Cholesterol varies widely by country and region, showing need for targeted recommendations
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Key takeaways:
- Lipid data from 17 countries show wide LDL variation after adjustment for age and sex.
- The data suggest a need for population-specific LDL recommendations to reduce CVD risk globally.
An analysis of nearly 500 million cholesterol readings globally shows LDL levels vary widely by country and region even after adjusting for age and sex, suggesting population-specific interventions may be needed, researchers reported.
In an analysis of lipid measurements across 17 countries and five continents using data from the Global Diagnostics Network (GDN), researchers found that mean adjusted total cholesterol levels exceeded the WHO risk threshold in seven countries, with LDL levels showing similar variations.
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“It is interesting to compare across countries and see where LDL levels may be more favorable or less favorable around the world,” Healio | Cardiology Today Editorial Board Member Seth S. Martin, MD, MHS, FAHA, cardiologist at Johns Hopkins Hospital and professor of medicine at Johns Hopkins University School of Medicine, told Healio. “Can we learn from each other? Multiple factors go into someone’s lipid levels, including genetics and lifestyle habits, as well as access to testing and treatments. Lipid levels are a key factor in determining CVD risk, and they are such an actionable factor. The goal of this paper is not to say, ‘This country is doing well and this country is not.’ The goal is for these data to serve as a starting point for innovative programs that can improve LDL levels.”
Assessing data across countries
In a cross-sectional study, Martin and colleagues analyzed data from 461,888,753 lipid results, using data from the first collaborative report of the GDN, which included nine laboratory organizations providing clinical laboratory testing in 17 countries on five continents.
“It is the first report of the GDN, established in 2018, as a strategic working group of diagnostic laboratories, each committed to unleashing and sharing local innovation to increase global access to diagnostic science and services — aimed at generating diagnostic insights and enhancing global health care,” the researchers wrote. “The GDN has a presence in countries representing two-thirds of the world’s population, with plans for further expansion.”
The researchers assessed aggregated lipid results from patients aged 20 to 89 years who underwent testing at GDN laboratories from 2018 through 2020. Lipid tests were performed in Australia (Healius), Brazil (DASA), Canada (Life Labs), India (Strand Life Sciences), Japan (LSI Medience), South Korea (GC Labs), Saudi Arabia (Al Borg Diagnostics), and the U.S. (Quest Diagnostics). Additionally, SYNLAB performed tests in Austria, Germany, North Macedonia, Slovakia, Spain, Switzerland, Turkey, United Arab Emirates and the United Kingdom. All countries included results from 2018 and 2019. Australia, Austria, Brazil, North Macedonia, South Korea, Slovakia, Spain, Switzerland, Turkey and the U.S. also included results from 2020. In addition to mean levels, the researchers also assessed the WHO total cholesterol risk target (< 193 mg/dL) and proportions in guideline-based LDL categories.
The findings were published in the European Heart Journal.
Researchers observed wide variation in LDL levels by country/region, sex and age.
For most countries, total cholesterol and LDL peaked at age 50 to 59 years for women and age 40 to 49 years for men. Sex- and age-group adjusted mean total cholesterol levels ranged from 177.1 mg/dL in South Korea to 208.8 mg/dL in Austria.
Mean total cholesterol levels exceeded WHO target in Australia, Austria, Germany, Japan, North Macedonia, Slovakia and Switzerland. North Macedonia had the highest proportions of LDL levels above 190 mg/dL for women (9.9%) and men (8.7%). LDL levels below 60 mg/dL were most common among women living in Canada (10.7%) and men living in the U.K. (17.3%).
‘Focus on the commonalities’
The researchers noted that the study does not account for possible repeated measurements and the percent and type of lipid-lowering therapies, and the fasting status of patients before testing was unknown, which may have impacted LDL calculation. Additionally, most data (79%) were from the U.S. and data were lacking for certain countries and the African WHO region. The GDN plans to expand to additional countries, including more low- and middle-income countries, Martin said.
“Even though there are differences between countries, a big takeaway is high lipid levels are a common global problem,” Martin told Healio. “We should not overly focus on the differences, but instead focus on the commonalities. We have many great therapies now to improve LDL.”
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