National Trends in Total Cholesterol Obscure Heterogeneous Changes in HDL and non-HDL Cholesterol and total-to-HDL Cholesterol Ratio: A Pooled Analysis of 458 Population-Based Studies in Asian and Western Countries

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Abstract

Background: Although high-density lipoprotein (HDL) and non-HDL cholesterol haveopposite associations with coronary heart disease, multi-country reports of lipid trendsonly use total cholesterol (TC). Our aim was to compare trends in total, HDL and non-HDL cholesterol and the total-to-HDL cholesterol ratio in Asian and Western countries.Methods: We pooled 458 population-based studies with 82.1 million participants in 23Asian and Western countries. We estimated changes in mean total, HDL and non-HDLcholesterol and mean total-to-HDL cholesterol ratio by country, sex and age group.Results: Since 1980, mean TC increased in Asian countries. In Japan and South Korea,the TC rise was due to rising HDL cholesterol, which increased by up to 0.17 mmol/L perdecade in Japanese women; in China, it was due to rising non-HDL cholesterol. TC declinedin Western countries, except in Polish men. The decline was largest in Finland andNorway, at 0.4 mmol/L per decade. The decline in TC in most Western countries wasthe net effect of an increase in HDL cholesterol and a decline in non-HDL cholesterol,with the HDL cholesterol increase largest in New Zealand and Switzerland. Meantotal-to-HDL cholesterol ratio declined in Japan, South Korea and most Western countries,by as much as 0.7 per decade in Swiss men (equivalent to 26% decline in coronaryheart disease risk per decade). The ratio increased in China.Conclusions: HDL cholesterol has risen and the total-to-HDL cholesterol ratio has declinedin many Western countries, Japan and South Korea, with only a weak correlationwith changes in TC or non-HDL cholesterol.
Original languageEnglish
Pages (from-to)173-192
Number of pages20
JournalInternational Journal of Epidemiology
Publication statusPublished - 2020

All Science Journal Classification (ASJC) codes

  • Epidemiology

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