Ischemic stroke in the context of high low-density lipoprotein cholesterol: A 30-year global burden perspective of 204 nations

Abstract

Background

High levels of low-density lipoprotein cholesterol (LDL-C) have a substantial impact on the onset and progression of ischemic stroke. However, the impact of high LDL-C level on ischemic stroke burden remains to be comprehensively investigated at the global, regional, and national levels. This study aimed to fill this gap by analyzing the trends of ischemic stroke associated with high LDL-C level from 1990 to 2021 using data obtained from the 2021 Global Burden of Disease (GBD) study to provide scientific evidence for policy-making and public health decision-making.

Methods

This population-based observational study used epidemiological data on ischemic stroke associated with high LDL-C level from the GBD 2021 study. The disability-adjusted life years (DALYs) and mortality data related to high LDL-C level were stratified by age, sex, country, and the Sociodemographic Index (SDI). The trends of ischemic stroke associated with high LDL-C level from 1990 to 2021 were evaluated using the estimated annual percentage change (EAPC). Hierarchical clustering analysis was conducted to evaluate the burden differences of high-LDL-C–related ischemic stroke across GBD regions. In addition, the Bayesian Age–Period–Cohort (BAPC) model was applied to predict the trends of high-LDL-C–related ischemic stroke for different sexes from 2022 to 2036.

Results

The number of DALYs caused by high-LDL-C–related ischemic stroke increased by 44.55 % globally, rising from 14,512,489.6 in 1990 to 20,977,423.91 in 2021. However, during the same period, the age-standardized DALY rate (ASDR) decreased from 390.89 per 100,000 population to 246.42, with a global EAPC of −1.72 (95 % uncertainty interval [UI] −1.82 to −1.63), which is consistent with the trend of age-standardized mortality rate (ASMR). The number of DALYs and deaths in regions with high-SDI exhibited a downward trend. As the SDI decreased, the age group with the highest number of deaths gradually shifted toward younger ages. The regions with increasing burden included Southern Sub-Saharan Africa, whereas those with substantial declines included high-income regions, such as Asia Pacific, Western Europe, and Australasia. In 2021, North Macedonia demonstrated the highest ASDR. Among countries, Portugal (EAPC of −6.18) and Singapore (EAPC of −6.88) had the most considerable declines. However, a few countries, such as Lesotho, saw an increase in disease burden (EAPC of 2.5). From 2022 to 2036, the ASDR and ASMR of high-LDL-C–related ischemic stroke are projected to significantly decrease for both men and women.

Conclusion

High LDL-C levels are a significant risk factor for ischemic stroke. From 1990 to 2021, the ASDR and ASMR of ischemic stroke caused by high LDL-C level have exhibited a global downward trend, which is projected to continue in the future. However, owing to population aging, the absolute burden is still increasing. In the future, it is necessary to strengthen lipid management policies, increase public health awareness, and implement targeted prevention and intervention strategies in areas with high prevalence of high LDL-C level and low socioeconomic status. This will further reduce the burden of hyperlipidemia-related ischemic stroke.