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Repositioning of the global epicentre of non-optimal cholesterol
Open accessAbstract
High blood cholesterol is typically considered a feature of wealthy western countries 1,2 . However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world 3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health 4,5 . However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the 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-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.
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- NCD Risk Factor Collaboration (NCD-RisC), Taddei, C., Zhou, B., Bixby, H., Carrillo-Larco, R. M., Danaei, G., Jackson, R. T., Farzadfar, F., Sophiea, M. K., Di Cesare, M., Iurilli, M. L. C., Martinez, A. R., Asghari, G., Dhana, K., Gulayin, P., Kakarmath, S., Santero, M., Voortman, T., Riley, L. M., Cowan, M. J., Savin, S., Bennett, J. E., Stevens, G. A., Paciorek, C. J., Aekplakorn, W., Cifkova, R., Giampaoli, S., Kengne, A. P., Khang, Y.-H., Kuulasmaa, K., Laxmaiah, A., Margozzini, P., Mathur, P., Nordestgaard, B. G., Zhao, D., Aadahl, M., Abarca-Gómez, L., Rahim, H. A., Abu-Rmeileh, N. M., Acosta-Cazares, B., Adams, R. J., Agdeppa, I. A., Aghazadeh-Attari, J., Aguilar-Salinas, C. A., Agyemang, C., Ahluwalia, T. S., Ahmad, N. A., Ahmadi, A., Ahmadi, N., Ahmed, S. H., Ahrens, W., Ajlouni, K., Alarouj, M., AlBuhairan, F., AlDhukair, S., Ali, M. M., Alkandari, A., Alkerwi, A., Aly, E., Amarapurkar, D. N., Amouyel, P., Andersen, L. B., Anderssen, S. A., Anjana, R. M., Ansari-Moghaddam, A., Aounallah-Skhiri, H., Araújo, J., Ariansen, I., Aris, T., Arku, R. E., Arlappa, N., Aryal, K. K., Aspelund, T., Assunção, M. C. F., Auvinen, J., Avdicová, M., Azevedo, A., Azizi, F., Azmin, M., Balakrishna, N., Bamoshmoosh, M., Banach, M., Bandosz, P., Banegas, J. R., Barbagallo, C. M., Barceló, A., Barkat, A., Bata, I., Batieha, A. M., Batyrbek, A., Baur, L. A., Beaglehole, R., Belavendra, A., Ben Romdhane, H., Benet, M., Benn, M., Berkinbayev, S., Bernabe-Ortiz, A., Bernotiene, G., Bettiol, H., Bhargava, S. K., Bi, Y., Bienek, A., Bikbov, M., Bista, B., Bjerregaard, P., Bjertness, E., Bjertness, M. B., Björkelund, C., Bloch, K. V., Blokstra, A., Bo, S., Boehm, B. O., Boggia, J. G., Boissonnet, C. P., Bonaccio, M., Bongard, V., Borchini, R., Borghs, H., Bovet, P., Brajkovich, I., Breckenkamp, J., Brenner, H., Brewster, L. M., Bruno, G., Bugge, A., Busch, M. A., de León, A. C., Cacciottolo, J., Can, G., Cândido, A. P. C., Capanzana, M. V., Capuano, E., Capuano, V., Cardoso, V. C., Carvalho, J., Casanueva, F. F., Censi, L., Chadjigeorgiou, C. A., Chamukuttan, S., Chaturvedi, N., Chen, C.-J., Chen, F., Chen, S., Cheng, C.-Y., Cheraghian, B., Chetrit, A., Chiou, S.-T., Chirlaque, M.-D., Cho, B., Cho, Y., Chudek, J., Claessens, F., Clarke, J., Clays, E., Concin, H., Confortin, S. C., Cooper, C., Costanzo, S., Cottel, D., Cowell, C., Crujeiras, A. B., Csilla, S., Cui, L., Cureau, F. V., D’Arrigo, G., d’Orsi, E., Dallongeville, J., Damasceno, A., Dankner, R., Dantoft, T. M., Dauchet, L., Davletov, K., De Backer, G., De Bacquer, D., de Gaetano, G., De Henauw, S., de Oliveira, P. D., De Ridder, D., De Smedt, D., Deepa, M., Deev, A. D., Dehghan, A., Delisle, H., Dennison, E., Deschamps, V., Dhimal, M., Di Castelnuovo, A. F., Dika, Z., Djalalinia, S., Dobson, A. J., Donfrancesco, C., Donoso, S. P., Döring, A., Dorobantu, M., Dragano, N., Drygas, W., Du, Y., Duante, C. A., Duda, R. B., Dzerve, V., Dziankowska-Zaborszczyk, E., Eddie, R., Eftekhar, E., Eggertsen, R., Eghtesad, S., Eiben, G., Ekelund, U., El Ati, J., Eldemire-Shearer, D., Eliasen, M., Elosua, R., Erasmus, R. T., Erbel, R., Erem, C., Eriksen, L., Eriksson, J. G., Escobedo-de la Peña, J., Eslami, S., Esmaeili, A., Evans, A., Faeh, D., Fall, C. H., Faramarzi, E., Farjam, M., Fattahi, M. R., Felix-Redondo, F. J., Ferguson, T. S., Fernández-Bergés, D., Ferrante, D., Ferrari, M., Ferreccio, C., Ferrieres, J., Föger, B., Foo, L. H., Forslund, A.-S., Forsner, M., Fouad, H. M., Francis, D. K., do Carmo Franco, M., Franco, O. H., Frontera, G., Fujita, Y., Fumihiko, M., Furusawa, T., Gaciong, Z., Galvano, F., Gao, J., Garcia-de-la-Hera, M., Garnett, S. P., Gaspoz, J.-M., Gasull, M., Gazzinelli, A., Geleijnse, J. M., Ghanbari, A., Ghasemi, E., Gheorghe-Fronea, O.-F., Ghimire, A., Gianfagna, F., Gill, T. K., Giovannelli, J., Gironella, G., Giwercman, A., Goltzman, D., Gonçalves, H., Gonzalez-Chica, D. A., Gonzalez-Gross, M., González-Rivas, J. P., González-Villalpando, C., González-Villalpando, M.-E., Gonzalez, A. R., Gottrand, F., Graff-Iversen, S., Grafnetter, D., Gregor, R. D., Grodzicki, T., Grøntved, A., Grosso, G., Gruden, G., Gu, D., Guallar-Castillón, P., Guan, O. P., Gudmundsson, E. F., Gudnason, V., Guerrero, R., Guessous, I., Gunnlaugsdottir, J., Gupta, R., Gutierrez, L., Gutzwiller, F., Ha, S., Hadaegh, F., Haghshenas, R., Hakimi, H., Hambleton, I. R., Hamzeh, B., Hantunen, S., Kumar, R. H., Hashemi-Shahri, S. M., Hata, J., Haugsgjerd, T., Hayes, A. J., He, J., He, Y., Hendriks, M. E., Henriques, A., Herrala, S., Heshmat, R., Hill, A. G., Ho, S. Y., Ho, S. C., Hobbs, M., Hofman, A., Homayounfar, R., Hopman, W. M., Horimoto, A. R. V. R., Hormiga, C. M., Horta, B. L., Houti, L., Howitt, C., Htay, T. T., Htet, A. S., Htike, M. M. T., Huerta, J. M., Huhtaniemi, I. T., Huisman, M., Hunsberger, M. L., Husseini, A. S., Huybrechts, I., Hwalla, N., Iacoviello, L., Iannone, A. G., Ibrahim, M. M., Wong, N. I., Iglesia, I., Ikeda, N., Ikram, M. A., Iotova, V., Irazola, V. E., Ishida, T., Islam, M., al-Safi Ismail, A., Iwasaki, M., Jacobs, J. M., Jaddou, H. Y., Jafar, T., James, K., Jamrozik, K., Janszky, I., Janus, E., Jarvelin, M.-R., Jasienska, G., Jelakovic, A., Jelakovic, B., Jennings, G., Jensen, G. B., Jeong, S.-L., Jha, A. K., Jiang, C. Q., Jimenez, R. O., Jöckel, K.-H., Joffres, M., Jokelainen, J. J., Jonas, J. B., Jørgensen, T., Joshi, P., Joukar, F., Józwiak, J., Juolevi, A., Kafatos, A., Kajantie, E. O., Kalter-Leibovici, O., Kamaruddin, N. A., Kamstrup, P. R., Karki, K. B., Katz, J., Kauhanen, J., Kaur, P., Kavousi, M., Kazakbaeva, G., Keil, U., Keinänen-Kiukaanniemi, S., Kelishadi, R., Keramati, M., Kerimkulova, A., Kersting, M., Khader, Y. S., Khalili, D., Khateeb, M., Kheradmand, M., Khosravi, A., Kiechl-Kohlendorfer, U., Kiechl, S., Killewo, J., Kim, H. C., Kim, J., Kim, Y.-Y., Klumbiene, J., Knoflach, M., Ko, S., Kohler, H.-P., Kohler, I. V., Kolle, E., Kolsteren, P., König, J., Korpelainen, R., Korrovits, P., Kos, J., Koskinen, S., Kouda, K., Kowlessur, S., Kratzer, W., Kriemler, S., Kristensen, P. L., Krokstad, S., Kromhout, D., Kujala, U. M., Kurjata, P., Kyobutungi, C., Laamiri, F. Z., Laatikainen, T., Lachat, C., Laid, Y., Lam, T. H., Lambrinou, C.-P., Lanska, V., Lappas, G., Larijani, B., Latt, T. S., Laugsand, L. E., Lazo-Porras, M., Lee, J., Lee, J., Lehmann, N., Lehtimäki, T., Levitt, N. S., Li, Y., Lilly, C. L., Lim, W.-Y., Lima-Costa, M. F., Lin, H.-H., Lin, X., Lin, Y.-T., Lind, L., Linneberg, A., Lissner, L., Liu, J., Loit, H.-M., Lopez-Garcia, E., Lopez, T., Lotufo, P. A., Lozano, J. E., Luksiene, D., Lundqvist, A., Lundqvist, R., Lunet, N., Ma, G., Machado-Coelho, G. L. L., Machado-Rodrigues, A. M., Machi, S., Madar, A. A., Maggi, S., Magliano, D. J., Magriplis, E., Mahasampath, G., Maire, B., Makdisse, M., Malekzadeh, F., Malekzadeh, R., Rao, K. M., Manios, Y., Mann, J. I., Mansour-Ghanaei, F., Manzato, E., Marques-Vidal, P., Martorell, R., Mascarenhas, L. P., Mathiesen, E. B., Matsha, T. E., Mavrogianni, C., McFarlane, S. R., McGarvey, S. T., McLachlan, S., McLean, R. M., McLean, S. B., McNulty, B. A., Mediene-Benchekor, S., Mehdipour, P., Mehlig, K., Mehrparvar, A. H., Meirhaeghe, A., Meisinger, C., Menezes, A. M. B., Menon, G. R., Merat, S., Mereke, A., Meshram, I. I., Metcalf, P., Meyer, H. E., Mi, J., Michels, N., Miller, J. C., Minderico, C. S., Mini, G. K., Miquel, J. F., Miranda, J. J., Mirjalili, M. R., Mirrakhimov, E., Modesti, P. A., Moghaddam, S. S., Mohajer, B., Mohamed, M. K., Mohammad, K., Mohammadi, Z., Mohammadifard, N., Mohammadpourhodki, R., Mohan, V., Mohanna, S., Yusoff, M. F. M., Mohebbi, I., Mohebi, F., Moitry, M., Møllehave, L. T., Møller, N. C., Molnár, D., Momenan, A., Mondo, C. K., Monterrubio-Flores, E., Moosazadeh, M., Morejon, A., Moreno, L. A., Morgan, K., Morin, S. 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K., Yoosefi, M., Yoshihara, A., You, S.-L., Younger-Coleman, N. O., Yusoff, A. F., Zainuddin, A. A., Zakavi, S. R., Zali, M. R., Zamani, F., Zambon, S., Zampelas, A., Zaw, K. K., Zdrojewski, T., Vrkic, T. Z., Zhang, Z.-Y., Zhao, W., Zhen, S., Zheng, Y., Zholdin, B., Zhussupov, B., Zoghlami, N., Cisneros, J. Z., Gregg, E. W., & Ezzati, M.
- Venue
- Nature
- Published
- 2020-06-03
- Volume
- 582
- Issue
- 7810
- Pages
- 73-77
- ISSN
- 0028-0836 (ISSN-L)
- 1476-4687
- OpenAlex
- W3033499384
- Cited by
- 298
- References
- 70
- FWCI
- 30.39
- Type
- journal article
- Language
- en
- Open access
- hybrid
- Licence
- creativecommons.org/licenses/by/4.0 (tdm)
- creativecommons.org/licenses/by/4.0 (vor)
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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How to cite
Cite CoChat for the checks on this page, and the paper for its own findings.
- This page
- CoChat. (2026). Citation check: Repositioning of the global epicentre of non-optimal cholesterol. https://app.cochat.ai/papers/10.1038/s41586-020-2338-1
- The paper
- NCD Risk Factor Collaboration (NCD-RisC), Taddei, C., Zhou, B., Bixby, H., Carrillo-Larco, R. M., Danaei, G., Jackson, R. T., Farzadfar, F., Sophiea, M. K., Di Cesare, M., Iurilli, M. L. C., Martinez, A. R., Asghari, G., Dhana, K., Gulayin, P., Kakarmath, S., Santero, M., Voortman, T., Riley, L. M., . . . Ezzati, M. (2020). Repositioning of the global epicentre of non-optimal cholesterol. Nature. https://doi.org/10.1038/s41586-020-2338-1
Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.