Objective  To analyze and predict the changing trends of cardiovascular disease (CVD) burden attributable to high low-density lipoprotein cholesterol (LDL-C) in China from 1990 to 2021.

Methods Based on the Global Burden of Disease 2021 database, Joinpoint regression analysis was used to analyze the changing trends of CVD attributable to high LDL-C. An age-period-cohort model was used to explore the effects of age, period, and cohort. An ARIMA model was used to predict the CVD burden trend attributable to high LDL-C from 2022 to 2031.

Results  In 2021, the disability-adjusted life year (DALY) of CVD attributable to high LDL-C was 18,407,700 person-years, with 832,800 deaths. From 1990 to 2021, there was no significant trend in the age-standardized DALYs rate (ASDR) of CVD attributable to high LDL-C [AAPC=-0.15%, 95%CI (-0.35%, 0.05%)]. There was no significant trend in ASDR in the ischemic heart disease subgroup [AAPC=0.06%, 95%CI (-0.18%, 0.30%)]. The ASDR in the ischemic stroke subgroup showed a decreasing trend [AAPC=-0.46%, 95%CI (-0.63%, -0.29%)]. Age- standardized mortality rate (ASMR) attributable to high LDL-C CVD showed no clear trend from 1990 to 2021 [AAPC=0.11%, 95%CI (-0.19%, 0.42%)]. The ASMR in the ischemic heart disease subgroup showed an increasing trend [AAPC=0.47%, 95%CI (0.18%, 0.76%)], while the ASMR in the ischemic stroke subgroup showed a decreasing trend [AAPC=-0.42%, 95%CI (-0.66%, -0.18%)]. In 2021, the CVD burden attributable to high LDL-C increased exponentially with age. The disease burden was higher in men than in women. The age effect showed that the rates of DALYs and mortality from CVD attributable to high LDL-C, ischemic heart disease, and ischemic stroke, increased with age. The period effect showed that the risks of DALYs and mortality from CVD, ischemic heart disease, and ischemic stroke attributable to high LDL-C all initially increased and then decreased. The cohort effect showed that later birth cohorts had lower risks of DALYs and mortality. The ARIMA model predicts that the overall CVD burden attributable to high LDL-C will increase from 2022 to 2031, but that of ischemic stroke will decrease.

Conclusion From 1990 to 2021, the overall CVD disease burden attributable to high LDL-C in China showed no significant trend, while the disease burden trends differed between ischemic heart disease and ischemic stroke subgroups. The burden increased with age, and the disease burden was higher in males than in females. The ARIMA model predicts that from 2022 to 2031, the overall CVD disease burden attributable to high LDL-C will increase, mainly driven by ischemic heart disease, while the ischemic stroke burden will continue to decline.

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