Prevalence of plasma lipid disorders with an emphasis on LDL cholesterol in selected countries in the Asia-Pacific region

Abstract

Cardiovascular disease (CVD) is a major cause of mortality and morbidity within the Asia-Pacific region, with the prevalence of CVD risk factors such as plasma lipid disorders increasing in many Asian countries. As members of the Cardiovascular RISk Prevention (CRISP) in Asia network, the authors have focused on plasma lipid disorders in the six countries within which they have clinical experience: Indonesia, Malaysia, Philippines, Thailand, Vietnam, and Australia. Based on country-specific national surveys, the prevalence of abnormal levels of total cholesterol, low- and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively), and triglycerides (TG) are reported. An important caveat is that countries have used different thresholds to define plasma lipid disorders, making direct comparisons difficult. The prevalence of abnormal lipid levels was as follows: high total cholesterol (30.2-47.7%, thresholds: 190-213 mg/dL); high LDL-C (33.2-47.5%; thresholds: 130-135 mg/dL); low/abnormal HDL-C (22.9-72.0%; thresholds: 39-50 mg/dL); and high/abnormal TG (13.9-38.7%; thresholds: 150-177 mg/dL). Similarities and differences between country-specific guidelines for the management of plasma lipid disorders are highlighted. Based on the authors' clinical experience, some of the possible reasons for suboptimal management of plasma lipid disorders in each country are described. Issues common to several countries include physician reluctance to prescribe high-dose and/or high-intensity statins and poor understanding of disease, treatments, and side effects among patients. Treatment costs and geographical constraints have also hampered disease management in Indonesia and the Philippines. Understanding the factors governing the prevalence of plasma lipid disorders helps enhance strategies to reduce the burden of CVD in the Asia-Pacific region.

Keywords: Asia-Pacific; Dyslipidemia; Guidelines; Plasma lipid disorders; Prevalence.

Fig. 1

Age-standardized death rates per 100,000 from CVD [3]. Data from countries of interest are represented as black bars. Abbreviation: CVD cardiovascular disease

Fig. 2

Percentage of patients with elevated total cholesterol in Asia and Australia/New Zealand [6]*. *Only studies from the Asia-Pacific Cohort Studies Collaboration that meet pre-defined criteria were used to generate these data [6]. The prevalence of plasma lipid disorders based on national survey data from Indonesia, Malaysia, Philippines, Thailand, Vietnam, and Australia is presented in Table 1

Fig. 3

Percentage of patients attaining LDL-C goals in Asian countries within the CEPHEUS study [51]. Abbreviation: LDL-C low-density lipoprotein cholesterol

Fig. 4

Goal attainment (LDL-C < 70 mg/dL) for Asian patients with a coronary heart disease and b acute coronary syndrome in the DYSIS-II study [52]. Abbreviations: LDL-C low-density lipoprotein cholesterol; LLT lipid-lowering therapies