Original Investigation 

Global Burden of Disease

Global Burden of Elevated LDL-C: Findings From the Global Burden of Disease Study 2023

GBD 2023 LDL Cholesterol Collaborators

JAMA Published Online: July 29, 2026

2026;336;(8):673-698

doi: 10.1001/jama.2026.8628

Key Points

Question  What is the global disease burden attributable to elevated low-density lipoprotein cholesterol (LDL-C)?

Findings  In 2023, high LDL-C caused 3.6 million deaths (6.0% of all deaths) and 90.7 million disability-adjusted life years (DALYs) (3.2% of total DALYs). Despite declines of 45.6% in age-standardized mortality rates and 39.5% in DALY rates, the absolute LDL-C–related burden increased by 38.5% from 1990 to 2023, driven by population growth and aging, with notable regional disparities shifting toward middle-sociodemographic settings.

Meaning  Strategic approaches to prevent, diagnose, and treat elevated LDL-C across populations globally are needed.

Abstract

Importance  Elevated low-density lipoprotein cholesterol (LDL-C) is a modifiable risk factor for cardiovascular disease, the leading cause of premature death worldwide. Assessing the LDL-C–related burden is critical for guiding prevention and treatment strategies.

Objectives  To estimate the global, regional, and national burden of ischemic heart disease and ischemic stroke attributable to elevated LDL-C (relative to 35-54 mg/dL) from 1990 to 2023 and to quantify the contributions of population growth, aging, risk-deleted burden, and exposure changes to burden trends.

Design, Setting, and Population  This comparative risk assessment, part of the Global Burden of Disease Study 2023, estimated population-level LDL-C exposure and associated health loss in 204 countries and territories. Mean LDL-C levels were estimated using spatiotemporal gaussian process regression based on 806 studies across 161 countries. Relative risks were derived from meta-analyses of 38 randomized clinical trials. Population-attributable fractions for deaths and disability-adjusted life-years (DALYs) were estimated by age and sex for adults aged 25 years or older from 1990 to 2023, with 95% uncertainty intervals.

Exposure  Population-level LDL-C concentrations.

Main Outcomes and Measures  Population-attributable fractions, counts, and rates (all ages and age standardized per 100 000) of LDL-C–attributable deaths and DALYs from ischemic heart disease and ischemic stroke, with uncertainty intervals.

Results  In 2023, elevated LDL-C accounted for 3.6 million deaths (95% uncertainty interval, 2.2-5.4 million; 6.0% of global mortality) and 90.7 million DALYs (95% uncertainty interval, 58.9-123.3 million; 3.2% of DALYs). Although global all-ages rates remained stable, age-standardized death and DALY rates decreased by 45.6% and 39.5%, respectively, since 1990. In 2023, age-standardized LDL-C–attributable DALY rates were highest in Eastern Europe and lowest in high-income Asia-Pacific. One-third of the global LDL-C burden occurred in India and China. Population growth and aging drove the increasing burden, with notable regional disparities in LDL-C exposure and risk-deleted DALY rates shifting toward middle-sociodemographic settings.

Conclusions and Relevance  Despite declining age-standardized rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries. Measurement and surveillance gaps persist. Strengthened prevention, diagnosis, and treatment access strategies are essential to mitigate the health burden of LDL-C.