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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

N. (NCD-RisC). Int J Epidemiol 49 (1): 173-192 (2020)

Abstract

BACKGROUND: Although high-density lipoprotein (HDL) and non-HDL cholesterol have opposite associations with coronary heart disease, multi-country reports of lipid trends only 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 23 Asian and Western countries. We estimated changes in mean total, HDL and non-HDL cholesterol 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 per decade in Japanese women; in China, it was due to rising non-HDL cholesterol. TC declined in Western countries, except in Polish men. The decline was largest in Finland and Norway, at ∼0.4 mmol/L per decade. The decline in TC in most Western countries was the 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. Mean total-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 coronary heart disease risk per decade). The ratio increased in China. CONCLUSIONS: HDL cholesterol has risen and the total-to-HDL cholesterol ratio has declined in many Western countries, Japan and South Korea, with only a weak correlation with changes in TC or non-HDL cholesterol.

Links and resources

DOI:
10.1093/ije/dyz099
URL:
https://watermark.silverchair.com/dyz099.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAArowggK2BgkqhkiG9w0BBwagggKnMIICowIBADCCApwGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM_bmGah0qXJ3QZy3tAgEQgIICbTA-OcaA-F4KNJGCgAsHpDCTA6wCBab0V66NEeCq1SH1CEFzHwNif5uZvdBA0xqx_kT1EYjXRLs81jlF1lQD93MpFLLVR6_L8jfQNccBLn79aAil03FxoqnHokhqz45Le96yZbFpa5TbZUC5NiWOzAriu_YZvNJIZGAsywWbUUjyG_d3apjUE8synC633oC5Nk7MIS0KC1q9bv2QfaLqMofUd352V3pp_CkCFM3rUl_kMH-CdPtu0ZUT-APYeNnyIWJBwu3F3HmgaK32mmq_fe7ss16Mq10IYL09xhCRdyPeydI7XlNwZgMh1OK7uDM5YcihQ7ZebP0ODlyOpbKrYS6zBwZYFzEGwgeJn2ydzKlfqdmUyqVhjW8fFuABhwhylFLe3ujfnFvZfUGImunZDIMHyhR66thstISP3glb1a73T344V5mSerV8SVTZzXm9btiwAbhenCtqe-TsLsxWjfMRiRIMu37iYcwi6WpF4mpUAeTZUCLM7Gx-AfPqiIcov4qzKJknJcmadgzu4GbsyKlbh3dAwZS-q0Fe5Dmbqao4MVfxwdnI7zuSUjZBiFqea3C1N6AZ9h8zQg8JbacJr1uT_DBMDMGR_7y7lbWUUe55b3yQcm0vF-Na78n6-L0grkDK3T0ikYaSMc-FukRoNDb1CoBlMT8aOBqlzNlPzcw3eMMSGuU8WWi3B3wr636wMC4B-U5ROakmUvbQM0PERnyEtspEhYArrbm6V6kHsIbU5EuhqAh6lJ9-q0DBkp5bIYCkBNGczFGPmKp4evgEGT89U0hx2dfyVsPCTz5OnSg1ICYt2nT1CCm0AuIvmg
BibTeX key:
RN60
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