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LDL-C-Related Cardiovascular Burden in China 2010 to 2030: Spatiotemporal Patterns and Scenario-Based Projections
Yixin Tian1, Xue Cao1, Xin Wang1
1Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Insights
High LDL-C levels are a growing public health concern in China, causing a significant increase in deaths and life years lost. Urgent population-wide control measures and statin treatment are needed to mitigate this burden.
Area of Science:
- Cardiovascular epidemiology
- Public health research
- Preventive medicine
Background:
- Previous research quantified high low-density lipoprotein cholesterol (LDL-C) burden globally and in high-income nations.
- The specific disease burden attributed to high LDL-C in China remains incompletely understood.
Purpose of the Study:
- To systematically evaluate the disease burden of high LDL-C in China between 2010 and 2020.
- To project the disease burden attributable to high LDL-C in China up to 2030.
Main Methods:
- Utilized a population-based study design with data from 644,189 adults across three large-scale, representative surveys.
- Employed a comparative risk assessment approach to quantify deaths and years of life lost due to high LDL-C.
- Conducted decomposition analysis to identify drivers of changes in attributable deaths and used a proportional change model for 2030 projections under various LDL-C control scenarios.
Main Results:
- In 2020, the age-standardized LDL-C level was 112.33 mg/dL (2.91 mmol/L).
- Attributable deaths and years of life lost were estimated at 813.53 thousand and 16,108.31 thousand, respectively.
- Between 2010 and 2020, the age-standardized mortality rate increased by 34.41%, and the number of deaths by 94.02%, driven by rising LDL-C levels, population growth, and aging. Projections indicate a potential doubling of the mortality rate by 2030 without intervention; a 10% LDL-C reduction is needed to decrease mortality.
Conclusions:
- High LDL-C presents a substantial public health challenge in China.
- The escalating mortality burden necessitates immediate, population-wide LDL-C control strategies.
- Expansion of national statin treatment coverage is crucial for addressing this growing health issue.
Background:
Previous studies have quantified the burden attributable to high low-density lipoprotein cholesterol (LDL-C) globally or in high-income countries. However, the disease burden of high LDL-C in China has not been fully elucidated.
Objectives:
The purpose of this study was to systematically evaluate the disease burden attributable to high LDL-C in China from 2010 to 2020, with projections to 2030.
Methods:
In this population-based study, data were obtained from 644,189 adults across 3 large-scale, nationally and provincially representative surveys. A comparative risk assessment approach was used to quantify deaths and years of life lost attributable to high LDL-C in China from 2010 to 2020, stratified by age, sex, and region. The drivers of changes in attributable deaths were assessed using decomposition analysis. Furthermore, a proportional change model was used to estimate projections to 2030 under 5 LDL-C control scenarios: natural scenario, halting the increase, 10% reduction, 20% reduction, and statin treatment improvement.
Results:
In 2020, the nationally age-standardized LDL-C level among adults aged ≥25 years was 112.33 mg/dL (95% uncertainty interval (UI): 99.97-124.68 mg/dL), equivalent to 2.91 mmol/L (95% UI: 2.59-3.23 mmol/L). We estimated that the number of deaths and years of life lost attributable to high LDL-C were 813.53 thousand (95% UI: 774.81-860.30 thousand) and 16,108.31 thousand (95% UI: 15,612.47-16,685.53 thousand) in 2020. Between 2010 and 2020, the age-standardized mortality rate attributable to high LDL-C increased by 34.41%, while number of deaths increased by 94.02%. This dramatic increase was closely associated with increasing LDL-C levels, population growth, and population ageing during the last 10 years. If current trends in LDL-C levels continue, the attributable mortality rate is projected to increase from 79.97 per 100,000 people (95% UI: 76.16-84.57 per 100,000 people) in 2020 to 155.52 per 100,000 people (95% UI: 141.73-174.65 per 100,000 people) by 2030. Only a reduction of at least 10% in LDL-C levels by 2030, compared with 2020 levels, would achieve a decrease in attributable mortality rate by 2030.
Conclusions:
High LDL-C remains a considerable public health challenge in China. The rapid increase in its attributable mortality burden underscores the urgent need for population-wide LDL-C control and expanded national coverage of statin treatment.
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