid-related risk, with non-optimalcholesterol shifting from a distinct feature of high-income countries in northwesternEurope, north America and Australasia to one that affects countries in east andsoutheast Asia and Oceania should motivate the use of population-based policies andpersonal interventions to improve nutrition and enhance access to treatmentthroughout the world.