LDL-C-Related Cardiovascular Burden in China 2010 to 2030: Spatiotemporal Patterns and Scenario-Based Projections.

Abstract

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. 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. 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. 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. 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.