Department of Global Health and Population, Harvard School of Public Health, Boston, MA, USA.
Lancet. 2011 Feb 12;377(9765):578-86. doi: 10.1016/S0140-6736(10)62038-7. Epub 2011 Feb 3.
Data for trends in serum cholesterol are needed to understand the effects of its dietary, lifestyle, and pharmacological determinants; set intervention priorities; and evaluate national programmes. Previous analyses of trends in serum cholesterol were limited to a few countries, with no consistent and comparable global analysis. We estimated worldwide trends in population mean serum total cholesterol.
We estimated trends and their uncertainties in mean serum total cholesterol for adults 25 years and older in 199 countries and territories. We obtained data from published and unpublished health examination surveys and epidemiological studies (321 country-years and 3·0 million participants). For each sex, we used a Bayesian hierarchical model to estimate mean total cholesterol by age, country, and year, accounting for whether a study was nationally representative.
In 2008, age-standardised mean total cholesterol worldwide was 4·64 mmol/L (95% uncertainty interval 4·51-4·76) for men and 4·76 mmol/L (4·62-4·91) for women. Globally, mean total cholesterol changed little between 1980 and 2008, falling by less than 0·1 mmol/L per decade in men and women. Total cholesterol fell in the high-income region consisting of Australasia, North America, and western Europe, and in central and eastern Europe; the regional declines were about 0·2 mmol/L per decade for both sexes, with posterior probabilities of these being true declines 0·99 or greater. Mean total cholesterol increased in east and southeast Asia and Pacific by 0·08 mmol/L per decade (-0·06 to 0·22, posterior probability=0·86) in men and 0·09 mmol/L per decade (-0·07 to 0·26, posterior probability=0·86) in women. Despite converging trends, serum total cholesterol in 2008 was highest in the high-income region consisting of Australasia, North America, and western Europe; the regional mean was 5·24 mmol/L (5·08-5·39) for men and 5·23 mmol/L (5·03-5·43) for women. It was lowest in sub-Saharan Africa at 4·08 mmol/L (3·82-4·34) for men and 4·27 mmol/L (3·99-4·56) for women.
Nutritional policies and pharmacological interventions should be used to accelerate improvements in total cholesterol in regions with decline and to curb or prevent the rise in Asian populations and elsewhere. Population-based surveillance of cholesterol needs to be improved in low-income and middle-income countries.
Bill & Melinda Gates Foundation and WHO.
为了了解血清胆固醇的饮食、生活方式和药物决定因素的影响，确定干预重点，并评估国家规划，我们需要有关血清胆固醇趋势的数据。以前对血清胆固醇趋势的分析仅限于少数几个国家，没有一致和可比的全球分析。我们估计了全球 25 岁及以上人群的血清总胆固醇的流行趋势。
我们估计了 199 个国家和地区 25 岁及以上成年人的血清总胆固醇的趋势及其不确定性。我们从已发表和未发表的健康检查调查和流行病学研究中获得了数据（321 个国家年和 300 万参与者）。对于每个性别，我们使用贝叶斯分层模型按年龄、国家和年份估算总胆固醇的平均值，同时考虑到研究是否具有全国代表性。
2008 年，全球男性血清总胆固醇的年龄标准化平均值为 4.64mmol/L（95%不确定区间 4.51-4.76），女性为 4.76mmol/L（4.62-4.91）。全球范围内，1980 年至 2008 年间，血清总胆固醇的变化很小，男性和女性每十年下降不到 0.1mmol/L。在高收入地区，包括澳大拉西亚、北美和西欧，以及中欧和东欧，血清总胆固醇下降；两性的区域下降幅度均约为每十年 0.2mmol/L，后验概率为 0.99 或更高，这些下降趋势是真实的。在东亚和太平洋地区，男性血清总胆固醇每十年增加 0.08mmol/L（-0.06 至 0.22，后验概率为 0.86），女性增加 0.09mmol/L（-0.07 至 0.26，后验概率为 0.86）。尽管呈收敛趋势，但 2008 年血清总胆固醇最高的地区仍为高收入地区，包括澳大拉西亚、北美和西欧；该地区男性的平均水平为 5.24mmol/L（5.08-5.39），女性为 5.23mmol/L（5.03-5.43）。在撒哈拉以南非洲，男性血清总胆固醇最低，为 4.08mmol/L（3.82-4.34），女性为 4.27mmol/L（3.99-4.56）。
应该使用营养政策和药物干预措施来加速改善下降地区的胆固醇总水平，并遏制或预防亚洲人口和其他地区的上升趋势。需要改善低收入和中等收入国家的基于人群的胆固醇监测。
比尔及梅琳达·盖茨基金会和世卫组织。
