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Global epidemiology of dyslipidaemias

Nature Reviews Cardiology volume 18, pages 689–700 (2021)Cite this article

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Abstract

Dyslipidaemias are alterations to the plasma lipid profile that are often associated with clinical conditions. Dyslipidaemias, particularly elevated plasma LDL-cholesterol levels, are major risk factors for cardiovascular disease, but some forms, such as hypertriglyceridaemia, are associated with severe diseases in other organ systems, including non-alcoholic fatty liver disease and acute pancreatitis. Dyslipidaemias can be genetically determined (primary or familial dyslipidaemias) or secondary to other conditions (such as diabetes mellitus, obesity or an unhealthy lifestyle), the latter being more common. Hypercholesterolaemia is the most common form of dyslipidaemia and is associated with an increased risk of cardiovascular disease, with elevated plasma LDL-cholesterol levels being the 15th leading risk factor for death in 1990, rising to 11th in 2007 and 8th in 2019. The global burden of dyslipidaemias has increased over the past 30 years. Furthermore, the combination of high triglyceride levels and low HDL-cholesterol levels (together with the presence of small, dense LDL particles), referred to as atherogenic dyslipidaemia, is highly prevalent in patients with diabetes or metabolic syndrome and increases their risk of cardiovascular disease. Given the increasing prevalence of diabetes worldwide, treating lipid abnormalities in these patients might reduce their risk of cardiovascular disease.

Key points

  • Dyslipidaemias, particularly elevated plasma LDL-cholesterol levels, are major risk factors for cardiovascular disease; among the different forms of dyslipidaemia, hypercholesterolaemia is the most prevalent.

  • Elevated plasma LDL-cholesterol levels are a major causal factor for ischaemic heart disease and ischaemic stroke in both the developed and the developing world.

  • The considerable increase in the use of statins in high-income countries has substantially lowered the average plasma cholesterol levels and deaths from cardiovascular disease in these regions.

  • By contrast, lipid-lowering drugs are still inaccessible to the majority of the population in low-income countries.

  • Rapid economic growth, changes in dietary habits and adoption of unhealthy lifestyles have largely contributed to the increases in plasma lipid levels and the prevalence of dyslipidaemias in low-income countries.

  • National guidelines adjusted to local needs and interventions are warranted to increase awareness of dyslipidaemias among clinicians and to reduce the burden of adverse lipid levels and cardiovascular disease.

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Fig. 1: Global death rates from IHD attributable to dyslipidaemia.

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Acknowledgements

G.D.N. is supported by Fondazione Cariplo (2016-0852), Telethon Foundation (GGP19146) and PRIN 2017K55HLC. A.L.C. is supported by Ministry of Health — Ricerca Corrente — IRCCS MultiMedica, PRIN 2017H5F943 and ERANET ER-2017-2364981.

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Authors and Affiliations

  1. Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy

    Angela Pirillo & Giuseppe D. Norata

  2. Center for the Study of Dyslipidaemias, Multimedica IRCCS, Milan, Italy

    Angela Pirillo, Manuela Casula & Alberico L. Catapano

  3. Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy

    Manuela Casula & Elena Olmastroni

  4. Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy

    Giuseppe D. Norata & Alberico L. Catapano

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All the authors contributed to researching data for the article, discussion of content, writing the article, and reviewing and editing the manuscript before submission.

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Correspondence to Alberico L. Catapano.

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G.D.N. reports personal fees from Amgen and Novartis, unrelated to this Review. A.L.C. reports grants from Amgen, Regeneron and Sanofi, and personal fees from Amgen, AstraZeneca, Merck, Novartis, Regeneron and Sanofi, unrelated to this Review. The other authors declare no competing interests.

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Pirillo, A., Casula, M., Olmastroni, E. et al. Global epidemiology of dyslipidaemias. Nat Rev Cardiol 18, 689–700 (2021). https://doi.org/10.1038/s41569-021-00541-4

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