E-Paper
India, China share 34% of global cholesterol-related disease burden
The burden remains concentrated in lower-income regions due to limitations in screening and statin access capabilities.
Cholesterol-related diseases are rising sharply worldwide, with the burden concentrated in India, China, and other lower-income regions where screening and statin access remain limited, according to a new study.
India and China together account for 34% of all disability-adjusted life years (DALYs) attributable to high low-density lipoprotein cholesterol (LDL-C) — the single largest concentration of cholesterol-related disease burden on the planet — according to the Global Burden of Disease (GBD) 2023 study, published in the medical journal JAMA.
In 2023 alone, elevated LDL-C, commonly known as “bad cholesterol”, caused 3.6 million deaths and 90.7 million healthy years lost. Nearly a third of ischaemic heart disease deaths and more than a quarter of ischaemic stroke deaths worldwide were attributed to it.
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Risks of “bad cholesterol”
The numbers have shifted dramatically since 1990, when researchers estimated 2.5 billion adults aged 25 or older had LDL-C levels of 54 mg/dL or higher. That figure has since risen to approximately 4.6 billion.
“Elevated bad cholesterol in itself is not a killer but it is surely the most important risk-factor besides other risk-factors. It is a marker for cardiovascular disease and stroke and is commonly found among Indians. These numbers are not unexpected. However, effective medicines, including injectables, are available to lower it,” said Dr VK Bahl, former head of the department of cardiology at the All India Institute of Medical Sciences-Delhi.
Contrary to popular belief, eating cholesterol-rich foods has little bearing on blood LDL-C levels for most people — global guidelines dropped daily dietary cholesterol limits nearly a decade ago after studies found no meaningful link. Doctors instead point to saturated fat intake, processed food consumption, and genetics as the stronger drivers of high LDL-C, with only a smaller group of “hyper-responders” showing a real dietary effect.
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High LDL-C was the second-leading driver of cardiovascular disease mortality and among the top 10 contributors to the global all-cause disease burden in 2023, accounting for 6% of all deaths and nearly a fifth of cardiovascular deaths, the study found.
Shifting burdens
Despite advances in LDL-C management, the absolute burden has continued to climb since 1990, driven by population growth and ageing, and has shifted increasingly toward middle-income countries, researchers said in the paper, titled ‘Global Burden of Elevated LDL-C — Findings from the Global Burden of Disease Study 2023’.
Age-standardised death rates fell 46% and DALY rates fell 40% since 1990, reflecting improved treatment and prevention. But total deaths and DALYs still climbed roughly 38.5% in absolute terms over the same period.
Men bore a heavier burden than women: LDL-C–related DALYs stood at 55 million for men against 35.7 million for women in 2023. Age-standardised DALY rates declined annually by 0.92% for men and 1.37% for women between 1990 and 2023.
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The study estimated population-level LDL-C exposure and associated health loss across 204 countries and territories, drawing relative risks from meta-analyses of 38 randomised clinical trials.
Researchers said measurement and surveillance gaps persist. “Strengthened prevention, diagnosis, and treatment access strategies are essential to mitigate the health burden of LDL-C,” they said.
