A landmark global study reveals cholesterol levels are declining in Europe and North America, while surging in many Asian countries.
Cholesterol, a vital lipid circulating in our blood, plays essential roles in cellular functions. Primarily produced by the liver—with about one-third from diet—it travels via proteins: HDL (high-density lipoproteins), the 'good' cholesterol that removes excess from arteries back to the liver, and LDL (low-density lipoproteins), the 'bad' type that delivers it to cells, where buildup can form artery-clogging plaques, raising risks of heart attacks and strokes.
Published in Nature, this comprehensive analysis by hundreds of researchers examined cholesterol data from 102 million people across 200 countries, spanning 1980 to 2018.
Results show total and non-HDL cholesterol levels have dropped significantly in high-income countries like those in North-West Europe, North America, and Australasia. The steepest declines occurred in Belgium and Iceland.
In contrast, levels have risen markedly in low- and middle-income countries, especially East, Central, and Southeast Asia. The largest non-HDL increases since 1980 were in Tokelau, Malaysia, the Philippines, Thailand, and China—which once had some of the world's lowest levels.
Dietary shifts and medication access drive these changes. In Western nations, saturated fats have given way to healthier unsaturated options, and statin use—effective cholesterol-lowering drugs—has surged since the 1990s.
Rising regions see increased intake of meat, dairy, refined carbs, and palm oil, with limited statin access.
"For the first time, the highest non-HDL cholesterol levels are outside the Western world," notes Majid Ezzati of Imperial College London. "We must globalize smart diet policies, regulations, and access to effective treatments to prevent millions of cholesterol-related deaths in emerging hotspots."
