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

• Published in: PLoS medicine 2021-10, Vol.18 (10)
• Main Authors: Maja E. Marcus, Cara Ebert, Pascal Geldsetzer, Michaela Theilmann, Brice Wilfried Bicaba, Glennis Andall-Brereton, Pascal Bovet, Farshad Farzadfar, Mongal Singh Gurung, Corine Houehanou, Mohammad-Reza Malekpour, Joao S. Martins, Sahar Saeedi Moghaddam, Esmaeil Mohammadi, Bolormaa Norov, Sarah Quesnel-Crooks, Roy Wong-McClure, Justine I. Davies, Mark A. Hlatky, Rifat Atun, Till W. Bärnighausen, Lindsay M. Jaacks, Jennifer Manne-Goehler, Sebastian Vollmer
• Format: Article
• Language: English
• ISSN: 1549-1277; 1549-1676

Background 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