WashU Cardiovascular Division faculty members Mark D. Huffman, MD, MPH, Victor G. Dávila-Román, MD, and Anubha Agarwal, MD, have published an editorial in JAMA accompanying a new Global Burden of Disease investigation examining worldwide trends in elevated low-density lipoprotein cholesterol (LDL-C) and its contribution to cardiovascular disease.
The editorial,“Global Low-Density Lipoprotein Cholesterol: Leveraging Estimation for Action,” discusses findings from the Global Burden of Disease Study, which evaluated the impact of elevated LDL cholesterol on cardiovascular health across countries and regions from 1990 to 2023. The authors note that while the age-adjusted burden of cardiovascular disease attributable to elevated LDL cholesterol has declined substantially over the past three decades, the absolute burden continues to rise because of population growth and aging. According to the analysis, elevated LDL cholesterol was associated with an estimated 3.6 million premature deaths and 90.7 million disability-adjusted life years globally in 2023.
The authors highlight disparities, with higher-income countries experiencing significant reductions in LDL-related cardiovascular disease burden while many lower-income countries have seen rates remain stable or increase. They also emphasize persistent gaps in lipid management worldwide, noting that statin use remains low in many settings, even among individuals at high cardiovascular risk.
Looking beyond the estimates, Huffman, Dávila-Román and Agarwal focus on how health systems can translate evidence into action. They highlight successful population-level approaches, including the elimination of artificial trans fats, and discuss opportunities to strengthen cardiovascular prevention through improved access to cholesterol testing, affordable lipid-lowering medications and integration of cardiovascular risk management into primary care. The authors also suggest that simplified treatment approaches, such as fixed-dose combination therapies and long-acting lipid-lowering medications, may help expand access to care while reducing strain on health systems.
The editorial concludes that the growing global burden of cardiovascular disease underscores the need for coordinated action across public health, clinical care and policy. As new data continue to document the impact of elevated LDL cholesterol worldwide, the authors call for stronger efforts to move from measurement and surveillance to implementation of proven prevention strategies.