Lipid distributions in the Global Diagnostics Network across five continents

Abstract

Aims

Lipids are central in the development of cardiovascular disease, and the present study aimed to characterize variation in lipid profiles across different countries to improve understanding of cardiovascular risk and opportunities for risk-reducing interventions.

Methods and results

This first collaborative report of the Global Diagnostics Network (GDN) evaluated lipid distributions from nine laboratory organizations providing clinical laboratory testing in 17 countries on five continents. This cross-sectional study assessed aggregated lipid results from patients aged 20–89 years, tested at GDN laboratories, from 2018 through 2020. In addition to mean levels, the World Health Organization total cholesterol risk target (<5.00 mmol/L, <193 mg/dL) and proportions in guideline-based low-density lipoprotein cholesterol (LDL-C) categories were assessed. This study of 461 888 753 lipid results found wide variation by country/region, sex, and age. In most countries, total cholesterol and LDL-C peaked at 50–59 years in females and 40–49 years in males. Sex- and age-group adjusted mean total cholesterol levels ranged from 4.58 mmol/L (177.1 mg/dL) in the Republic of Korea to 5.40 mmol/L (208.8 mg/dL) in Austria. Mean total cholesterol levels exceeded the World Health Organization target in Japan, Australia, North Macedonia, Switzerland, Germany, Slovakia, and Austria. Considering LDL-C categories, North Macedonia had the highest proportions of LDL-C results >4.91 mmol/L ( >190 mg/dL) for both females (9.9%) and males (8.7%). LDL-C levels <1.55 mmol/L (<60 mg/dL) were most common among females in Canada (10.7%) and males in the UK (17.3%).

Conclusion

With nearly a half billion lipid results, this study sheds light on the worldwide variability in lipid levels, which may reflect inter-country differences in genetics, lipid testing, lifestyle habits, and pharmacologic treatment. Despite variability, elevated atherogenic lipid levels are a common global problem, and these results can help inform national policies and health system approaches to mitigate lipid-mediated risk of cardiovascular disease.

Structured Graphical Abstract

Structured Graphical Abstract

Key question, findings, and take-home messages: The world map displays age- and sex-adjusted mean total cholesterol levels ( A) and low-density lipoprotein cholesterol levels ( B) by country across World Health Organization regions. Levels are presented first in mmol/L, and in parentheses, mg/dL units are also provided. There is a continuous green/yellow/orange/red shading scale ranging from 4.50 to 5.50 mmol/L (174–213 mg/dL) for total cholesterol and from 2.5 to 3.5 mmol/L (97–135 mg/dL) for low-density lipoprotein cholesterol levels. Country codes are as follows: Australia (AUS); Austria (AUT); Brazil (BRA); Canada (CAN); Germany (DEU); India (IND); Japan (JPN); North Macedonia (MKD); Republic of Korea (KOR); Saudi Arabia (SAU); Slovakia (SVK); Spain (ESP); Switzerland (CHE); Turkey (TUR); United Arab Emirates (ARE); United Kingdom (GBR); United States of America (USA). LDL, low-density lipoprotein.