Temporal trends of the burden of ischemic stroke attributable to high low-density lipoprotein cholesterol in China from 1999 to 2019.
China’s burden of disease
Disability adjusted life year
High low-density lipoprotein cholesterol
Ischemic stroke
Mortality
Trends
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
30 Oct 2024
30 Oct 2024
Historique:
received:
21
02
2024
accepted:
18
10
2024
medline:
31
10
2024
pubmed:
31
10
2024
entrez:
31
10
2024
Statut:
epublish
Résumé
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.
Sections du résumé
BACKGROUND
BACKGROUND
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.
METHODS
METHODS
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.
RESULTS
RESULTS
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.
CONCLUSIONS
CONCLUSIONS
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.
Identifiants
pubmed: 39478553
doi: 10.1186/s12889-024-20461-5
pii: 10.1186/s12889-024-20461-5
doi:
Substances chimiques
Cholesterol, LDL
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3003Subventions
Organisme : the Hunan Province Natural Science Foundation
ID : 2022JJ80043
Organisme : the Scientific research project of Hunan Health Commission
ID : 202203014949
Informations de copyright
© 2024. The Author(s).
Références
GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet Neurol. 2021;20(10):795–820. https://doi.org/10.1016/S1474-4422(21)00252-0 .
doi: 10.1016/S1474-4422(21)00252-0
GBD 2017 DALYs and, Collaborators HALE. Global, regional, and national disability-adjusted life-years (DALYs) for 359 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2018;392(10159):1859–922. https://doi.org/10.1016/S0140-6736(18)32335-3 .
doi: 10.1016/S0140-6736(18)32335-3
Ma Q, Li R, Wang L, Yin P, Wang Y, Yan C, et al. Temporal trend and attributable risk factors of stroke burden in China, 1990–2019: an analysis for the global burden of disease study 2019. Lancet Public Health. 2021;6(12):e897–906. https://doi.org/10.1016/S2468-2667(21)00228-0 .
doi: 10.1016/S2468-2667(21)00228-0
pubmed: 34838196
Fatahzadeh M, Glick M. Stroke: epidemiology, classification, risk factors, complications, diagnosis, prevention, and medical and dental management. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102(2):180–91. https://doi.org/10.1016/j.tripleo.2005.07.031 .
doi: 10.1016/j.tripleo.2005.07.031
pubmed: 16876060
Liu L, Chen W, Zhou H, Duan W, Li S, Huo X, et al. Chinese stroke association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of ischaemic cerebrovascular diseases. Stroke Vasc Neurol. 2020;5(2):159–76. https://doi.org/10.1136/svn-2020-000378 .
doi: 10.1136/svn-2020-000378
pubmed: 32561535
pmcid: 7337371
Ding Q, Liu S, Yao Y, Liu H, Cai T, Han L. Global, regional, and national burden of ischemic stroke, 1990–2019. Neurology. 2022;98(3):e279–90. https://doi.org/10.1212/WNL.0000000000013115 .
doi: 10.1212/WNL.0000000000013115
pubmed: 34911748
Sun T, Chen S, Wu K, Sun M, Zhang X, You C. Trends in incidence and mortality of stroke in China from 1990 to 2019. Front Neurol. 2021;12:759221. https://doi.org/10.3389/fneur.2021.759221 .
doi: 10.3389/fneur.2021.759221
pubmed: 34880825
pmcid: 8645546
Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111–88. https://doi.org/10.1093/eurheartj/ehz455 .
doi: 10.1093/eurheartj/ehz455
pubmed: 31504418
Amarenco P, Bogousslavsky J, Callahan AR, Goldstein LB, Hennerici M, Rudolph AE, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006;355(6):549–59. https://doi.org/10.1056/NEJMoa061894 .
doi: 10.1056/NEJMoa061894
pubmed: 16899775
Sillesen H, Amarenco P, Hennerici MG, Callahan A, Goldstein LB, Zivin J, et al. Atorvastatin reduces the risk of cardiovascular events in patients with carotid atherosclerosis: a secondary analysis of the stroke prevention by aggressive reduction in cholesterol levels (SPARCL) trial. Stroke. 2008;39(12):3297–302. https://doi.org/10.1161/STROKEAHA.108.516450 .
doi: 10.1161/STROKEAHA.108.516450
pubmed: 18845807
Amarenco P, Goldstein LB, Szarek M, Sillesen H, Rudolph AE, Callahan AR, et al. Effects of intense low-density lipoprotein cholesterol reduction in patients with stroke or transient ischemic attack: the stroke prevention by aggressive reduction in cholesterol levels (SPARCL) trial. Stroke. 2007;38(12):3198–204. https://doi.org/10.1161/STROKEAHA.107.493106 .
doi: 10.1161/STROKEAHA.107.493106
pubmed: 17962589
Amarenco P, Lavallee PC, Monteiro TL, Labreuche J, Albers GW, Abboud H, et al. Five-year risk of stroke after TIA or MINOR ischemic stroke. N Engl J Med. 2018;378(23):2182–90. https://doi.org/10.1056/NEJMoa1802712 .
doi: 10.1056/NEJMoa1802712
pubmed: 29766771
Amarenco P, Kim JS, Labreuche J, Charles H, Abtan J, Bejot Y, et al. A comparison of two LDL cholesterol targets after ischemic stroke. N Engl J Med. 2020;382(1):9. https://doi.org/10.1056/NEJMoa1910355 .
doi: 10.1056/NEJMoa1910355
pubmed: 31738483
Banach M, Shekoohi N, Mikhailidis DP, Lip G, Hernandez AV, Mazidi M. Relationship between low-density lipoprotein cholesterol, lipid-lowering agents and risk of stroke: a meta-analysis of observational studies (n = 355,591) and randomized controlled trials (n = 165,988). Arch Med Sci. 2022;18(4):912–29. https://doi.org/10.5114/aoms/145970 .
doi: 10.5114/aoms/145970
pubmed: 35832716
Joint Committee on the Chinese Guidelines for Lipid Management. [Chinese guidelines for lipid management. (2023)]. Zhonghua Xin Xue Guan Bing Za Zhi 2023;51:221 – 55. https://doi.org/10.3760/cma.j.cn112148-20230119-00038
Zhang M, Deng Q, Wang L, Huang Z, Zhou M, Li Y, et al. Prevalence of dyslipidemia and achievement of low-density lipoprotein cholesterol targets in Chinese adults: a nationally representative survey of 163,641 adults. Int J Cardiol. 2018;260:196–203. https://doi.org/10.1016/j.ijcard.2017.12.069 .
doi: 10.1016/j.ijcard.2017.12.069
pubmed: 29622441
Du H, Shi Q, Song P, Pan XF, Yang X, Chen L, et al. Global burden attributable to high low-density lipoprotein-cholesterol from 1990 to 2019. Front Cardiovasc Med. 2022;9:903126. https://doi.org/10.3389/fcvm.2022.903126 .
doi: 10.3389/fcvm.2022.903126
pubmed: 35757342
Zheng J, Wang J, Zhang Y, Xia J, Guo H, Hu H, et al. The global burden of diseases attributed to high low-density lipoprotein cholesterol from 1990 to 2019. Front Public Health. 2022;10:891929. https://doi.org/10.3389/fpubh.2022.891929 .
doi: 10.3389/fpubh.2022.891929
pubmed: 36051998
GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):1204–22. https://doi.org/10.1016/S0140-6736(20)30925-9 .
doi: 10.1016/S0140-6736(20)30925-9
GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet. 2020;396(10258):1223–49. https://doi.org/10.1016/S0140-6736(20)30752-2 .
doi: 10.1016/S0140-6736(20)30752-2
Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strasser T. Cerebrovascular disease in the community: results of a who collaborative study. Bull World Health Organ. 1980;58(1):113–30.
pubmed: 6966542
pmcid: 2395897
Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19(3):335–51. https://doi.org/10.1002/(sici)1097-0258(20000215)19:3%3C335::aid-sim336%3E3.0.co;2-z .
doi: 10.1002/(sici)1097-0258(20000215)19:3<335::aid-sim336>3.0.co;2-z
pubmed: 10649300
Yang Y, Land KC. Age-period-cohort analysis: New models, methods, and empirical applications. 1st ed. London: Chapman and Hall/CRC; 2013.
Tian W, Zhu G, Xiao W, Gao B, Lu W, Wang Y. Stroke burden and attributable risk factors in China, 1990–2019. Front Neurol. 2023;14:1193056. https://doi.org/10.3389/fneur.2023.1193056 .
doi: 10.3389/fneur.2023.1193056
pubmed: 37292127
pmcid: 10245554
Elshourbagy NA, Meyers HV, Abdel-Meguid SS. Cholesterol: the good, the bad, and the ugly - therapeutic targets for the treatment of dyslipidemia. Med Princ Pract. 2014;23(2):99–111. https://doi.org/10.1159/000356856 .
doi: 10.1159/000356856
pubmed: 24334831
Gu X, Li Y, Chen S, Yang X, Liu F, Li Y, et al. Association of lipids with ischemic and hemorrhagic stroke: a prospective cohort study among 267 500 Chinese. Stroke. 2019;50(12):3376–84. https://doi.org/10.1161/STROKEAHA.119.026402 .
doi: 10.1161/STROKEAHA.119.026402
pubmed: 31658904
Kurth T, Everett BM, Buring JE, Kase CS, Ridker PM, Gaziano JM. Lipid levels and the risk of ischemic stroke in women. Neurology. 2007;68(8):556–62. https://doi.org/10.1212/01.wnl.0000254472.41810.0d .
doi: 10.1212/01.wnl.0000254472.41810.0d
pubmed: 17310025
Yuan S, Tang B, Zheng J, Larsson SC. Circulating lipoprotein lipids, apolipoproteins and ischemic stroke. Ann Neurol. 2020;88(6):1229–36. https://doi.org/10.1002/ana.25916 .
doi: 10.1002/ana.25916
pubmed: 32981134
pmcid: 7756401
Alloubani A, Nimer R, Samara R. Relationship between hyperlipidemia, cardiovascular disease and stroke: a systematic review. Curr Cardiol Rev. 2021;17(6):e0418418537. https://doi.org/10.2174/1573403X16999201210200342 .
doi: 10.2174/1573403X16999201210200342
National Bureau of Statistics of China. The seventh population census of China 2020. http://www.stats.gov.cn/sj/tjgb/rkpcgb/qgrkpcgb/index_1.html (1 June 2023, date last accessed).
National Health Commission of China. The Chinese Health Statistical Yearbook. 2021. http://www.nhc.gov.cn/mohwsbwstjxxzx/tjzxtjsj/tjsj_list.shtml (1 June 2023, date last accessed).
Wang YJ, Li ZX, Gu HQ, Zhai Y, Zhou Q, Jiang Y, et al. China stroke statistics: an update on the 2019 report from the national center for healthcare quality management in neurological diseases, China national clinical research center for neurological diseases, the Chinese stroke association, national center for chronic and non-communicable disease control and prevention. Stroke Vasc Neurol. 2022;7(5):415–50. https://doi.org/10.1136/svn-2021-001374 . Chinese center for disease control and prevention and institute for global neuroscience and stroke collaborations.
doi: 10.1136/svn-2021-001374
pubmed: 35443985
Xu XH, Yang J, Wang LJ, Yin P, Liu JM, Dong WL, et al. [Burden of disease attributed to high level serum low-density lipoprotein cholesterol in China in 2017]. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(6):839–44. https://doi.org/10.3760/cma.j.cn112338-20191205-00861 .
doi: 10.3760/cma.j.cn112338-20191205-00861
pubmed: 32564546
Bushnell CD, Chaturvedi S, Gage KR, Herson PS, Hurn PD, Jimenez MC, et al. Sex differences in stroke: challenges and opportunities. J Cereb Blood Flow Metab. 2018;38(12):2179–91. https://doi.org/10.1177/0271678X18793324 .
doi: 10.1177/0271678X18793324
pubmed: 30114967
Krause DN, Duckles SP, Pelligrino DA. Influence of sex steroid hormones on cerebrovascular function. J Appl Physiol (1985). 2006;101(4):1252–61. https://doi.org/10.1152/japplphysiol.01095.2005 .
doi: 10.1152/japplphysiol.01095.2005
pubmed: 16794020
Wu S, Wu B, Liu M, Chen Z, Wang W, Anderson CS, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol. 2019;18(4):394–405. https://doi.org/10.1016/S1474-4422(18)30500-3 .
doi: 10.1016/S1474-4422(18)30500-3
pubmed: 30878104
Bai R, Liu Y, Zhang L, Dong W, Bai Z, Zhou M. Projections of future life expectancy in China up to 2035: a modelling study. Lancet Public Health. 2023;8(12):e915–22. https://doi.org/10.1016/S2468-2667(22)00338-3 .
doi: 10.1016/S2468-2667(22)00338-3
pubmed: 37004714
Yang W, Xiao J, Yang Z, Ji L, Jia W, Weng J, et al. Serum lipids and lipoproteins in Chinese men and women. Circulation. 2012;125(18):2212–21. https://doi.org/10.1161/CIRCULATIONAHA.111.065904 .
doi: 10.1161/CIRCULATIONAHA.111.065904
pubmed: 22492668
Maranhao RC, Pala D, Freitas FR. Lipoprotein removal mechanisms and aging: implications for the cardiovascular health of the elderly. Curr Opin Endocrinol Diabetes Obes. 2020;27(2):104–9. https://doi.org/10.1097/MED.0000000000000529 .
doi: 10.1097/MED.0000000000000529
pubmed: 32011347
Chen F, Hu W, Chen S, Si A, Zhang Y, Ma J. Stroke mortality attributable to high red meat intake in China and South Korea: an age-period-cohort and joinpoint analysis. Front Nutr. 2022;9:921592. https://doi.org/10.3389/fnut.2022.921592 .
doi: 10.3389/fnut.2022.921592
pubmed: 36313118
pmcid: 9614311
Chen Z, Peto R, Zhou M, Iona A, Smith M, Yang L, et al. Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet. 2015;386(10002):1447–56. https://doi.org/10.1016/S0140-6736(15)00340-2 .
doi: 10.1016/S0140-6736(15)00340-2
pubmed: 26466050
pmcid: 4691901
Millwood IY, Li L, Smith M, Guo Y, Yang L, Bian Z, et al. Alcohol consumption in 0.5 million people from 10 diverse regions of China: prevalence, patterns and socio-demographic and health-related correlates. Int J Epidemiol. 2017;46(6):2103. https://doi.org/10.1093/ije/dyx210 .
doi: 10.1093/ije/dyx210
pubmed: 29025163
pmcid: 5837380
Li Z, Jiang Y, Li H, Xian Y, Wang Y. China’s response to the rising stroke burden. BMJ. 2019;364:l879. https://doi.org/10.1136/bmj.l879 .
doi: 10.1136/bmj.l879
pubmed: 30819725
pmcid: 6394375
Wang K, Liang R, Yu X, Shum D, Roalf D, Chan R. The thinner the better: evidence on the internalization of the slimness ideal in Chinese college students. Psych J. 2020;9(4):544–52. https://doi.org/10.1002/pchj.346 .
doi: 10.1002/pchj.346
pubmed: 32043314
Fang EF, Xie C, Schenkel JA, Wu C, Long Q, Cui H et al. A research agenda for ageing in China in the 21st century (2nd edition): focusing on basic and translational research, long-term care, policy and social networks. Ageing Res Rev. 2020;64:101174. https://doi.org/10.1016/j.arr.2020.101174
Wu S, Anderson CS. Healthy eating for secondary stroke prevention. Lancet Neurol. 2021;20(2):87–9. https://doi.org/10.1016/S1474-4422(20)30450-6 .
doi: 10.1016/S1474-4422(20)30450-6
pubmed: 33347807
Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet Glob Health. 2018;6(10):e1077–86. https://doi.org/10.1016/S2214-109X(18)30357-7 .
doi: 10.1016/S2214-109X(18)30357-7
pubmed: 30193830
Chen H, Zhou Z, Li Z, Liang S, Zhou J, Zou G, et al. Time trends in the burden of stroke and subtypes attributable to pm2.5 in China from 1990 to 2019. Front Public Health. 2022;10:1026870. https://doi.org/10.3389/fpubh.2022.1026870 .
doi: 10.3389/fpubh.2022.1026870
pubmed: 36311576
pmcid: 9605206
Osmond C, Kajantie E, Forsen TJ, Eriksson JG, Barker DJ. Infant growth and stroke in adult life: the Helsinki birth cohort study. Stroke. 2007;38(2):264–70. https://doi.org/10.1161/01.STR.0000254471.72186.03 .
doi: 10.1161/01.STR.0000254471.72186.03
pubmed: 17218608
Spence JD. Nutrition and risk of stroke. Nutrients. 2019;11(3). https://doi.org/10.3390/nu11030647 .