Worldwide Changes in Total Cholesterol and Non-HDL-Cholesterol Trends Indicate Where the Challenges Are for the Coming Years

Hypercholesterolemia is one of the most relevant causal factors for cardiovascular disease (CVD). In the last 40 years, western countries, mainly Europe and Northern America, have experienced a reduction in coronary heart disease (CHD) mortality rates, owing to improvements in therapy, specifically the use of statins. On the other hand, an increase in population life expectancy and widespread adoption of western lifestyles has occurred in low- and middle-income countries, leading to a substantial increase of plasma cholesterol concentrations at population level, with a consequential change in the global epidemiology of atherosclerotic CVD. In a recently published report, the NCD Risk Factor Collaboration presented trends from 1980 to 2018 for mean total cholesterol (TC), non-HDL-C, and HDL-C for 200 countries (1). They showed that, despite global age-standardized mean concentrations of TC and non-HDL-C did not change substantially over the past 4 decades, a net decrease in high-income western countries (Europe, North America, and Australasia) and a net increase in East and Southeast Asia were observed, thus resulting in the repositioning of the global epicenter of non-optimal cholesterol concentrations (1).