Cholesterol levels are decreasing in Western countries and increasing in Asia

A study published in the journal Nature showed that cholesterol levels are decreasing in Western countries, and increasing in low- and middle-income countries, particularly in Asia. The research analyzed cholesterol levels in 200 countries over the past four decades. The Instituto de Saúde Pública da Universidade do Porto (ISPUP) participated in this investigation, which included data from the EPIPorto and EPITeen population cohorts.

Led by Imperial College London, the article analyzed the serum cholesterol values of 102.6 million individuals, from 200 countries, who were assessed between 1980 and 2018.

The evolution of cholesterol levels was analyzed considering two groups: “HDL cholesterol”, which is a protective factor for cardiovascular diseases, and “non-HDL cholesterol”, that is, triglycerides and LDL cholesterol, which is a marker of cardiovascular risk, so it is important that it remains within the desirable values.

3.9 million deaths from high cholesterol

The results of the work revealed that, in the last four decades, 3.9 million people have died worldwide due to high levels of non-HDL (“bad”) cholesterol and that half of these deaths have occurred in Asia (in the east, south and southeast of the continent).

Over the analyzed period, there was a change in the cholesterol pattern. Non-HDL cholesterol levels fell sharply in the highest-income countries, particularly in Northwest Europe, North America, Australia, New Zealand and New Guinea, where they were highest, and increased in low- and middle-income countries, notably in East and Southeast Asia, which had lower values at the beginning of the study period.

Possible explanations…

The Nature article does not analyze the factors that explain this change in the non-HDL cholesterol pattern, but it could be that the increase in “bad” cholesterol levels in low- and middle-income countries is possibly related to behavioral changes observed in the last four decades.

As explained by the ISPUP researcher, Elisabete Ramos, “in low- and middle-income countries, there have been, in the last decades, behavioral changes that led to the abandonment of a more traditional diet, which resulted in the incorporation of more processed foods in people’s diet. Additionally, there was also a reduction in physical activity and an increase in sedentary levels. These changes may justify the high non-HDL cholesterol levels found there”.

In Western countries, on the other hand, the decrease in the “bad” cholesterol values observed, may be related “not to the adoption of healthier behaviors, but to the increase in the use of pharmacological treatment to control the levels of this cholesterol”, adds the researcher.

ISPUP’s participation

Although the study also has the collaboration of other Portuguese researchers, ISPUP provided data from the only Portuguese populations to be included in this Nature publication. Data from ISPUP´s population cohorts EPIPorto and EPITeen was provided – EPIPorto studies, since 1998, the health determinants of the adult population residing in the city of Porto, and EPITeen investigates, since 1990, how the habits and behaviors acquired in adolescence will be reflected in health in adulthood.

The article entitled Repositioning of the global epicenter of non-optimal cholesterol is available HERE and is signed by the international network NCD Risk Factor Collaboration (NCD-RisC), which involves scientists from all over the world, and includes the following researchers from ISPUP: Ana Azevedo, Ana Henriques, Elisabete Ramos, Joana Araújo and Nuno Lunet.

Image: Pixabay/rud0070