Cristina TaddeiBin ZhouHonor BixbyRodrigo M. Carrillo-LarcoGoodarz DanaeiRod T. JacksonFarshad FarzadfarMarisa K. SophieaMariachiara Di CesareMaria Laura Caminia IurilliAndrea Rodriguez MartinezGolaleh AsghariKlodian DhanaPablo GulayinSujay KakarmathMarilina SanteroTrudy VoortmanLeanne M. RileyMelanie J. CowanStefan SavinJames E. BennettGretchen A. StevensChristopher J. PaciorekWichai AekplakornRenata CifkovaSimona GiampaoliAndre Pascal KengneYoung Ho KhangKari KuulasmaaAvula LaxmaiahPaula MargozziniPrashant MathurBørge G. NordestgaardDong ZhaoMette AadahlLeandra Abarca-GómezHanan Abdul RahimNiveen M. Abu-RmeilehBenjamin Acosta-CazaresRobert J. AdamsImelda A. AgdeppaJavad Aghazadeh-AttariCarlos A. Aguilar-SalinasCharles AgyemangTarunveer S. AhluwaliaNoor Ani AhmadAli AhmadiNaser AhmadiSoheir H. AhmedWolfgang AhrensKamel AjlouniMonira AlaroujFadia AlBuhairanShahla AlDhukairMohamed M. AliAbdullah AlkandariAla’a AlkerwiEman AlyDeepak N. AmarapurkarPhilippe AmouyelLars Bo AndersenSigmund A. AnderssenRanjit Mohan AnjanaAlireza Ansari-MoghaddamHajer Aounallah-SkhiriJoana AraújoInger AriansenTahir ArisRaphael E. ArkuNimmathota ArlappaKrishna K. AryalThor AspelundMaria Cecília F. AssunçãoJuha AuvinenMária AvdicováAna AzevedoFereidoun AziziMehrdad AzminNagalla BalakrishnaMohamed BamoshmooshMaciej BanachPiotr BandoszJosé R. BanegasCarlo M. BarbagalloAlberto BarcelóAmina BarkatIqbal BataAnwar M. BatiehaAssembekov BatyrbekLouise A. BaurRobert BeagleholeAntonisamy BelavendraHabiba Ben RomdhaneMikhail BenetMarianne BennSalim BerkinbayevAntonio Bernabe-OrtizGailute BernotieneHeloisa BettiolSantosh K. BhargavaDasman Diabetes InstituteUniversity of Science and Technology, YemenWestern Norway University of Applied SciencesLietuvos sveikatos mokslų universitetasKazakh National Medical UniversityUniversité de LilleCaja Costarricense de Seguro SocialBeijing Anzhen Hospital, Capital Medical UniversityQatar UniversityBirzeit UniversityLuxembourg Institute of HealthAl Farabi Kazakh National UniversityFood and Nutrition Research Institute ManilaUniversidad Peruana Cayetano HerediaHaskoli IslandsJordan University of Science and TechnologyInstitute for Clinical Effectiveness and Health Policy, Ciudad Autonoma de Buenos AiresUniversity of Tunis El ManarNational Center for Diabetes, Endocrinology and Genetics JordanHarvard T.H. Chan School of Public HealthErasmus MCZahedan University of Medical SciencesPontificia Universidad Católica de ChileSouth African Medical Research CouncilTehran University of Medical SciencesOrganisation Mondiale de la SantéUniversidad Autónoma de MadridThe University of SydneyIndian Council of Medical ResearchUniversity of California, BerkeleyShahid Beheshti University of Medical Sciences, Research Institute for Endocrine ScienceShahrekord University of Medical SciencesUrmia University of Medical SciencesFlinders UniversityMohammed V University in RabatShahid Beheshti University of Medical SciencesRush University Medical CenterUniversità degli Studi di PalermoNational Institute of Nutrition IndiaOulu University HospitalCharles UniversitySteno Diabetes Center CopenhagenDalhousie UniversityCopenhagen University HospitalImperial College LondonUniversidade Federal de PelotasUniversity of Massachusetts AmherstMiddlesex UniversityPan American Health OrganizationSeoul National UniversityOulun YliopistoKementerian Kesihatan MalaysiaMahidol UniversityGdanski Uniwersytet MedycznyNorwegian Institute of Public HealthBombay Hospital and Medical Research CentreUniversitetet i OsloIstituto Superiore Di SanitaInstituto Nacional de la Nutrición Salvador ZubiranInstituto Mexicano del Seguro SocialUniversity of BremenUniversidade de Sao Paulo - USPUniversidade do PortoFrederiksberg HospitalMedical University of LodzUniversity of AucklandNorges idrettshøgskoleHarvard Medical SchoolUniversiteit van AmsterdamChristian Medical College, VelloreMadras Diabetes Research FoundationAbt AssociatesIndependent ResearcherAldara Hospital and Medical CenterCafam University FoundationFinnish Institute for Health and WelfareNational Institute of Public HealthKing Abdullah International Medical Research CenterThomayer HospitalRegional Authority of Public HealthSunder Lal Jain Hospital2020-08-252020-08-252020-06-04Nature. Vol.582, No.7810 (2020), 73-7714764687002808362-s2.0-85085994877https://repository.li.mahidol.ac.th/handle/20.500.14594/58419© 2020, The Author(s), under exclusive licence to Springer Nature Limited. High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.Mahidol UniversityMultidisciplinaryArticleSCOPUS10.1038/s41586-020-2338-1