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NCD Risk Factor Collaboration (NCD-RisC). (2023) "Long-term and recent trends in serum cholesterol treatment and control in 14 high-income countries: an analysis of 1XX nationally representative surveys".
Background: Lipid-lowering therapies are effective at preventing cardiovascular events and are therefore recommended by national and international guidelines. However, guidelines are not uniform nor are they consistently applied across countries. We aim to compare treatment and control of elevated serum cholesterol in high-income countries over time.
Methods: We used data from people aged 40-79 years who participated in 1XX nationally representative health examination surveys from 1990 to 2020 in 14 high-income countries: Australia, Belgium, Chile, the Czech Republic, Finland, Ireland, Italy, Malta, Poland, Slovakia, South Korea, Spain, the UK, and the USA. Accounting for complex survey design, we calculated the proportion of participants eligible for lipid-lowering therapy, which was defined as non-HDL-C 5.69 mmol/L (220 mg/dL) or more, or a combination of elevated 10-year risk of cardiovascular disease and non-HDL-C levels above guideline, or being on pharmacological treatment for elevated serum cholesterol. We also calculated the proportion of those eligible who were treated and whose serum cholesterol levels were optimally controlled (i.e. non-HDL-C lower than 3.36 mmol/L or 130 mg/dL).
Findings: Data from XXX XXX participants met our inclusion criteria. The prevalence of elevated serum cholesterol varied substantially and declined over time in all countries except South Korea and Poland. In the early 1990s, treatment coverage was close to zero, but increased rapidly after 2000. Improvements occurred first in the USA and Australia with coverage in most other countries only converging after 2010. In their most recent surveys, South Korea, the UK, and the USA had the highest rates of treatment and control, whereas Finland, Slovakia, and Italy had the lowest. Despite progress, treatment coverage was still less than 80% and optimal control was less than 60% in the best performing countries. Treatment coverage declined with age in all countries, even in high risk subgroups. Among 40-49 year olds with elevated serum cholesterol, the prevalence of untreated severe (
Interpretation: Treatment and control of elevated serum cholesterol have improved substantially in high-income countries since the 1990s. However, few countries have achieved rates of optimal treatment and control of high-quality hypercholesterolemia programmes. Considerable gaps remain in treatment coverage among younger age groups at high risk.