Globally, raised total cholesterol affects approximately 39% of adults. In 2019, the number of DALYs (disability-adjusted life years) due to high non-HDL cholesterol reached 98.6 million. It also caused an estimated 4.4 million deaths.
While the tapestry of global health has improved in recent decades, a grim pattern remains woven into its fabric: cardiovascular diseases (CVDs) still cast a long shadow as the leading cause of death and disability worldwide. At the heart of this shadow lies ischemic heart disease (IHD), a thief claiming half of all CVD lives. High blood cholesterol, or hypercholesterolemia, acts as a key accomplice, fueling the fires of IHD.
Fortunately, the arsenal against this foe has grown stronger in recent years, with effective cholesterol-lowering drugs becoming increasingly accessible. Yet, a troubling chasm persists: awareness of dyslipidaemia – the medical term for abnormal cholesterol levels – and subsequent healthcare investments vary dramatically across different regions of the world.
The global battle against high cholesterol reveals a tale of two tracks. While no overall shift in average cholesterol levels has been observed in the past three decades, stark disparities emerge when income divides are considered. Only high-income countries have witnessed a victory on the cholesterol front, with improved lipid profiles translating into a significant drop in IHD deaths and disabilities. In contrast, low- and middle-income countries stand witness to a stagnant, or even worsening, fight, with cholesterol levels holding firm or even rising.
Unsurprisingly, the casualties of IHD due to high LDL cholesterol (the "bad" cholesterol) primarily fall among those above 60, though income once again casts a stark shadow on this statistic. Low- and middle-income countries bear a disproportionate burden of these losses, highlighting the urgent need to bridge the treatment gap for hypercholesterolemia.
Women and older individuals emerge as particularly vulnerable populations within this global narrative. Tailored measures are crucial to ensure they receive the necessary access to diagnosis, treatment, and education about cholesterol management.
In conclusion, the global tapestry of IHD reveals a persisting imbalance. While medical advancements have empowered us to tackle this adversary, societal and economic realities create uneven battlegrounds. To truly vanquish this threat, we must bridge the divide in awareness, access, and resources, ensuring effective cholesterol management reaches all corners of the world, with particular attention to women and older adults. Only then can we truly turn the tide on IHD and reclaim a healthier future for all.