Cardiovascular risk from the accumulation of “bad” cholesterol in blood vessels is shifting from high-income Western countries, especially those in Europe, to low- and middle-income countries, particularly in East and Southeast Asia. A meta-analysis of 1,127 studies comprising 102.6 million people worldwide shows a significant drop in bad cholesterol from 1980 to 2018 in countries such as Finland, Belgium and the U.S. and a strong rise in Thailand, Malaysia, Nigeria and Malawi. Two major factors in high-income populations are less consumption of saturated fats and widespread use of lipid-lowering medications, notably statins, says study co-leader Majid Ezzati of Imperial College London. In lower-income populations, eating saturated fats is rising, and statins are not common. Researchers had limited evidence about an emerging shift a decade ago, but Ezzati is surprised to see “just how far it has gone.”

Non-HDL cholesterol and related death rates generally went down in high-income countries and up in low-income countries 1980 to 2018
Credit: Jen Christiansen; Source: “Repositioning of the Global Epicenter of Non-Optimal Cholesterol,” by NCD Risk Factor Collaboration (NCD-RISC), in Nature, Vol. 582; June 4, 2020 (data)