Department of Pharmacy, the Third Xiangya Hospital, Central South University, Changsha, Hunan, 410013, China.
Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, Hunan, 410078, China.
BMC Public Health. 2024 Oct 30;24(1):3003. doi: 10.1186/s12889-024-20461-5.
High levels of low-density lipoprotein cholesterol (LDL-C) can lead to the occurrence and development of atherosclerosis, which is one of the important risk factors for ischemic stroke (IS). However, details regarding the evolution of the IS burden attributable to high LDL-C in China has not been available. The objective of this study was to examine the changes over time, from 1990 to 2019, in the burden of IS attributed to high levels of LDL-C in China and to estimate the individual impacts of age, period, and cohort on the burden of IS associated with high LDL-C.
Detailed data on IS burden attributable to high LDL-C from 1990 to 2019 in China were extracted from the Global Burden of Disease (GBD) Study 2019. The numbers and age-standardized rates of IS-related mortality and disability-adjusted life years (DALYs) attributable to high LDL-C were assessed by age and sex. The annual percentage change (APC) and average annual percentage change (AAPC) in the burden of IS due to high LDL-C were analyzed using Joinpoint regression model. The age-period-cohort analysis was carried out to assess the individual impacts of age, period, and cohort on the trends over time of mortality and DALY rate.
The number of IS-related deaths and DALYs due to high LDL-C in China were 182.7 thousand and 4.43 million in 2019, respectively, both more than double the corresponding numbers reported in 1990. However, despite these increased, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) remained unchanged. In 2019, men under 84 years of age had higher death and under 79 years of age had higher DALYs than women. However, above these ages, the gender disparities were reversed. Furthermore, age-specific rates of death, as well as DALY of IS attributable to high LDL-C in 2019 increased with age for both women and men, except for death in adults over 95 years old; and were greater in men than in women. From 1990 to 2019, males consistently had a higher ASMR and ASDR than females in China. During 1990-2019, the ASMR in women slightly decreased before 1997, sharply increased from 1997 to 2004, and then continuously decreased from 2004 to 2019, with an overall AAPC value of -0.4% (95% CI -0.8%, -0.0%). However, for the ASMR of men in China, the overall trend is upward and the AAPC is 0.5%(95% CI 0.1%, 0.8%). The ASDR in women and men had the similar trend as the ASMR over the time, with an AAPC of -0.4% (95% CI -0.7%, -0.1%) and 0.3% (95% CI 0.1%, 0.5%), respectively. The age-period-cohort analysis indicated a rise in period effects and a decline in cohort effects on mortality and DALY rate associated with IS caused by high LDL-C in both genders. Age effect on mortality rates from IS due to high LDL-C showed an exponential increased with age in all women and men except for the 60-69 age group and over 95 age group. The age relative risk of IS DALY rate due to high LDL-C increased with age in both genders except for 65-74 age group and over 95 age group.
From 1990 to 2019, the burden of IS caused by high LDL-C in China significantly increased among both sexes combined and among men, while significantly decreased among women. Elderly have a substantial burden of IS attributable to high LDL-C. Therefore, effective and tailored strategies based on gender and age for IS primary prevention and management of IS and high LDL-C are urgently needed in China.
低密度脂蛋白胆固醇（LDL-C）水平升高可导致动脉粥样硬化的发生和发展，这是缺血性脑卒中（IS）的重要危险因素之一。然而，中国 LDL-C 水平升高导致的 IS 负担的演变细节尚未可知。本研究旨在探讨 1990 年至 2019 年期间中国 LDL-C 水平升高导致的 IS 负担的变化，并估计年龄、时期和队列对与 LDL-C 升高相关的 IS 负担的个体影响。
从 2019 年全球疾病负担研究（GBD）中提取了 1990 年至 2019 年中国与高 LDL-C 相关的 IS 负担的详细数据。按年龄和性别评估了与高 LDL-C 相关的 IS 相关死亡率和残疾调整生命年（DALY）的数量和年龄标准化率。使用 Joinpoint 回归模型分析了由于高 LDL-C 导致的 IS 负担的年变化百分比（APC）和平均年变化百分比（AAPC）。进行年龄-时期-队列分析，以评估年龄、时期和队列对死亡率和 DALY 率随时间变化趋势的个体影响。
2019 年，中国因高 LDL-C 导致的 IS 相关死亡人数和 DALY 分别为 18.27 万和 4430 万，均比 1990 年增加了一倍多。尽管有所增加，但年龄标准化死亡率（ASMR）和年龄标准化 DALY 率（ASDR）保持不变。2019 年，84 岁以下男性死亡人数高于女性，79 岁以下男性 DALY 高于女性。然而，在这些年龄以上，性别差异就逆转了。此外，2019 年，除了 95 岁以上的成年人外，女性和男性的 IS 归因于高 LDL-C 的死亡和 DALY 年龄特异性率均随年龄增加而增加，且男性高于女性。1990 年至 2019 年，中国男性的 ASMR 和 ASDR 始终高于女性。1990 年至 2019 年期间，中国女性的 ASMR 在 1997 年之前略有下降，1997 年至 2004 年急剧上升，然后从 2004 年持续下降至 2019 年，总体 AAPC 值为-0.4%（95%CI-0.8%，-0.0%）。然而，对于中国男性的 ASMR，总体趋势是上升的，AAPC 为 0.5%（95%CI0.1%，0.8%）。女性和男性的 ASDR 随时间的变化趋势与 ASMR 相似，AAPC 值分别为-0.4%（95%CI-0.7%，-0.1%）和 0.3%（95%CI0.1%，0.5%）。年龄-时期-队列分析表明，两性的时期效应增加，与高 LDL-C 相关的 IS 导致的死亡率和 DALY 率的队列效应下降。除了 60-69 岁和 95 岁以上年龄组外，高 LDL-C 导致的 IS 死亡率的年龄效应在所有女性和男性中均表现出指数增长。除了 65-74 岁和 95 岁以上年龄组外，高 LDL-C 导致的 IS DALY 率的年龄相对风险在两性中均随年龄增加而增加。
1990 年至 2019 年，中国 LDL-C 水平升高导致的 IS 负担在两性和男性中均显著增加，而在女性中则显著下降。老年人的 LDL-C 水平升高与 IS 负担较大。因此，中国迫切需要基于性别和年龄制定有效的、有针对性的 IS 一级预防和管理策略，以及针对 LDL-C 升高的 IS 治疗策略。
