Unmet need for hypercholesterolemia care in 35 low- and middle-income countries : a cross-sectional study of nationally representative surveys

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dc.contributor.authorMarcus, Maja E.en_ZA
dc.contributor.authorEbert, Caraen_ZA
dc.contributor.authorGeldsetzer, Pascalen_ZA
dc.contributor.authorTheilmann, Michaelaen_ZA
dc.contributor.authorBicaba, Brice Wilfrieden_ZA
dc.contributor.authorAndall-Brereton, Glennisen_ZA
dc.contributor.authorBovet, Pascalen_ZA
dc.contributor.authorFarzadfar, Farshaden_ZA
dc.contributor.authorGurung, Mongal Singhen_ZA
dc.contributor.authorHouehanou, Corineen_ZA
dc.contributor.authorMalekpour, Mohammad-Rezaen_ZA
dc.contributor.authorMartins, Joao S.en_ZA
dc.contributor.authorMoghaddam, Sahar Saeedien_ZA
dc.contributor.authorMohammadi, Esmaeilen_ZA
dc.contributor.authorNorov, Bolormaaen_ZA
dc.contributor.authorQuesnel-Crooks, Sarahen_ZA
dc.contributor.authorWong-McClure, Royen_ZA
dc.contributor.authorDavies, Justine I.en_ZA
dc.contributor.authorHlatky, Mark A.en_ZA
dc.contributor.authorAtun, Rifaten_ZA
dc.contributor.authorBarnighausen, Till W.en_ZA
dc.contributor.authorJaacks, Lindsay M.en_ZA
dc.contributor.authorManne-Goehler, Jenniferen_ZA
dc.contributor.authorVollmer, Sebastianen_ZA
dc.date.accessioned2022-01-05T06:46:08Z
dc.date.available2022-01-05T06:46:08Z
dc.date.issued2021-10
dc.descriptionCITATION: Marcus, M. E. et al. 2021. Unmet need for hypercholesterolemia care in 35 low- and middle-income countries : a crosssectional study of nationally representative surveys. PLoS Medicine, 18(10):e1003841, doi:10.1371/journal.pmed.1003841.
dc.descriptionThe original publication is available at https://journals.plos.org
dc.description.abstractBackground: As the prevalence of hypercholesterolemia is increasing in low- and middle-income countries (LMICs), detailed evidence is urgently needed to guide the response of health systems to this epidemic. This study sought to quantify unmet need for hypercholesterolemia care among adults in 35 LMICs. Methods and findings: We pooled individual-level data from 129,040 respondents aged 15 years and older from 35 nationally representative surveys conducted between 2009 and 2018. Hypercholesterolemia care was quantified using cascade of care analyses in the pooled sample and by region, country income group, and country. Hypercholesterolemia was defined as (i) total cholesterol (TC) ≥240 mg/dL or self-reported lipid-lowering medication use and, alternatively, as (ii) low-density lipoprotein cholesterol (LDL-C) ≥160 mg/dL or self-reported lipid-lowering medication use. Stages of the care cascade for hypercholesterolemia were defined as follows: screened (prior to the survey), aware of diagnosis, treated (lifestyle advice and/or medication), and controlled (TC <200 mg/dL or LDL-C <130 mg/dL). We further estimated how age, sex, education, body mass index (BMI), current smoking, having diabetes, and having hypertension are associated with cascade progression using modified Poisson regression models with survey fixed effects. High TC prevalence was 7.1% (95% CI: 6.8% to 7.4%), and high LDL-C prevalence was 7.5% (95% CI: 7.1% to 7.9%). The cascade analysis showed that 43% (95% CI: 40% to 45%) of study participants with high TC and 47% (95% CI: 44% to 50%) with high LDL-C ever had their cholesterol measured prior to the survey. About 31% (95% CI: 29% to 33%) and 36% (95% CI: 33% to 38%) were aware of their diagnosis; 29% (95% CI: 28% to 31%) and 33% (95% CI: 31% to 36%) were treated; 7% (95% CI: 6% to 9%) and 19% (95% CI: 18% to 21%) were controlled. We found substantial heterogeneity in cascade performance across countries and higher performances in upper-middle-income countries and the Eastern Mediterranean, Europe, and Americas. Lipid screening was significantly associated with older age, female sex, higher education, higher BMI, comorbid diagnosis of diabetes, and comorbid diagnosis of hypertension. Awareness of diagnosis was significantly associated with older age, higher BMI, comorbid diagnosis of diabetes, and comorbid diagnosis of hypertension. Lastly, treatment of hypercholesterolemia was significantly associated with comorbid hypertension and diabetes, and control of lipid measures with comorbid diabetes. The main limitations of this study are a potential recall bias in self-reported information on received health services as well as diminished comparability due to varying survey years and varying lipid guideline application across country and clinical settings. Conclusions: Cascade performance was poor across all stages, indicating large unmet need for hypercholesterolemia care in this sample of LMICs—calling for greater policy and research attention toward this cardiovascular disease (CVD) risk factor and highlighting opportunities for improved prevention of CVD.en_ZA
dc.description.urihttps://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003841
dc.description.versionPublisher's version
dc.format.extent20 pages : illustrations
dc.identifier.citationMarcus, M. E. et al. 2021. Unmet need for hypercholesterolemia care in 35 low- and middle-income countries : a crosssectional study of nationally representative surveys. PLoS Medicine, 18(10):e1003841, doi:10.1371/journal.pmed.1003841.
dc.identifier.issn1549-1277 (online)
dc.identifier.otherdoi:10.1371/journal.pmed.1003841
dc.identifier.urihttp://hdl.handle.net/10019.1/124042
dc.language.isoen_ZAen_ZA
dc.publisherPublic Library of Science
dc.rights.holderAuthors retain copyright
dc.subjectHypercholesterolemiaen_ZA
dc.subjectCholesterolen_ZA
dc.subjectHypercholesteremia -- Diagnosisen_ZA
dc.subjectHypercholesteremia -- Patientsen_ZA
dc.titleUnmet need for hypercholesterolemia care in 35 low- and middle-income countries : a cross-sectional study of nationally representative surveysen_ZA
dc.typeArticleen_ZA
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