TY - JOUR
T1 - Global Burden of Elevated LDL-C Findings From the Global Burden of Disease Study 2023
AU - GBD 2023 LDL Cholesterol Collaborators
AU - Razo, Christian
AU - DeCleene, Nicole K.
AU - Johnson, Catherine O.
AU - Stark, Benjamin A.
AU - LeGrand, Kate
AU - Aalruz, Hasan
AU - Abaraogu, Ukachukwu O.
AU - ElHafeez, Samar Abd
AU - Abdelmasseh, Michael
AU - Abdelnabi, Mahmoud
AU - Abd-Elsalam, Sherief
AU - Elshenawy, Rasha Abdelsalam
AU - Abdelwahab, Siddig Ibrahim
AU - Abdolizadeh, Ali
AU - Abdollahi, Arash
AU - Abdoun, Meriem
AU - Abdrabou, Mostafa M.
AU - Abdulah, Deldar Morad
AU - Abdullahi, Auwal
AU - Abdul-Rahman, Toufik
AU - Abebe, Melese Shenkut
AU - Getahun, Habtamu Abebe
AU - Abiodun, Olugbenga Olusola
AU - Abiodun, Olumide
AU - Abohashem, Shady
AU - Abonie, Ulric Sena
AU - Abourashed, Nagah M.
AU - Abramov, Dmitry
AU - Abrar, Mohammed Mehdi
AU - Abtahi, Dariush
AU - Farha, Rana Kamal Abu
AU - Abubakar, Bilyaminu
AU - Abuhelwa, Ahmad Y.
AU - Abukhadijah, Hana J.
AU - Aburuz, Salahdein
AU - Abushanab, Dina
AU - Adams, Lisa C.
AU - Adamu, Nuhu Lawan Lawan
AU - Adane, Mesafint Molla
AU - Addo, Isaac Yeboah
AU - Adedokun, Kamoru Ademola
AU - Adegbile, Oluwatobi E.
AU - Adegoke, Nurudeen A.
AU - Adekola, Saheed Ayodeji
AU - Ali, Mohammad Daud
AU - Rahman, Mohammad Hifz Ur
AU - Rahman, Muhammad Aziz
AU - Shiue, Ivy
AU - Singh, Lucky
AU - Wang, Cong
PY - 2026/8/25
Y1 - 2026/8/25
N2 - Importance: Elevated low-density lipoprotein cholesterol (LDL-C) is a modifiable risk factor for cardiovascular disease, the leading cause of premature death worldwide. Assessing the LDL-C–related burden is critical for guiding prevention and treatment strategies.Objectives: To estimate the global, regional, and national burden of ischemic heart disease and ischemic stroke attributable to elevated LDL-C (relative to 35-54 mg/dL) from 1990 to 2023 and to quantify the contributions of population growth, aging, risk-deleted burden, and exposure changes to burden trends.Design, Setting, and Population: This comparative risk assessment, part of the Global Burden of Disease Study 2023, estimated population-level LDL-C exposure and associated health loss in 204 countries and territories. Mean LDL-C levels were estimated using spatiotemporal gaussian process regression based on 806 studies across 161 countries. Relative risks were derived from meta-analyses of 38 randomized clinical trials. Population-attributable fractions for deaths and disability-adjusted life-years (DALYs) were estimated by age and sex for adults aged 25 years or older from 1990 to 2023, with 95% uncertainty intervals.Exposure: Population-level LDL-C concentrations.Main Outcomes and Measures: Population-attributable fractions, counts, and rates (all ages and age standardized per 100 000) of LDL-C–attributable deaths and DALYs from ischemic heart disease and ischemic stroke, with uncertainty intervals.Results: In 2023, elevated LDL-C accounted for 3.6 million deaths (95% uncertainty interval, 2.2-5.4 million; 6.0% of global mortality) and 90.7 million DALYs (95% uncertainty interval, 58.9-123.3 million; 3.2% of DALYs). Although global all-ages rates remained stable, age-standardized death and DALY rates decreased by 45.6% and 39.5%, respectively, since 1990. In 2023, age-standardized LDL-C–attributable DALY rates were highest in Eastern Europe and lowest in high-income Asia-Pacific. One-third of the global LDL-C burden occurred in India and China. Population growth and aging drove the increasing burden, with notable regional disparities in LDL-C exposure and risk-deleted DALY rates shifting toward middle-sociodemographic settings.Conclusions and Relevance: Despite declining age-standardized rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries. Measurement and surveillance gaps persist. Strengthened prevention, diagnosis, and treatment access strategies are essential to mitigate the health burden of LDL-C.
AB - Importance: Elevated low-density lipoprotein cholesterol (LDL-C) is a modifiable risk factor for cardiovascular disease, the leading cause of premature death worldwide. Assessing the LDL-C–related burden is critical for guiding prevention and treatment strategies.Objectives: To estimate the global, regional, and national burden of ischemic heart disease and ischemic stroke attributable to elevated LDL-C (relative to 35-54 mg/dL) from 1990 to 2023 and to quantify the contributions of population growth, aging, risk-deleted burden, and exposure changes to burden trends.Design, Setting, and Population: This comparative risk assessment, part of the Global Burden of Disease Study 2023, estimated population-level LDL-C exposure and associated health loss in 204 countries and territories. Mean LDL-C levels were estimated using spatiotemporal gaussian process regression based on 806 studies across 161 countries. Relative risks were derived from meta-analyses of 38 randomized clinical trials. Population-attributable fractions for deaths and disability-adjusted life-years (DALYs) were estimated by age and sex for adults aged 25 years or older from 1990 to 2023, with 95% uncertainty intervals.Exposure: Population-level LDL-C concentrations.Main Outcomes and Measures: Population-attributable fractions, counts, and rates (all ages and age standardized per 100 000) of LDL-C–attributable deaths and DALYs from ischemic heart disease and ischemic stroke, with uncertainty intervals.Results: In 2023, elevated LDL-C accounted for 3.6 million deaths (95% uncertainty interval, 2.2-5.4 million; 6.0% of global mortality) and 90.7 million DALYs (95% uncertainty interval, 58.9-123.3 million; 3.2% of DALYs). Although global all-ages rates remained stable, age-standardized death and DALY rates decreased by 45.6% and 39.5%, respectively, since 1990. In 2023, age-standardized LDL-C–attributable DALY rates were highest in Eastern Europe and lowest in high-income Asia-Pacific. One-third of the global LDL-C burden occurred in India and China. Population growth and aging drove the increasing burden, with notable regional disparities in LDL-C exposure and risk-deleted DALY rates shifting toward middle-sociodemographic settings.Conclusions and Relevance: Despite declining age-standardized rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries. Measurement and surveillance gaps persist. Strengthened prevention, diagnosis, and treatment access strategies are essential to mitigate the health burden of LDL-C.
UR - https://www.scopus.com/pages/publications/105047028159
U2 - 10.1001/jama.2026.8628
DO - 10.1001/jama.2026.8628
M3 - Article
C2 - 42525403
AN - SCOPUS:105047028159
SN - 0098-7484
VL - 336
SP - 673
EP - 698
JO - JAMA
JF - JAMA
IS - 8
ER -
SDG 3 Good Health and Well-being