High cholesterol, or hypercholesterolemia, is the presence of elevated levels of lipids, primarily low-density lipoprotein cholesterol (LDL-C), in the bloodstream. This condition is a major global risk factor because it leads to atherosclerosis—the hardening and narrowing of arteries—which underlies most cardiovascular diseases (CVD) and strokes. Understanding worldwide statistics is necessary for public health monitoring and for directing prevention and treatment resources effectively. The sheer number of affected individuals and corresponding health consequences make hypercholesterolemia a significant global public health challenge.
Global Prevalence and Magnitude
Globally, raised total cholesterol affects an estimated 39% of adults worldwide. The World Health Organization (WHO) uses a total cholesterol level of \(\ge 5.00 \text{ mmol/L}\) (or \(\ge 193 \text{ mg/dL}\)) as a standardized threshold for identifying populations at risk. A more specific focus for cardiovascular risk is placed on non-HDL cholesterol or LDL-C, often referred to as “bad cholesterol.”
The standardization of these definitions allows different countries and regions to compare their population health data accurately. Although the overall global mean cholesterol level has remained relatively stable over the last few decades, its distribution and the resulting burden on health systems have undergone significant shifts.
Regional Distribution and Economic Disparity
The geographic distribution of high cholesterol prevalence demonstrates a transition associated with economic development and lifestyle changes. Historically, the highest mean cholesterol levels were observed in high-income Western regions, including North America, Australasia, and Western Europe. These regions have since seen impressive reductions in mean cholesterol levels due to successful public health initiatives and widespread use of cholesterol-lowering medications.
The focus of the global high cholesterol burden has shifted toward East and Southeast Asia, as well as the Pacific region. Countries in these developing regions, often classified as middle-income nations, have experienced notable increases in their population’s mean cholesterol levels. Eastern Europe continues to report some of the highest age-standardized rates of deaths and Disability-Adjusted Life Years (DALYs) linked to high LDL-C. This pattern highlights a distinct economic disparity, where countries with moderate Socio-demographic Index (SDI) levels are grappling with an increasing burden of hypercholesterolemia, sometimes lacking robust healthcare infrastructure for widespread screening and treatment.
Demographic Breakdown and Temporal Trends
High cholesterol prevalence varies significantly across different demographic groups, particularly by age and sex. Prevalence rates increase with age across both sexes, reflecting the cumulative effect of diet, lifestyle, and physiological changes over time. Mean total cholesterol and LDL-C levels typically peak earlier in males (40–49 age range), while in females, the peak tends to occur later (around 50–59 years), often related to hormonal shifts following menopause.
Data from the Global Burden of Disease study indicate that while females may have a slightly higher age-standardized summary exposure value (SEV) rate for high LDL-C, males experience higher age-standardized rates of death and DALYs attributed to the condition. Analyzing temporal trends reveals that the age-standardized rate of high LDL-C globally has decreased over the past few decades, suggesting improved prevention and treatment efforts relative to population size. Despite this improvement in the rate, the absolute number of global deaths and DALYs attributed to high LDL-C has increased substantially, with deaths rising by approximately 46% between 1990 and 2019. This increase in absolute burden is primarily driven by global population growth and the aging of the world population.
Health Burden and Mortality Link
The substantial prevalence statistics translate directly into a major global health burden, primarily through cardiovascular events. High LDL-C is a direct contributing factor to millions of deaths annually, causing approximately 4.4 million deaths worldwide in 2019. This risk factor is linked to a large proportion of global ischemic heart disease and stroke cases.
Beyond mortality, the condition results in a loss of healthy life years, quantified by DALYs, which reached an estimated 98.6 million globally in 2019. The economic impact is also considerable, as high cholesterol contributes to the overall costs of managing cardiovascular diseases, which exceed $863 billion worldwide and are projected to rise significantly. Direct costs associated with hypercholesterolemia management—including medications, hospitalizations for heart events, and long-term care—place a significant strain on national healthcare budgets and individual finances globally.