The percentage of people with high cholesterol who are effectively treated remains small in selected high- and middle-income countries, according to a World Health Organization study. Many of those affected are unaware of their condition. Lowering total serum cholesterol levels is an ideal strategy for reducing the burden of cardiovascular disease.

The study analyzed data sampling close to 80,000 adults age 40-79 years from England, Germany, Japan, Jordan, Mexico, Scotland, Thailand and the United States. The proportion of undiagnosed individuals was highest in Thailand (78 percent) and lowest in the United States (16 percent). The fraction diagnosed but untreated ranged from nine percent in Thailand to 53 percent in Japan. The proportion being treated who had attained evidence of control ranged from four percent in Germany to 58 percent in Mexico. Time series estimates showed improved control of high total serum cholesterol over the past two decades in England and the United States.

“These findings support the growing recognition that cardiovascular diseases are not merely ‘diseases of affluence’ and that some middle-income countries are beginning to face a double burden of both chronic and communicable diseases,” the study said.

The study recommended that programs designed to achieve higher detection and control of high blood cholesterol should be developed and implemented. Dried blood spot technology offers a new and affordable approach to screening in low-income settings. At the same time, better chronic disease surveillance is needed to monitor and guide these programs.

“Untreated high blood cholesterol represents a missed opportunity in the face of a global epidemic of chronic diseases,” the study concluded.

1. Roth GA, Fihn SD, Mokdad AH, et al. High total serum cholesterol, medication coverage and therapeutic control: an analysis of national health examination survey data from eight countries. Bulletin of the World Health Organization 2011; 89: 92-101. (open access)