National trends in total cholesterol obscure heterogeneous changes in HDL and non-HDL cholesterol and total-to-HDL cholesterol ratio: a pooled analysis of 458 population-based studies in Asian and Western countries
Authors:   NCD Risk Factor Collaboration (NCD-RisC), Taddei Cristina , Jackson Rod , Zhou Bin , Bixby Honor , Danaei Goodarz , Di Cesare Mariachiara , Kuulasmaa Kari , Hajifathalian Kaveh , Bentham James , Bennett James E , Aekplakorn Wichai , Cifkova Renata , Dallongeville Jean , DeBacquer Dirk , Giampaoli Simona , Gudnason Vilmundur , Khang Young-Ho , Laatikainen Tiina , Mann JimI , Marques-Vidal Pedro , Mensah George A , Müller-Nurasyid Martina , Ninomiya Toshiharu , Petkeviciene Janina , Rodríguez-Artalejo Fernando , Servais Jennifer , Söderberg Stefan , Stavreski Bill , Wilsgaard Tom , Zdrojewski Tomasz , Zhao Dong , Stevens Gretchen A , Savin Stefan , Cowan Melanie J , Riley Leanne M , Ezzati Majid , Adams Robert J , Aekplakorn Wichai , Ahrens Wolfgang , Amouyel Philippe , Amuzu Antoinette , Anderssen Sigmund A , Ariansen Inger , Arveiler Dominique , Aspelund Thor , Auvinen Juha , Avdicová Mária , Banach Maciej , Bandosz Piotr , Banegas José R , Barbagallo Carlo M , Bata Iqbal , Baur Louise A , Beaglehole Robert , Bennett James E , Bernotiene Gailute , Bi Yufang , Bienek Asako , Björkelund Cecilia , Bo Simona , Boehm Bernhard O , Bonaccio Marialaura , Bongard Vanina , Borchini Rossana , Borghs Herman , Breckenkamp Juergen , Brenner Hermann , Bruno Graziella , Busch Markus A , Cabrera de León Antonio , Capuano Vincenzo , Casanueva Felipe F , Casas Juan-Pablo , Caserta Carmelo A , Censi Laura , Chen Fangfang , Chen Shuohua , Chirlaque María-Dolores , Cho Belong , Cho Yumi , Chudek Jerzy , Cifkova Renata , Claessens Frank , Clarke Janine , Clays Els , Cooper Cyrus , Costanzo Simona , Cottel Dominique , Cowell Chris , Crujeiras Ana B , Cui Liufu , D'Arrigo Graziella , Dallongeville Jean , Dauchet Luc , De Backer Guy , De Bacquer Dirk , de Gaetano Giovanni , De Henauw Stefaan , De Smedt Delphine , Dennison Elaine , Deschamps Valérie , DiCastelnuovo Augusto , Dobson Annette J , Donfrancesco Chiara , Döring Angela , Drygas Wojciech , Du Yong , Dziankowska-Zaborszczyk Elzbieta , Eggertsen Robert , Ekelund Ulf , Elosua Roberto , Eriksson Johan G , Evans Alun , Faeh David , Felix-Redondo Francisco J , Fernández-Bergés Daniel , Ferrari Marika , Ferrieres Jean , Finn Joseph D , Forslund Ann-Sofie , Forsner Maria , Frontera Guillermo , Fujita Yuki , Gaciong Zbigniew , Galvano Fabio , Gao Jingli , Garcia-de-la-Hera Manoli , Garnett Sarah P , Gaspoz Jean-Michel , Gasull Magda , Gates Louise , Giampaoli Simona , Gianfagna Francesco , Gill Tiffany K , Giovannelli Jonathan , Goltzman David , GonzalezGross Marcela , Gottrand Frederic , Graff-Iversen Sidsel , Grafnetter Dušan , Gregor Ronald D , Grodzicki Tomasz , Grosso Giuseppe , Gruden Grabriella , Gu Dongfeng , Guallar-Castillón Pilar , Gudmundsson Elias F , Gudnason Vilmundur , Guessous Idris , Gunnlaugsdottir Johanna , Gutzwiller Felix , Hardy Rebecca , Hata Jun , Haugsgjerd Teresa , Hayes Alison J , He Jiang , He Yuna , Herrala Sauli , TapaniHihtaniemi Ilpo , Hobbs Michael , Hopman Wilma M , MaríaHuerta José , Huybrechts Inge , Iacoviello Licia , Iannone Anna G , Ikeda Nayu , Iwasaki Masanori , Jackson Rod , Jamrozik Konrad , Janszky Imre , Jarvelin Marjo-Riitta , Jasienska Grazyna , Jennings Garry , Jeong Seung-lyeal , QiangJiang Chao , Joffres Michel , Jokelainen Jari J , Jonas Jost B , Jóźwiak Jacek , Kajantie Eero O , Kauhanen Jussi , Keil Ulrich , Keinänen-Kiukaanniemi Sirkka , Kersting Mathilde , Khang Young-Ho , Kiechl-Kohlendorfer Ursula , Kiechl Stefan , Kim Jeongseon , Kim Yeon-Yong , Klumbiene Jurate , Knoflach Michael , Ko Stephanie , Kolle Elin , Korpelainen Raija , Koskinen Seppo , Kouda Katsuyasu , Kratzer Wolfgang , Kriemler Susi , Krokstad Steinar , Kujala Urho M , Kurjata Pawel , Kuulasmaa Kari , Laatikainen Tiina , HingLam Tai , Lanska Vera , Lappas Georg , Laugsand Lars E , Lee Jeonghee , Lehtimäki Terho , Li Yanping , Lilly Christa L , Lin Xu , Lind Lars , Lissner Lauren , Liu Jing , Lopez-Garcia Esther , Lorbeer Roberto , EugenioLozano José , Luksiene Dalia , Lundqvist Annamari , Lundqvist Robert , Lytsy Per , Ma Guansheng , Machi Suka , Maggi Stefania , Magliano Dianna J , Mann JimI , Manzato Enzo , Marques-Vidal Pedro , Mathiesen Ellisiv B , McLachlan Stela , McLean Rachael M , McLean Scott B , Meirhaeghe Aline , Meisinger Christa , Metcalf Patricia , Mi Jie , Miller Jody C , Moreno Luis A , Morin Suzanne , Mossakowska Malgorzata , Muiesan Maria L , Müller-Nurasyid Martina , Mursu Jaakko , Nakamura Harunobu , Námešná Jana , Nauck Matthias , MariaNavarrete-Muñoz Eva , Neal William A , Nenko Ilona , Niiranen Teemu J , Ning Guang , Ninomiya Toshiharu , Noale Marianna , Norie Sawada , Noto Davide , O'Neill Terence , O'Reilly Dermot , Oh Kyungwon , Olafsson Örn , MichelPaccaud Fred , Pajak Andrzej , Palmieri Luigi , Panza Francesco , Parnell Winsome R , Peltonen Markku , Peters Annette , Petersmann Astrid , Petkeviciene Janina , Pigeot Iris , Pilotto Lorenza , Piwonska Aleksandra , Plans-Rubió Pedro , Porta Miquel , Price Jacqueline F , Puder Jardena J , Puhakka Soile E , Radisauskas Ricardas , Raitakari Olli , Ramos Rafel , Redon Josep , Rigo Fernando , Rodríguez-Artalejo Fernando , Rodriguez-Perez MaríadelCristo , Romaguera Dora , Ronkainen Kimmo , Rosengren Annika , Roy Joel G R , Ruidavets Jean-Bernard , Rutkowski Marcin , Salanave Benoit , Salmerón Diego , Salomaa Veikko , Salonen Jukka T , Salvetti Massimo , Sans Susana , Saramies Jouko L , Saum Kai-Uwe , Scheidt-Nave Christa , Schienkiewitz Anja , Schipf Sabine , Schmidt Carsten O , Schöttker Ben , Sebert Sylvain , Sen Abhijit , Servais Jennifer , Shaw Jonathan E , Shibuya Kenji , WookShin Dong , Shiri Rahman , Simons Judith , Simons Leon A , Sjöström Michael , Slowikowska-Hilczer Jolanta , Slusarczyk Przemyslaw , Söderberg Stefan , Solfrizzi Vincenzo , Sonestedt Emily , Soumare Aicha , Staessen Jan A , Stathopoulou Maria G , Stavreski Bill , Steene-Johannessen Jostein , Stehle Peter , Stieber Jutta , Stöckl Doris , Stokwiszewski Jakub , Sundström Johan , Suriyawongpaisal Paibul , Tamosiunas Abdonas , JooTan Eng , Taylor Anne , Tell Grethe , Thijs Lutgarde , Tolonen HannaK , Topór-Madry Roman , JoséTormo María , Torrent Maties , Tsugane Shoichiro , Tuomainen Tomi-Pekka , Tuomilehto Jaakko , Tzourio Christophe , Uusitalo Hannu M T , Van Herck Koen , Vanderschueren Dirk , Vanuzzo Diego , Vatten Lars , Vega Tomas , Veronesi Giovanni , Vioque Jesus , Virtanen JyrkiK , Visvikis-Siest Sophie , Vollenweider Peter , Voutilainen Sari , Vrijheid Martine , Wagner Aline , Wagner Anne , Wang Ming-Dong , Wang Qian , XingWang Ya , Wannamethee S Goya , Wei Wenbin , Whincup Peter H , Wiecek Andrzej , Willeit Johann , Willeit Peter , Wilsgaard Tom , Wojtyniak Bogdan , Wong Andrew , Woodward Mark , GiwercmanWu Aleksander , Wu Frederick C , Wu Shouling , Xu Haiquan , Xu Liang , Yan Weili , Yang Xiaoguang , Ye Xingwang , Yoshihara Akihiro , Zambon Sabina , Zdrojewski Tomasz , Zhao Dong , Zhao Wenhua 
Published: April 2019

Abstract

Background
Although high-density lipoprotein (HDL) and non-HDL cholesterol have opposite associations with coronary heart disease, multi-country reports of lipid trends only use total cholesterol (TC). Our aim was to compare trends in total, HDL and non-HDL cholesterol and the total-to-HDL cholesterol ratio in Asian and Western countries.

Methods
We pooled 458 population-based studies with 82.1 million participants in 23 Asian and Western countries. We estimated changes in mean total, HDL and non-HDL cholesterol and mean total-to-HDL cholesterol ratio by country, sex and age group.

Results
Since ∼1980, mean TC increased in Asian countries. In Japan and South Korea, the TC rise was due to rising HDL cholesterol, which increased by up to 0.17 mmol/L per decade in Japanese women; in China, it was due to rising non-HDL cholesterol. TC declined in Western countries, except in Polish men. The decline was largest in Finland and Norway, at ∼0.4 mmol/L per decade. The decline in TC in most Western countries was the net effect of an increase in HDL cholesterol and a decline in non-HDL cholesterol, with the HDL cholesterol increase largest in New Zealand and Switzerland. Mean total-to-HDL cholesterol ratio declined in Japan, South Korea and most Western countries, by as much as ∼0.7 per decade in Swiss men (equivalent to ∼26% decline in coronary heart disease risk per decade). The ratio increased in China.

Conclusions
HDL cholesterol has risen and the total-to-HDL cholesterol ratio has declined in many Western countries, Japan and South Korea, with only a weak correlation with changes in TC or non-HDL cholesterol.