{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:24:38Z","timestamp":1793330678820,"version":"4.5.0"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,8,25]]},"abstract":"\n Importance<\/jats:title>\n Elevated low-density lipoprotein cholesterol (LDL-C) is a modifiable risk factor for cardiovascular disease, the leading cause of premature death worldwide. Assessing the LDL-C\u2013related burden is critical for guiding prevention and treatment strategies.<\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To estimate the global, regional, and national burden of ischemic heart disease and ischemic stroke attributable to elevated LDL-C (relative to 35-54 mg\/dL) from 1990 to 2023 and to quantify the contributions of population growth, aging, risk-deleted burden, and exposure changes to burden trends.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Population<\/jats:title>\n This comparative risk assessment, part of the Global Burden of Disease Study 2023, estimated population-level LDL-C exposure and associated health loss in 204 countries and territories. Mean LDL-C levels were estimated using spatiotemporal gaussian process regression based on 806 studies across 161 countries. Relative risks were derived from meta-analyses of 38 randomized clinical trials. Population-attributable fractions for deaths and disability-adjusted life-years (DALYs) were estimated by age and sex for adults aged 25 years or older from 1990 to 2023, with 95% uncertainty intervals.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n Population-level LDL-C concentrations.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Population-attributable fractions, counts, and rates (all ages and age standardized per 100\u202f000) of LDL-C\u2013attributable deaths and DALYs from ischemic heart disease and ischemic stroke, with uncertainty intervals.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n In 2023, elevated LDL-C accounted for 3.6 million deaths (95% uncertainty interval, 2.2-5.4 million; 6.0% of global mortality) and 90.7 million DALYs (95% uncertainty interval, 58.9-123.3 million; 3.2% of DALYs). Although global all-ages rates remained stable, age-standardized death and DALY rates decreased by 45.6% and 39.5%, respectively, since 1990. In 2023, age-standardized LDL-C\u2013attributable DALY rates were highest in Eastern Europe and lowest in high-income Asia-Pacific. One-third of the global LDL-C burden occurred in India and China. Population growth and aging drove the increasing burden, with notable regional disparities in LDL-C exposure and risk-deleted DALY rates shifting toward middle-sociodemographic settings.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Despite declining age-standardized rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries. Measurement and surveillance gaps persist. Strengthened prevention, diagnosis, and treatment access strategies are essential to mitigate the health burden of LDL-C.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2026.8628","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T15:30:26Z","timestamp":1785339026000},"page":"673","source":"Crossref","is-referenced-by-count":8,"title":["Global Burden of Elevated LDL-C"],"prefix":"10.1001","volume":"336","author":[{"name":"GBD 2023 LDL Cholesterol Collaborators","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Razo","sequence":"additional","affiliation":[{"name":"Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, Washington"},{"name":"Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole 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