The global burden attributable to elevated LDL-C has grown substantially since 1990, driven largely by population growth and aging despite significant declines in age-standardized rates, according to findings from the Global Burden of Disease Study 2023 (GBD 2023) Cholesterol Collaborators published July 29 in JAMA.

"LDL-C is central in CVD risk prediction models, a primary therapeutic target in clinical guidelines, and a key indicator for monitoring global noncommunicable disease trends," write the authors, citing the 2026 ACC/AHA/Multisociety Guideline on the Management of Dyslipidemia, among other sources. Drawing on data provided by the GBD 2023 from 806 studies representing 4.7 billion individuals across 161 countries, the investigators estimated LDL-C-attributable deaths and disability-adjusted life-years (DALYs) among adults aged 25 years and older from 1990 through 2023.

In 2023, elevated LDL-C was linked to 3.6 million deaths and 90.7 million DALYs globally, representing 6% of all deaths and 3.2% of all DALYs.

Although age-standardized death and DALY rates attributable to LDL-C declined by 46% and 40%, respectively, between 1990 and 2023, the overall burden continued to rise. During that period, absolute LDL-C burden increased by 39%, making elevated LDL-C the second-leading contributor to cardiovascular disease mortality in 2023 and one of the top 10 contributors to overall global disease burden. One-third of total global LDL-C burden occurred in India and China.

LDL-C-related burden is increasingly shifting toward middle-sociodemographic countries while important gaps in cholesterol measurement and surveillance remain. In 2023, age-standardized LDL-C-attributable DALY rates were highest in Eastern Europe and lowest in high-income Asia-Pacific regions.

"Addressing the global LDL-C-related burden requires a comprehensive framework beyond pharmacological intervention," writes the Collaboration. "Primordial and primary prevention are fundamental; robust evidence supports regular physical activity and dietary patterns high in fiber and plant-based foods, alongside reduced intake of trans and saturated fats, to improve lipid profiles and cardiovascular health."