Serum Lipids and Lipoproteins in Chinese Men and Women

Total and LDL cholesterol levels high and increasing in Chinese population

Yang W, Xiao J, et al.
Circulation 2012 April doi: 10.1161/CIRCULATIONAHA.111.065904

Background

With rapid economic development and resulting adverse changes in lifestyle (such as a high intake of dietary saturated fat and increased physical inactivity), cardiovascular diseases have become the leading cause of death in China.[1,2] National data on serum lipids and lipoproteins are scarce, especially in developing countries. The objectives of this study are to provide current and reliable data on population levels of serum lipids and lipoproteins in the general adult population in China; to estimate the prevalence, awareness, treatment, and control of hypercholesterolemia in the Chinese population; and to examine the association between metabolic risk factors and levels of serum lipids and lipoproteins in the Chinese population.

Methods

A multiple-stage stratified sampling method was used to select a nationally representative sample of the general population aged ≥20 years in China. 45,757 adults were included in the final analysis.

Main results

• The age and gender-standardised mean levels of total, HDL, and LDL cholesterol and triglycerides were 4.72, 1.30, 2.68, and 1.57 mmol/L, respectively, in the general Chinese population aged ≥20 years.
• Age-standardized mean levels of total and LDL cholesterol and triglycerides were significantly higher in residents living in urban compared to in rural China (all p<0.0001), for both men and women. 
• The age-standardised prevalence of borderline high total cholesterol (5.18–6.21 mmol/L) and high total cholesterol (≥6.22 mmol/L) was 22.5% and 9.0%, respectively. 
• The age-standardized prevalence of borderline high (3.37-4.13 mmol/L), high (4.14-4.91 mmol/L) and very high (≥4.92 mmol/L) LDL-cholesterol was 13.9%, 3.5%, and 3.0%, respectively.
• The awareness, treatment and control rates of hypercholesterolemia were low.

Conclusion

Mean levels of total and LDL cholesterol and triglycerides are much higher than previously reported in the general Chinese adult population [3-6]. These study findings argue for more focus on the prevention and control of chronic diseases, such as hyperlipidemia and associated atherosclerotic cardiovascular diseases in China.

References

1. Zhai F, Wang H, et al. Prospective study on nutrition transition in China. Nutr Rev. 2009;67:S56–61.
2. He J, Gu D, et al. Major causes of death among men and women in China. N Engl J Med. 2005;353:1124–1134.
3. People's Republic of China-United States Cardiovascular and Cardiopulmonary Epidemiology Research Group. An epidemiological study of cardiovascular and cardiopulmonary disease risk factors in four populations in the People's Republic of China. Baseline report from the P.R.C.-U.S.A. Collaborative Study. Circulation. 1992;85:1083–1096.
4. Li YH, Li Y, et al. Serum cholesterol changes from 1983-1984 to 1993-1994 in the People's Republic of China. Nutr Metab Cardiovasc Dis. 2002;12:118–126.
5. He J, Gu D, et al; InterASIA Collaborative Group. Serum total and lipoprotein cholesterol levels and awareness, treatment, and control of hypercholesterolemia in China. Circulation. 2004;110:405–411.
6. The 2002 China National Nutrition and Health Survey (1): General Report. Wong LD, eds. People Health Publishing House: Beijing; 2005.

Abstract

Background—Due to rapid change in lifestyle risk factors, cardiovascular disease has become the leading cause of death in China. We aimed to estimate the national levels of serum lipids and lipoproteins among the Chinese adult population.
Methods and Results—We conducted a cross-sectional study in a nationally representative sample of 46,239 adults aged ≥20 years. Fasting serum total, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol and triglycerides were measured using standard methods. The age-standardized estimates of total, HDL and LDL cholesterol, and triglycerides were 4.72 (95% confidence interval 4.70-4.73), 1.30 (1.29-1.30), 2.68 (2.67-2.70), and 1.57 (1.55-1.58) mmol/L, respectively, in the Chinese adult population. In addition, 22.5% (21.8-23.3) or 220.4 million (212.1-228.8) Chinese adults had borderline high total cholesterol (5.18-6.21 mmol/L) while 9.0% (8.5-9.5) or 88.1 million (83.4-92.8) had high total cholesterol (≥6.22 mmol/L). The population estimates for borderline high (3.37-4.13 mmol/L), high (4.14-4.91 mmol/L) and very high (≥4.92 mmol/L) LDL-cholesterol were 13.9% (13.3-14.5) or 133.5 million (127.0-140.1), 3.5% (3.3-3.8) or 33.8 million (31.2-36.5), and 3.0 (2.8-3.3) or 29.0 million (26.3-31.8) persons, respectively. In addition, 22.3% (21.6-23.1) or 214.9 million (207.0-222.8) persons had low HDL-cholesterol (<1.04 mmol/L). The awareness, treatment, and control of borderline high or high total cholesterol were 11.0%, 5.1%, and 2.8%, respectively, in the Chinese adult population.
Conclusions—Serum total and LDL cholesterol levels were high and increasing in the Chinese population. Without effective intervention, atherosclerotic cardiovascular diseases may soar in the near future in China.