For the Global Burden of Disease (GBD) 2020 project, researchers assessed the population’s low-density lipoprotein (LDL) cholesterol trends and estimated related CVD morbidity and death. In addition, they assessed the CVD burden related to higher LDL (compared to the theoretical minimum risk exposure threshold of 1.3-1.7 mmol/L) by age, gender, nation, and year among persons over 25 from 1990 to 2020 using all available high-quality data. 

They estimated LDL means using a spatiotemporal Gaussian process regression using microdata to determine standard deviation (SD) and define the global LDL distribution. They used a meta-regression to assess the relative risks of ischemic heart disease (IHD) and ischemic stroke based on data from 52 randomized control studies. These were then utilized to compute the attributable population fraction and the burden of increased LDL. Investigators showed the standard deviation (SD) and the 95% uncertainty interval (UI) in brackets. 

LDL values in mmol/L increased globally from 1.4 [0.4] to 1.7 [0.4] in men and 1.5 [0.4] to 1.8 [0.5] in females between 1990 and 2020. Over 30 years, high-income nations, Central and Eastern Europe, and Central Asia had the highest LDL values. LDL values were lowest in Sub-Saharan Africa. Elevated LDL was responsible for one-third (2.9 million [95% UI: 1.2-4.5 million]) and one-fifth (1.5 million [919,750-2.1 million]) of IHD and ischemic stroke fatalities in 2020, respectively. Since 1990, the predicted number of deaths and disability-adjusted life-years (DALYs) due to high LDL has grown, reaching 4.5 million [2.6 – 6.2] fatalities and 91.8 million [53.6 – 127] DALYs in 2020. Men experienced more DALYs as a result of increased LDL than women (52.8 [29.7 – 73.4] vs. 39 [23.9 – 53.5] million). The worldwide all-age rates for fatalities and DALYs per 100,000 people were constant throughout the research period, at 58 [34-80] and 1,177 [688-1,629], respectively. The number of age-standardized fatalities and DALYs owing to high LDL levels reduced from 90 [55-123] to 57 [34-79] per 100,000, and the number of DALYs decreased from 1,657 [981-2,251] to 1,610 [650-1,532] per 100,000. Eastern Europe, Central Asia, North Africa, and the Middle East had the greatest age-standardized DALYs owing to elevated LDL cholesterol. 

High-income Asia Pacific and Andean Latin America have the lowest amounts. Globally, the CVD burden caused by LDL is growing. LDL was responsible for one-fifth of CVD deaths and DALYs in 2020. Differences in trends between all-age and age-standardized rates show that population increase and aging have contributed to the LDL load. When analyzing these patterns, measurement and estimation errors must be taken into account. Novel population-level techniques, in addition to safe and cost-effective pharmaceutical and behavioral therapies, are required to lower the LDL load.