Cholesterol, coronary heart disease, and stroke in the Asia Pacific region.
Open accessAbstract
BACKGROUND: Cholesterol levels in many Asian countries are rising. Predictions of the likely effects of this on the incidence of cardiovascular diseases have mostly relied on data from Western populations. Whether the associations between total cholesterol and cardiovascular diseases are similar in Asia is not established. METHODS: The Asia Pacific Cohort Studies Collaboration (APCSC) is an individual-participant data meta-analysis of prospective studies from the Asia-Pacific region. Cox models were applied to the combined data from 29 cohorts to estimate the region-, sex-, and age-specific hazard ratios of major cardiovascular diseases by the fifths of total cholesterol. RESULTS: At baseline, the age/sex-adjusted mean value of total cholesterol was higher in Australia and New Zealand (ANZ) (5.52 +/- 1.05 mmol/l) than in Asia (4.87 +/- 1.05 mmol/l). During 2 million person-years of follow-up among 352 033 individuals, 4841 cardiovascular deaths were recorded. The association of total cholesterol with coronary heart disease and stroke was similar in Asian and ANZ cohorts. Overall, each 1-mmol/l higher level of total cholesterol was associated with 35% (95% CI: 26-44%) increased risk of coronary death, 25% (95% CI: 13-40%) increased risk of fatal or non-fatal ischaemic stroke, and 20% (95% CI: 8-30%) decreased risk of fatal haemorrhagic stroke. CONCLUSIONS: In both Asian and non-Asian populations in the Asia-Pacific region, total cholesterol is similarly strongly associated with the risk of CHD and ischaemic, but not haemorrhagic, stroke. Rising population-wide levels of cholesterol would be expected to contribute to a substantial increase in the overall burden of cardiovascular diseases in this region.
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The burden of high total cholesterol is lower than in the 2000 comparative risk assessment because effects on ischaemic stroke were negligible at old ages when data were pooled, and because exposure fell in high-income countries.
“In contrast to these risks, the burden of high total cholesterol is lower than that estimated in the 2000 comparative risk assessment, because the effects on ischaemic stroke were negligible at old ages when data from the Asia-Pacific Cohort Studies Collaboration and Prospective Studies Collaboration were pooled,68,185 and because exposure has fallen in high-income countries.67”
Current evidence suggests that when measured comparably the proportional effects of the risk factors considered in this analysis are similar across populations, such as Western and Asian populations.
“The current evidence suggests that when measured comparably the proportional effects of the risk factors considered in this analysis are similar across populations, e.g., Western and Asian populations [7],[20],[21].”
From The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (2009) · cites this paper as [20]
For cerebral infarction, the major risk factors for cardiogenic cerebral embolism are hypertension and cardiac thrombi.
“With respect to cerebral infarction, the major risk factors for cardiogenic cerebral embolism are hypertension and cardiac thrombi849, 850).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [850]
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- Authors
- Asia Pacific Cohort Studies Collaboration
- Corresponding author
- Asia Pacific Cohort Studies Collaboration
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 2003-08-01
- Volume
- 32
- Issue
- 4
- Pages
- 563-572
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- OpenAlex
- W2175592470
- Cited by
- 382
- References
- 0
- Citations by year
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- FWCI
- 3.15
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- YUHSpace (Yonsei University Medical Library) (submittedVersion, cc-by-nc-nd)
- Funders
- Medical Research Council
- Topics
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- total cholesterol, coronary artery disease, stroke, ischemic stroke, hemorrhagic stroke, cardiovascular mortality, cardiovascular disease burden, Asia-Pacific region, Australia and New Zealand
- MeSH terms
- Adult, Aged, Asia, Southeastern, Australia, Cerebral Hemorrhage, Brain Ischemia, Cholesterol, Coronary Disease, Female, Follow-Up Studies, Humans, Male, Middle Aged, New Zealand, Risk Factors, Biomarkers, Proportional Hazards Models
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