Comparing Burden of Ischemic Stroke Caused by High Low-Density Lipoprotein Cholesterol in Global and China: Trends and Projections

Jiali Zhang^1*Mingxiu Liu²Junlin Yue¹Liang Zuo³Qiuzhu Xu⁴Jie Yang¹Gao Liu⁵Enli Cai⁵

• ¹The Third Affiliated Hospital of Yunnan University of Chinese Medicine, Kunming, China
• ²Bishan hospital of Chongqing Medical University, Chongqing, China
• ³The Second Affiliated Hospital of Yunnan University of Traditional Chinese Medicine, Kunming, China
• ⁴Haikou Orthopedic and Diabetes Hospital of Shanghai Sixth People's Hospital, Haikou, China
• ⁵Yunnan University of Chinese Medicine, Kunming, China

Background: Ischemic stroke (IS) remains a major global cause of death and disability, with elevated low-density lipoprotein cholesterol (LDL-C) identified as a key modifiable risk factor. This study evaluates the global and Chinese burden of IS attributable to high LDL-C from 1990 to 2021, and projects future trends through 2046. Materials and Methods: Data on IS mortality, disability-adjusted life years (DALYs), and age-standardized rates (ASRs) were sourced from the Global Burden of Disease (GBD) 2021 database. Analyses were stratified by age and sex. Temporal trends were assessed using Joinpoint regression, calculating the annual percentage change (APC) and the average annual percentage change (AAPC). Future burden was projected using the Nordpred model. Results: In 2021, IS deaths due to high LDL-C reached 936,192 globally (an increase of 43.04%) and 300,053 in China (an increase of 161.86%), despite age-standardized mortality rate (ASMR) declining by 43.16% and 12.61%, respectively. DALYs increased by 44.55% globally and 126.94% in China, with smaller reductions in age-standardized DALY rate (ASDR). Mortality and DALYs increased with age and were higher in men. China's elderly (≥90 years) exhibited particularly high mortality (1,058.69/100,000) compared to the global ≥95 age group (482.32/100,000). AAPCs indicated more consistent declines globally than in China. Projections estimate IS deaths will reach 1.86 million globally and 630,000 in China by 2046, with DALYs rising to 36.8 million and 11.4 million, respectively. China's projected ASMR and ASDR will remain higher than global averages. Conclusion: Despite declines in age-standardized rates, the absolute burden of IS attributable to high LDL-C continues to rise globally, driven by population aging and growth. China, in particular, faces a disproportionately higher burden compared to global trends, with slower progress in reducing these rates. Significant age- and sex-based disparities remain. These findings underscore the urgent need for targeted public health strategies to address the growing burden of IS, particularly in China, by focusing on effective LDL-C management.